Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran

Objective： To describe mortality pattern and to determine undiagnosed fatal injuries according to autopsy findings among road traffic accident victims in Yazd, Iran.
Methods： In this retrospective study, 251 victims of road traffic accidents who were admitted to a tertiary trauma hospital over a two-year period （2006 and 2007） and received medical cares were included. Hospital records were reviewed to gather demographic characteristics, road user type, and medical data. Autopsy records were also reviewed to determine actual causes of death and possible undiagnosed injuries occurred in the initial assessment of the emergency unit or during hospitalization.
Results： There were 202 males （80.5%） and 49 females （19.5%）. The mean （＋SD） age of fatalities was 34.1 （＋21.5） years. Pedestrian-vehicle accidents were the most common cause of trauma （100 cases, 39.8%）. The most common cause of death was central nervous system injury （146 cases, 58.1%）. The other causes were skull base fractures （10%）, internalbleeding （8%）, lower limb hemorrhage （8%）, skull vault fractures （4%）, cervical spinal cord injury （3.6%）, airway compromise （3.2%）, and multifactor cases （5.1%）, respectively. Thirty-six fatal injuries in 30 victims （12%） mainly contributed to death according to autopsy, but were not diagnosed in initial assessments. The head （72.2%） and cervical spine （13.8%） regions were the two most common sites for undi- agnosed injuries.
Conclusion： Training courses for emergency unit medical staff with regard to interpreting radiological findings of head and neck and high clinical suspicion for cervical spine injuries are essential to improve the quality of early hospital care and reduce the mortality and morbidity of traffic accident patients.     

Child road traffic injury mortality in Victoria,Australia (0–14 years), the need for targeted action

IntroductionExtensive efforts to reduce unintentional injury were enacted in the last three decades of the 20th century. Examination of road traffic injury mortality indicates the extent of fatal, unintentional child injuries (0–14 years) future interventions must address.Aims(1) describe in-depth child road traffic injury (RTI) deaths 2001–2012 in Victoria, Australia (2) identify the potential preventability of the RTI causes by currently available countermeasures and scope for enhanced implementation and novel solutions.MethodFatal Victorian child injury data were extracted from the National Coronial Information System (NCIS) for the 12 year period January 2001–December 2012. All on-road data was analysed. Data for passenger and pedestrian deaths was examined in depth. Associated factors were determined using univariate and pairwise analysis of factors. Published WHO key prevention strategies, and the recent literature were reviewed, focusing on the identified fatalities among children 0–14 years.ResultsFor 172 RTI deaths, head injury was the leading medical cause of death (68%). Significantly, the most vulnerable age group for both passengers and pedestrians was 0–4 years. Rural children were over-represented with children aged 0–4 years at greatest risk. Common factors for occupants were loss of control and veering to the incorrect side. For pedestrians the major factors related to rural residence and supervision.Discussion and ConclusionsThis study confirms that RTIs are complex and follow chains of events. Numerous promising interventions were identified. Wider implementation of these advanced engineering, education and enforcement strategies may further improve mortality rates in Victoria. Feasible solutions for aspects of the child pedestrian problem remain elusive. This study describes the RTI problem in greater depth than previous studies and reveals that some existing measures are not fully implemented. The need for targeted action in: 0–4 year olds; head injury; and rural regions of Victoria is highlighted. The need for a safe systems approach is paramount.     

Fatal head injuries in Cape Town

Between 1 July 1983 and 30 June 1985 there were 563 cases of fatal head injuries in people over the age of 15 years recorded at the Salt River Police Mortuary, Cape Town. The demographic character of these cases was reviewed according to: (i) age, race and sex; (ii) date, day and time of injury; (iii) cause of death; and (iv) positive blood alcohol test. Assaults and transport-related accidents in association with a positive blood alcohol test in coloured males aged 40-60 years were a major characteristic.     

Firearm-related injuries and deaths among children and adolescents in Cape Town--1992-1996.

OBJECTIVE: To determine the epidemiological profile of firearm-related injuries among children and adolescents in Cape Town during recent years in order to further understand the epidemic of firearm violence as a public health problem in South Africa. DESIGN: A retrospective study was conducted of hospital, medico-legal laboratory (mortuary) and police data. SETTING: Metropolitan Cape Town, 1 January 1992-31 December 1996. STUDY POPULATION: All children and adolescents (under 19 years of age) with firearm injuries living in the Cape Town metropole during the study period. RESULTS: During the study period at least 1,736 children and adolescents were victims of firearm-related incidents; of these, 322 died (19%). The incidence of firearm injuries among this group almost tripled from 20.2/100,000 in 1992 to 58.1/100,000 in 1996. The firearm mortality rate also almost tripled during the period under review from 3.8/100,000 in 1992 to 10.3/100,000 in 1996. Approximately 60% of victims were coloured males, with 86% between 13 and 18 years of age. Twenty-one per cent of all victims aged over 12 years who died were intoxicated. Other characteristics of the victims and the circumstances surrounding the incidents are presented. CONCLUSIONS: These findings demonstrate the escalating epidemic of firearm-related injuries and deaths among children and adolescents in Cape Town. In addition, the study indicates the need for an integrated injury and death reporting system. Further research is needed to understand firearm-related injuries among children and adolescents in South Africa, and to develop policies and programmes for prevention that are effective in this setting.     

Autopsies and death certification in deaths due to blunt trauma: What are we missing?

OBJECTIVES: To determine the frequency, body region and severity of injuries missed by the clinical team in patients who die of blunt trauma, and to examine the accuracy of the cause of death as recorded on death certificates. DESIGN: A retrospective review. SETTING: London Health Sciences Centre, London, Ont. PATIENTS: One hundred and eight deaths due to blunt trauma occurring during the period Apr. 1, 1991, to Mar. 31, 1997. Two groups were considered: clinically significant missed injuries were identified by comparing patient charts only (group 1) and more detailed injury lists from the autopsies and charts of the patients (group 2). OUTCOME MEASURES: Chart and autopsy findings. RESULTS: Of the 108 patients, 78 (72%) were male, and they had a median age of 39 years (range from 2 to 90 years). The most common cause of death was neurologic injury (27%), followed by sepsis (17%) and hemorrhage (15%). There was disagreement between the treating physicians and the causes of death listed on the death certificate in 40% of cases and with the coroner in 7% of cases. Seventy-seven clinically significant injuries were missed in 51 (47%) of the 108 patient deaths. Injuries were missed in 29% of inhospital deaths and 100% of emergency department deaths. Abdominal and head injuries accounted for 43% and 34% of the missed injuries, respectively. CONCLUSIONS: The information contained on the death certificate can be misleading. Health care planners utilizing this data may draw inaccurate conclusions regarding causes of death, which may have an impact on trauma system development. Missed injuries continue to be a concern in the management of patients with major blunt trauma.     

Pattern of road traffic injuries in Ghana: implications for control

Road traffic injuries and fatalities are increasing in Ghana. Police-collected crash and injury data for the period 1994-1998 were aggregated and analyzed using the MAAP5 accident analysis package developed by the Transport Research Laboratory, U.K. Published results of recent transport-related epidemiological and other surveys provided an additional data source. According to the 1994-1998 police data, road traffic crashes were a leading cause of death and injuries in Ghana. The other leading causes of death and injuries are occupational injuries which involve non-mechanized farming and tribal conflicts. The majority of road traffic fatalities (61.2%) and injuries (52.3%) occurred on roads in rural areas. About 58% more people died on roads in the rural areas than in urban areas, and generally more severe crashes occurred on rural roads compared with urban areas. Pedestrians accounted for 46.2% of all road traffic fatalities. The majority of these (66.8%) occurred in urban areas. The second leading population of road users affected was riders in passenger-ferrying buses, minibuses and trucks. The majority of these (42.8%) were killed on roads that pass through rural areas. Pedestrian casualties were overrepresented (nearly 90%) in five regions located in the southern half of the country. Efforts to tackle pedestrian safety should focus on the five regions of the country where most pedestrian fatalities occur in urban areas. Policies are also needed to protect passengers in commercially operated passenger-ferrying buses, minibuses and trucks because these vehicles carry a higher risk of being involved in fatal crashes.     

Autopsies following death due to traumatic injuries in The Netherlands: an evaluation of current practice

INTRODUCTION: Because of a steady decline in the number of autopsies following death due to traumatic injuries, valuable information concerning possible missed injuries and potential improvements in management is lost. This retrospective study describes current practice in the Amsterdam region of the Netherlands regarding such autopsies, and their rates. METHOD: The current protocols for autopsies were reviewed. Data from government databases and hospitals for the year 2005 were collected. For all patients included that died an unnatural death due to traumatic injury, causes of death and recommendations for autopsy were reviewed. The number of clinical and medico-legal autopsies was determined. RESULTS: Of 872 registered unnatural deaths, 414 were due to traumatic injuries; 63% of these died before reaching hospital and 37% died in hospital. There were more male deaths, and average age was 54 years. In 23% an autopsy was advised by the medical examiners, more often for pre-hospital deaths. The rate of autopsies was 46% when advice was given for a medico-legal autopsy. CONCLUSION: The rates of both medico-legal and clinically desirable autopsies are very low. Currently, the system in Amsterdam focuses mainly on the former, and the latter with its attendant educational aspects is largely ignored. The role of the government should be expanded to optimise the autopsy system in unnatural deaths following traumatic injuries.     

Effect of civil unrest on the incidence of violent and non-natural deaths

The unrest situation in South Africa since September 1984 has led to the escalation of violence and numerous incidents of confrontation between security forces and unruly crowds. The failure of routine law enforcement methods to alleviate the situation resulted in declaration of a State of Emergency in various parts of the country on 21 July 1985 and in the Western Cape area on 26 October 1985. The possible effect of civil unrest on the incidence and nature of underlying violence and crime in society leading to non-natural deaths is analysed from data for a 10-year period obtained from the official Death Register of the South African Police mortuary draining the Greater Cape Town area. Yearly and monthly trends in the incidence of non-natural deaths are also compared with those for death from natural causes. Attention is given to the incidence of homicidal sharp and blunt injuries and specifically to fatal gunshot injuries resulting from civilian shootings compared with those resulting from police or security force action. Mortality and general unrest figures associated with the situation in the Greater Cape Town area are finally compared with national figures for 1985 and the first months of 1986. Some effects of lifting of the State of Emergency in the whole country on 7 March 1986 on mortality and unrest figures are presented. In conclusions, some recommendations are made for alterations to riot control methods in an attempt to prevent or reduce fatalities.     

Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey

Objective: To determine the epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran.Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011.The data were from the Fars Forensic Medicine Registry.In 4 923 recorded road traffic accident fatalities,971 deaths were due to pedestrian accidents.The demographic and accident-related information were analyzed by SPSS version 11.5.P value less than 0.05 was considered significant.Results: The mean age of decedents was (47.2±26.2)years,ranging from 6 months to 103 years old.Males accounted for 69.8％ of all deaths.Fatal accidents were most common in September; 56.1％ of the fatal injuries occurred on intracity roads and 33.1％ on extracity roads.Fatal head injuries were present in 60.54％ of cases.Evaluation of the injury site and the cause of death found that they were significantly associated with age,interval between injury and death.Besides,the type of roads played an important role in mortality.Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade,decreasing the burden of injuries needs coordination among trauma system organizations.     

Road crash in China from 2003 to 2005

Objective： To analyze characteristics and causes of road crash and injuries in China from 2003 to 2005.
Methods： The data of road crash in 2003-2005 were collected to study the characteristics including total vehicle number, occurrence rates of traffic accidents and serious traffic accidents so as to discuss the causes and characteristics of road crash in China.
Results： From 2003 to 2005, the numbers of traffic accidents, injuries and deaths as well as the mortality rates per 100 000 persons and per 10 000 vehicles declined in China. Until 2005, the total number of traffic accidents decreased to 450 000 and deaths to 99 000, with the mortality rate per 10 000 vehicles being 7.6 persons. While the drivers and passengers accounted for 33.2 % and 26.6 % of death casualties respectively in 2005. Most traffic accidents were caused by drivers, especially those with driving experience less than 3 years. Traffic accidents occurred on suburban roads accounted for 60%. The mortality rate of the traffic accidents per 100 km on the first grade road ranked the highest. The mortality rate of the traffic accidents on expressways ranked the highest, with continual increase of death and injury.
Conclusions. At present, the increase trend of traffic accidents and casualties in China has been slowed down to some extent and shows a declining tendency, but the situation is far away from being optimistic. In order to cut down the number of traffic accidents and casualties, we should pay more attention to training and managing drivers with less than three driving years and those driving buses. Strict prevention measures should be laid on traffic accidents on first grade roads, expressways and suburban roads as well as the enhancement on improving first-aid system.     

Secular trends in rates of unintentional injury deaths among adult Finns

This study assessed the current secular trends in unintentional injury deaths among persons 15 years of age or older in Finland. For this purpose, we obtained from the Finnish Official Cause-of-Death Statistics (OCDS) the data for persons aged 15 years or older whose deaths occurred in 1971--2003 due to an unintentional injury. Among Finnish men, the most drastic change occurred in road traffic crashes. The age-standardised death rate (per 100,000 person-years) of men's road traffic crashes was 47 in 1971 but only 11 in 2003. In contrast, the rate of fall-induced deaths among Finnish men gradually rose, from 18 in 1971 to 24 in 2003, by which time falls became the leading category of men's unintentional injury death. Also alcohol poisonings seemed to bypass road traffic crashes as the cause of men's injury death. Among Finnish women, the age-standardised rate of fall-induced deaths decreased till 1975, after which the curve was rather flat. The death rate (per 100,000 person-years) of women's falls was 30 in 1971 and 18 in 2003. During the entire period of 1971--2003, traffic caused fewer deaths in women than men, but the declining trend in women's death rates was also clear, from 17 in 1971 to 5 in 2003. Other unintentional causes accounted for few deaths in women during 1971--2003, although it was of interest that the rate of women's deaths due to alcohol poisoning rose from 1 in 1971 to 4 in 2003. In conclusion, during 1971--2003 falls replaced road traffic crashes as the leading cause of unintentional injury death in adult Finns. The rise in men's fall-induced deaths occurred even with a rate that cannot be explained merely by demographic changes, and therefore, systematic fall prevention measures are needed to control the development. The rising incidence of women's deaths due to alcohol poisoning needs close follow-up.     

Rib fractures in children: a marker of severe trauma

The early recognition of life-threatening injury is paramount to the prompt initiation of appropriate care. This study assesses the importance of multiple rib fractures as a marker of severe injury in children. We analyzed physiologic, etiologic, and injury data for 2,080 children with blunt or penetrating trauma aged 0-14 years consecutively admitted to a Level I pediatric trauma center. Analysis of variance, Student's t-test, and the Chi-square test of independence were used to test for differences between children with rib fractures and other children. Probability of survival was modeled using stepwise logistic regression. There were 14 deaths among 33 children with rib fractures, a mortality rate of 42%. Child abuse accounted for 63% of the injuries to children less than 3 years old, while pedestrian injuries predominated among older children. Children with rib fractures were significantly more severely injured than children with blunt or penetrating trauma but without rib fractures. When compared to children without rib fractures, children with rib fractures had a higher mortality rate, but no statistically significant difference in morbidity. The mortality rate for the 18 children with both rib fractures and head injury was 71%. A logistic model with variables measuring severity of head injury and number of ribs fractured correctly predicted survival in more than 85% of children with thoracic trauma. Although rib fractures are rare injuries in childhood, they are associated with a high risk of death. The risk of mortality increases with the number of ribs fractured. The combination of rib fractures and head injury was usually fatal.     

Fatal cervical spinal injuries in road traffic accidents

The present study analyses fatal road traffic accidents involving private cars and vans in Finland during the period 1972-1982, in which an injury to the cervical spine was the main cause of death. The material consists of 289 victims; this being 10.5 per cent of all the fatalities in this category of road traffic accidents. Front seat and rear seat passengers seem to have an equal risk of sustaining a fatal cervical spinal injury. However, front seat passengers have a significantly greater chance (P less than 0.001) of having fatal cervical spinal injuries than the drivers. Of the victims 21.1 per cent had worn safety belts but there was no statistical difference between those who did and those who did not wear safety belts. Increasing age seems to increase the risk of fatal cervical spinal injuries. Patients between 16 and 25 years of age had the lowest risk and patients over the age of 60 had the highest risk of sustaining a fatal cervical spinal injury (P less than 0.001). In 48.1 per cent of the cases, the victims were multiply injured and this is similar to other main causes of death in road traffic accidents. Wearers of safety belts had significantly (P less than 0.001) more multiple injuries. Of the patients who died of cervical injury, only 8.8 per cent survived transportation to hospital and 1.4 per cent survived longer than 24 hours. A direct blow was the most common mechanism of the cervical injury (47.1 per cent) and deceleration was found in 13.1 per cent of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Characteristics of pediatric firearm fatalities

An increase in the awareness of the problem of gunshot fatalities in children has occurred nationwide over the last year. Unintentional firearm deaths are more common among children and young adults. These deaths may be addressed by preventive measures beyond those available for pediatric firearm suicide and homicide. This study focuses on the incidence of fatal gunshot injuries in children under 16 years of age during the years 1979 through 1987 in our state. Over the past 9 years 132 children (0 to 16 years) were shot and killed as a result of firearm injuries (M:F ratio, 3:1). No difference in absolute number in racial distribution existed. Deaths were classified as homicide, 61 (46%); accidental, 33 (25%); suicide, 29 (22%); undetermined, 7 (5%); and other, 2 (1.5%). Over 70% of these fatal injuries occurred in the home environment. Types of weapons involved included handguns (48%), shotguns (22%), rifles (17%), unspecified weapon (12%), and air rifle (1%). In a large number of cases, guns were found in the home unsecured. The perpetrator was known by the victim in 64 instances, while unknown in 27. Thirty-nine self-inflicted wounds and two shotgun blasts in the line of fire accounted for the remaining deaths. The most common anatomical injury and ultimate cause of death was cranial central nervous system (CNS) (62%), followed by chest/mediastinum (20%), abdomen (10%), and other (8%). A child who has sustained a firearm injury is more likely to know the perpetrator, be killed in the home by a readily available unsecured firearm, and die from severe head injury.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eight-fold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Causes of death at Tshepong, a rural hospital, 1986-1987

A prospective study was undertaken to determine causes of death at Tshepong Hospital in the western Transvaal over 1 year. Specific attention was paid to the accurate coding of causes of death; this entailed discussions with the attending doctor as well as 38 autopsies. Only 2.4% of deaths were coded under 'symptoms, signs and ill-defined conditions'. The 1046 deaths followed a typical Third-World pattern when classified according to the International Classification of Diseases (1979). Deaths during the perinatal period were additionally classified according to the recommendations of the Third Conference on Priorities in Perinatal Care in South Africa. The commonest cause of death was conditions originating in the perinatal period (19.2%), followed by infections and parasitic diseases (15.9%), diseases of the circulatory system (14.8%), endocrine, nutritional and metabolic diseases and immune-disorders (12.1%), and neoplasms (8.8%). The other main groups accounted for under 8% each. The commonest cause of death in all age groups above 35 years was diseases of the cardiovascular system, and the commonest cause of death among females aged 15 - 35 years was complications of pregnancy, childbirth and the puerperium. The hospital maternal mortality rate was 4.7/1,000 deliveries and the hospital perinatal mortality rate was 53/1,000 deliveries.     

Road traffic fatalities among pedestrians, bicyclists and mo-tor vehicle occupants in Sirjan, Kerman, Iran

Objective: To analyze the crash and injury data in forensic medicine for years of 2004-2007. Methods: A sample of over 567 accident cases (9 pedestrians, 116 bicyclists, and 442 motor vehicle occupants) was considered from the Department of Foren-sic Medicine, Shahid Bahonar University of Kerman, in-volving drivers of all ages and covering a four-year period.Results: The male fatality rates were significantly higher than female ones. The groups at 15-30 years old and at 30-55 years old had the first and second highest numbers of deaths (40% and 34%, respectively). There were sub-stantial differences in distribution of injuries in motor ve-hicle occupants and pedestrians and bicyclists. Among motor vehicle occupants, there were more head injuries, such as skull fracture, brain contusion, subdural haemorrhage, and epidural haemorrhage. Nearly 77% of fatalities occurred during 08:00-22:00 in Sirjan. Internal bleeding was also higher in motor vehicle occupants. Pedestrians and bicyclists also had head injuries frequently.Conclusions: In spite of reduction of road traffic fatali-ties in Sirjan in 2007, it is still one of the cities with high road traffic fatality in the world. These results underline the im-portance of preventive strategies in transportation, sug-gesting that different methods are necessary to reduce fa-talities of various traffic participants.     

Trends in childhood injury mortality in three South African population groups, 1968-1985

Trends in major causes of injury mortality and the proportion of total deaths attributable to injuries from 1968 to 1985 for white, coloured and Asian children less than 15 years in the RSA were examined. There were 937 injury deaths in 1968 and 853 in 1985 but no clear trends in overall mortality rates were observed. There were, however, marked fluctuations in injury mortality rates from year to year with peaks in 1975 and 1981/1982. The impact of injury as a cause of death has increased relative to a decrease in other diseases, notably gastro-enteritis and malnutrition in children less than 5 years. Patterns varied considerably between age, sex and population groups. Overall, road and burn death rates decreased while drowning and assault rates increased. Reasons for observed trends are discussed and the need for the collection of reliable national data for the total population is highlighted.     

Pedestrian traffic injuries in Mexico: a country update

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash--525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.     

The prevalence of locomotor disability and handicap in the Cape Peninsula. Part II. The black population of Nyanga

A door-to-door survey to identify the locomotor-disabled was carried out on 8.5% of the population of a black residential area of the Cape Peninsula (2072 people). The prevalence rate of locomotor disability was 18.3/1000; causes of disability related to illness (36.8%), trauma (31.6%) and congenital factors (23.7%). The main illnesses described were cerebrovascular accidents (26.1%) and poliomyelitis (21.7%). Persons aged 15 years or less constituted 18,4% of the disabled, while 42.1% were aged 16-59 years and 39.5% 60 years or more. Although many of the disabled individuals identified could move about independently, the proportion bedridden was high (15.8%). At the time of the survey 13.3% of adults were working and 51.1% of children over 6 years old attended school. Eighty per cent had no contact with health services.