title: Fatal and non-fatal injuries due to intentional explosions in Nepal, 2008-2011: analysis of surveillance data.
abstract: BACKGROUND
  Nepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and to describe time trends and epidemiologic patterns for these events.
  
  
  METHODS
  We analyzed surveillance data on fatal and non-fatal injuries due to intentional explosions in Nepal that occurred between 1 January 2008 and 31 December 2011. The case definition included casualties injured or killed by explosive devices knowingly activated by an individual or a group of individuals with the intent to harm, hurt or terrorize. Data were collected through media-based and active community-based surveillance.
  
  
  RESULTS
  Analysis included 437 casualties injured or killed in 131 intentional explosion incidents. A decrease in the number of incidents and casualties between January 2008 and June 2009 was followed by a pronounced increase between July 2010 and June 2011. Eighty-four (19.2%) casualties were among females and 40 (9.2%) were among children under 18 years of age. Fifty-nine (45.3%) incidents involved one casualty, 47 (35.9%) involved 2 to 4 casualties, and 6 involved more than 10 casualties. The overall case-fatality ratio was 7.8%. The highest numbers of incidents occurred in streets or at crossroads, in victims' homes, and in shops or markets. Incidents on buses and near stadiums claimed the highest numbers of casualties per incident. Socket, sutali, and pressure cooker bombs caused the highest numbers of incidents.
  
  
  CONCLUSIONS
  Intentional explosion incidents still pose a threat to the civilian population of Nepal. Most incidents are caused by small homemade explosive devices and occur in public places, and males aged 20 to 39 account for a plurality of casualties. Stakeholders addressing the explosive device problem in Nepal should continue to use surveillance data to plan interventions.
authors.affiliation: International Emergency and Refugee Health Branch, Center for Global Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-60, Atlanta, GA, 30341, USA. obilukha1@cdc.gov.
authors.forename: Oleg O
authors.initials: OO
authors.lastname: Bilukha
authors.forename: Kristin
authors.initials: K
authors.lastname: Becknell
authors.forename: Hugues
authors.initials: H
authors.lastname: Laurenge
authors.forename: Luhar
authors.initials: L
authors.lastname: Danee
authors.forename: Krishna P
authors.initials: KP
authors.lastname: Subedi