Injury prevalence and causality in developing nations: Results from a countrywide population-based survey in Nepal.
BACKGROUND
Traumatic injury affects nearly 5.8 million people annually and causes 10% of the world's deaths. In this study we aimed to estimate injury prevalence, to describe risk-factors and mechanisms of injury, and to estimate the number of injury-related deaths in Nepal, a low-income South Asian country.


METHODS
A cluster randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in Nepal in 2014. Questions were structured anatomically and designed around a representative spectrum of operative conditions. Two-stage cluster sampling was performed: 15 of 75 districts were chosen randomly proportional to population; within each district, after stratification for urban and rural populations, 3 clusters were randomly chosen. Injury-related results were analyzed.


RESULTS
A total of 1,350 households and 2,695 individuals were surveyed verbally, with a response rate of 97%. A total of 379 injuries were reported in 354 individuals (13.1%, 95% confidence interval 11.9-14.5%), mean age of 32.6. The most common mechanism of injury was falls (37.5%), road traffic injuries (19.8%), and burns (14.2%). The most commonly affected anatomic site was the upper extremity (42.0%). Of the deaths reported in the previous year, 16.3% were injury-related; 10% of total deaths may have been averted with access to operative care.


CONCLUSIONS
This study provides baseline data on the epidemiology of traumatic injuries in Nepal and is the first household-based countrywide assessment of injuries in Nepal. These data provide valuable information to help advise policymakers and government officials for allocation of resources toward trauma care.
University of California San Francisco, East Bay, Oakland, CA; Surgeons Overseas, New York, NY. Electronic address: Shailvi.gupta@gmail.com.
Shailvi
S
Gupta
McGill University Centre for Global Surgery, Montreal, Quebec, Canada; Surgeons Overseas, New York, NY.
Evan G
EG
Wong
Manipal College of Medical Sciences, Pokhara, Nepal.
Sarthak
S
Nepal
Department of Surgery, Nepal Medical College, Sinamangal, Kathmandu, Nepal.
Sunil
S
Shrestha
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons Overseas, New York, NY.
Adam L
AL
Kushner
Nationwide Children's Hospital, Columbus, OH; Surgeons Overseas, New York, NY.
Benedict C
BC
Nwomeh
Stanford School of Medicine, Stanford, CA.
Sherry M
SM
Wren
D000059:Accidents / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019049:Developed Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D015995:Prevalence; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult