title: Burden of road traffic injuries in Nepal: results of a countrywide population-based survey.
abstract: BACKGROUND
  Road traffic injury has emerged as a leading cause of mortality, contributing to 2·1% of deaths globally and is predicted to be the third highest contributor to the global burden of mortality by 2020. This major public health problem disproportionately affects low-income and middle-income countries, where such incidents are too often underreported. Our study aims to explore the epidemiology of road traffic injurys in Nepal at a population level via a countrywide study.
  
  
  METHODS
  The Surgeons OverSeas Assessment of Surgical Need (SOSAS) tool, a cluster randomised, cross-sectional nationwide survey, was conducted in Nepal between May 25, and June 12, 2014. 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, and three clusters were randomly chosen. Questions were structured anatomically and designed around a representative spectrum of surgical conditions. Road traffic injury-related results were reported.
  
  
  RESULTS
  1350 households and 2695 individuals were surveyed with a response rate of 97%. 75 road traffic injuries were reported in 72 individuals (2·67% [95% CI 2·10-3·35] of the study population), with a mean age of 33·2 years (SD 1·85). The most commonly affected age group was 30-44 years, with females showing significantly lower odds of sustaining a road traffic injury than men (crude odds ratio 0·29 [95% CI 0·16-0·52]). Road traffic injuries composed 19·8% of the injuries reported. Motorcycle crashes were the most common road traffic injuries (48·0%), followed by car, truck, or bus crashes (26·7%), and pedestrian or bicycle crashes (25·3%). The extremity was the most common anatomic site injured (74·7%). Of the 80 deaths reported in the previous year, 7·5% (n=6) were due to road traffic injuries.
  
  
  CONCLUSIONS
  This study provides the epidemiology of road traffic injuries at a population-based level in the first countrywide surgical needs assessment in Nepal. WHO reported that mortality due to road traffic injuries in Nepal in 2011 was 1·7%, whereas our study reported 7·5%, consistent with the concept of underreporting of deaths in police and hospital level data noted in previous literature. Road traffic injuries continue to be a significant problem in Nepal, probably greater than previously reported; future efforts should focus on addressing this growing epidemic through preventive and mitigating strategies.
  
  
  BACKGROUND
  The Association for Academic Surgery and Surgeons OverSeas.
authors: Manipal College of Medical Sciences, Pokhara, Nepal.
authors: Sarthak
authors: S
authors: Nepal
authors: University of California, San Francisco East Bay, Oakland, CA, USA. Electronic address: shailvi.gupta@gmail.com.
authors: Shailvi
authors: S
authors: Gupta
authors: McGill University Centre for Global Surgery, Montreal, QC, Canada.
authors: Evan G
authors: EG
authors: Wong
authors: Kathmandu Medical College, Kathmandu, Nepal.
authors: Susant
authors: S
authors: Gurung
authors: Northwestern Feinburg School of Medicine, Chicago, IL, USA.
authors: Mamta
authors: M
authors: Swaroop
authors: Surgeons OverSeas, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Adam L
authors: AL
authors: Kushner
authors: Surgeons OverSeas, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
authors: Benedict C
authors: BC
authors: Nwomeh