title: Fall injuries in Baghdad from 2003 to 2014: Results of a randomised household cluster survey.
abstract: BACKGROUND
  Falls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad.
  
  
  METHODS
  A two-stage, cluster randomised, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.
  
  
  RESULTS
  Nine hundred households totaling 5148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15-64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30-8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%).
  
  
  CONCLUSIONS
  Falls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: stewarb@uw.edu.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Lafta
authors.affiliation: Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq.
authors.forename: Sahar A
authors.initials: SA
authors.lastname: Esa Al Shatari
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Cherewick
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, Seattle, WA, USA.
authors.forename: Abraham
authors.initials: A
authors.lastname: Flaxman
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
authors.affiliation: Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, Columbia University, New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000517:prevention & control
keywords: Aging; Community assessment; Conflict; Epidemiology; Fall; Global surgery; Iraq; War