title: Fall Injuries in Nepal: A Countrywide Population-based Survey.
abstract: BACKGROUND
  An estimated 424,000 fatal falls occur globally each year, making falls the second leading cause of unintentional injury-related deaths after road traffic injuries. More than 80% of fall-related fatalities occur in low- and middle-income countries. Data from low-income South Asian countries like Nepal are lacking, particularly at the population level. The aim of this study was to provide an estimate of fall-injury prevalence and the number of fall injury-related deaths countrywide in Nepal and to describe the epidemiology of fall injuries in Nepal at the community level.
  
  
  METHODS
  A countrywide cross-sectional study was performed in 15 of the 75 districts in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool. The SOSAS survey gathers data in 2 sections: demographic data, including the household's access to health care and recent deaths in the household, and assessment of a representative spectrum of surgical conditions, including injuries. Data was collected regarding an individuals' experience of injury including road traffic injuries, falls, penetrating trauma, and burns. Data included anatomic location, timing of injury, and whether health care was sought. If health care was not sought, the reason for barrier to care was included. Descriptive statistics were used to analyze the data.
  
  
  RESULTS
  Of 2695 individuals from 1350 households interviewed, 141 reported injuries secondary to falls (5.2%; 95% confidence interval [CI], 4.4%-6.1%), with a mean age of 30.7 years; 58% were male. Falls represented 37.2% of total injuries (n = 379) reported (95% CI, 32.3%-42.3%). Twelve individuals who suffered from a fall injury were unable to access surgical care (8.5%; 95% CI, 4.5%-14.4%). Reasons for barrier to care included no money for health care (n = 3), facility/personnel not available (n = 7), and fear/no trust (n = 2). Of the 80 recent deaths reported, 7 were due to fall injury (8.8%; 95% CI, 3.6%-17.2%), and patients had a mean age of 46 years (SD 22.8). Surgical care was not delivered to those who died for the following reasons: no time (n = 4), facility/personnel not available (n = 1), fear/no trust (n = 1), and no need (n = 1).
  
  
  CONCLUSIONS
  The Nepal SOSAS study provides countrywide, population-based data on fall-injury prevalence in Nepal and has identified falls as a crucial public health concern. These data highlight persistent barriers to access to care for the injured and the need to improve trauma care systems in developing countries such as Nepal.
authors.affiliation: University of California, San Francisco - East Bay, Department of Surgery, Surgeons OverSeas, Oakland, CA. Electronic address: Shailvi.gupta@gmail.com.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Government Medical College Jammu, Jammu & Kashmir, India.
authors.forename: Shyam Kumar
authors.initials: SK
authors.lastname: Gupta
authors.affiliation: BP Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Sagar
authors.initials: S
authors.lastname: Devkota
authors.affiliation: Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Anju
authors.initials: A
authors.lastname: Ranjit
authors.affiliation: Division of Trauma and Critical Care, Feinberg School of MEdicine, Chicago, IL.
authors.forename: Mamta
authors.initials: M
authors.lastname: Swaroop
authors.affiliation: Department of International Health and Surgeons OverSeas, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Department of Pediatric Surgery and Surgeons OverSeas, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland, CA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Victorino
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011795:Surveys and Questionnaires; D035502:Trust; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology*; D055815:Young Adult
keywords: Nepal; developing countries; falls; global surgery; trauma