title: Pediatric injury during conflict and prolonged insecurity in Iraq from 2003-2014.
abstract: Injury disproportionately affects low- and middle-income countries, and in Iraq, this risk has been compounded by conflict and insecurity since the Coalition invasion in 2003. Children in such settings are particularly vulnerable; yet, the epidemiology of pediatric injury during conflict has not been previously described. This study aimed to characterize the pattern and outcomes of pediatric injury in Baghdad, Iraq from 2003-2014.
  
  
  
  We conducted a cluster-randomized, cross-sectional, community-based survey in Baghdad in 2014 to determine the epidemiology and impact of injuries since 2003. This study details the injury patterns and outcomes among children (ie, <18 years of age) as well as care sought and provided.
  
  
  
  A total of 900 households, which represented 5,148 persons, were surveyed. There were 152 pediatric injuries from 2003-2014 (28% of all injuries). The incidence of childhood injury during the study period was 6.5 per 1,000 life years. The most common cause of injury was fall (52 injuries; 34% of pediatric injuries) followed by road traffic crash (32; 22%). Fifteen percent of pediatric injuries were directly related to conflict (22 injuries). There were 10 reported deaths (7% of pediatric injuries).
  
  
  
  Although falls and road traffic crashes were the most common causes of childhood injury, conflict was directly responsible for 1 in 6 injuries. The number of pediatric injuries that resulted in death far exceeded that of low- and middle-income countries unaffected by conflict. These findings reflect the importance of pediatric injury prevention, protection of vulnerable populations, and essential trauma care during conflict.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Lucas C
authors.initials: LC
authors.lastname: Carlson
authors.affiliation: Al Munstansiriya University, College of Medicine, Baghdad, Iraq.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Lafta
authors.affiliation: Human Development and Training Center, Ministry of Health, Baghdad, Iraq.
authors.forename: Sahar
authors.initials: S
authors.lastname: Al-Shatari
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Surgeons OverSeas (SOS), New York, NY. Electronic address: akushne1@jhu.edu.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019049:Developed Countries; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014947:Wounds and Injuries / Q000453:epidemiology*