Prasanthi Puvanachandra

Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan

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Publications (23)28.46 Total impact

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    ABSTRACT: Objectives. We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). Methods. We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. Results. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. Conclusions. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children's safety and underscoring the need for intensified context-appropriate injury prevention. (Am J Public Health. Published online ahead of print January 16, 2014: e1-e6. doi:10.2105/AJPH.2013.301607).
    American Journal of Public Health 01/2014; · 3.93 Impact Factor
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    ABSTRACT: Road traffic injuries pose a significant threat to the Egyptian population. Recent estimates revealed that Egypt experiences 42 road traffic deaths per 100,000 population (1.8% of all deaths in the country), which is the highest death rate in the region. More than half of the road traffic crashes that resulted in injuries occurred on the country's highways. Despite the significance of this public health problem, very little risk factor information currently exists. The overall goal of this paper is to understand the burden of speeding and the level of seatbelt and child restraint use on a highway (Cairo Ring Road) and two urban roads crossing Alexandria city (Kornish and Gamal Abd-Elnaser roads). Two rounds of seatbelt and child restraint observational studies and one round of speed observational study were carried out between 2011 and 2012. Findings revealed that seatbelt use among drivers and front seat passengers were low for all three sites (range: 11.1% to 19.8% for drivers; 2.9% to 4.0% for front seat passengers). Similarly, child restraint use in cars with children was very low ranging from 1.1% to 3.9% on all three roads. All three roads experienced a high percentage of vehicles driving above the speed limit (39.4% on Kornish Road, 22.6% on Cairo Ring Road, 11.8% on Gamal Abd Elnaser Road), with the majority of these vehicles driving 1 to 10 kilometer above the speed limit. Future interventions need to focus on enhancing enforcement of speed and seatbelt wearing, closing gaps in legislation, and standardizing existing data systems to help inform good road safety policies.
    Injury 12/2013; 44 Suppl 4:S45-8. · 1.93 Impact Factor
  • Prasanthi Puvanachandra, David Bishai, Adnan A Hyder
    Injury 12/2013; 44 Suppl 4:S1-2. · 1.93 Impact Factor
  • Prasanthi Puvanachandra, Subramaniam Kulanthayan, Adnan A Hyder
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    ABSTRACT: In 2006, the Malaysian government began implementing road safety education (RSE) programs in primary schools, involving numerous stakeholders. We interviewed 19 stakeholders. Thematic analysis led to the identification of four themes: road traffic injuries (RTIs) among children in Malaysia, the role of RSE, factors affecting successful implementation, and intersectoral involvement. The latter was identified as a significant strength of the overall approach to implementation, and is one of the first examples in Malaysia and in the region of such an approach. Lack of official documentation surrounding ownership, funding responsibilities, and roles among the various sectors led to resistance from some groups. Although we know from scientific studies what works in terms of reducing RTIs, the more important question is how such interventions can be successfully and sustainably implemented, particularly in low- and middle-income countries (LMIC). The results of this study permit stronger understanding of issues surrounding the implementation of RTI interventions in LMIC.
    Qualitative Health Research 08/2012; 22(11):1476-85. · 2.19 Impact Factor
  • Türker Ozkan, Prasanthi Puvanachandra, Timo Lajunen, Connie Hoe, Adnan Hyder
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    ABSTRACT: The validity of self-reported seatbelt use among low belt use populations in low belt use countries has not been evaluated directly. Nine hundred and ninety drivers were recruited from shopping centers, car parks, and other suitable locations located in Afyon and Ankara cities of Turkey in order to compare the self-reported and observed seatbelt usage rates. Data sets were collected simultaneously from the participants not being aware of having their seatbelt use observed. Participants interviewed in Afyon (n=301) and Ankara (n=658) reported seatbelt usage ("always using a seatbelt") rates of 39% and 45%, respectively. When observed, however, only 47% in Afyon and 70% in Ankara of these drivers actually fasten their seat-belts. It seems that the drivers in both cities exaggerated their use seat belts considerably.
    Accident; analysis and prevention 02/2012; 47:75-7. · 1.65 Impact Factor
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    Nukhba Zia, Uzma R Khan, Junaid A Razzak, Prasanthi Puvanachandra, Adnan A Hyder
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    ABSTRACT: Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment. This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of the four major tertiary care hospitals of Karachi, Pakistan. The surveillance included 566 injured children of which 409 (72%) injuries had taken place at/around home. Of 409 children, 66% were males and mostly between 5 and 11 years of age. Injuries commonly occurred during play time (51%). Fall (59%), dog bites (11%) and burns (9%) were the commonest mechanisms of injury. The majority of the children (78%) were directly discharged from the emergency room with predicted short term disability (42%). There were 2 deaths in the emergency department both due to falls. Childhood injury surveillance system provides valuable in-depth information on child injuries. The majority of these unintentional childhood injuries occur at home; with falls, dog bites and burns being the most common types of unintentional childhood home injuries. Specific surveillance systems for child injuries can provide new and valuable information for countries like Pakistan.
    BMC Research Notes 01/2012; 5:37.
  • P Puvanachandra, C Hoe, Türker Ozkan, Timo Lajunen
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    ABSTRACT: Road traffic injuries (RTIs) are one of the leading causes of global deaths, contributing to 1.3 million lives lost each year. Although all regions are affected, low- and middle-income countries share a disproportionate burden. The significance of this public health threat is growing in Turkey, where current estimates show that 2.0 percent of all deaths in the country are due to RTIs. Despite the significance of this growing epidemic, data pertaining to RTIs in Turkey are limited. In order to address the gap in knowledge, this article presents an overview of the epidemiology of RTIs in Turkey through an analysis of available secondary data sets and a comprehensive review of scientifically published studies. A literature review was performed during December 2010 using PubMed, Embase, and ISIS Web of Knowledge databases and Google search engines. Peer-reviewed literature pertaining to Turkey and RTIs were selected for screening. Secondary data were also procured with assistance from Turkish colleagues through an exploration of data sources pertaining to RTIs in Turkey. The literature review yielded a total of 70 studies with publication years ranging from 1988 to 2010. Secondary data sources were procured from the ministries of Health and Interior as well as the Turkish Statistical Institute. These data sources focus primarily on crashes, injuries, and fatalities (crash rate of 1328.5 per 100,000 population; injury rate of 257.9 per 100,000 population; fatality rate of 5.9 per 100,000). Risk factor data surrounding road safety are limited. The findings reveal the significant burden that RTIs pose on the health of the Turkish population. The introduction of new technologies such as the novel digital recording systems in place to record pre-hospital services and Global Positioning System (GPS) tracking of road traffic crashes by the police have allowed for a more accurate picture of the burden of RTIs in Turkey. There are, however, some considerable gaps and limitations within the data systems. Incorporation of standardized definitions, regular data audits, and timely review of collated data will improve the utility of RTI data and allow it to be used for policy influence.
    Traffic injury prevention 01/2012; 13 Suppl 1:64-75.
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    ABSTRACT: Road traffic injuries (RTIs) are a major cause of global mortality and morbidity, killing approximately 1.3 million people and injuring 20 to 50 million each year. The significance of this public health threat is most pronounced in low- and middle-income countries where 90 percent of the world's road traffic-related fatalities take place. Current estimates for Egypt show a road traffic fatality rate of 42 deaths per 100,000 population-one of the highest in the Eastern Mediterranean Region. RTIs are also responsible for 1.8 percent of all deaths and 2.4 percent of all disability-adjusted life years (DALYs) lost in the country. Despite this, studies surrounding this topic are scarce, and reliable data are limited. The overall goal of this article is to define the health impact of RTIs in Egypt and to identify the strengths and weaknesses of each data source for the purpose of improving the current RTI data systems. A 2-pronged approach was undertaken to assess the burden of RTIs in Egypt. First, a thorough literature review was performed using PubMed, Embase, ISIS Web of Knowledge, and Scopus databases. Articles pertaining to Egypt and road traffic injuries were selected for screening. With assistance from Egyptian colleagues, a comprehensive exploration of data sources pertaining to RTIs in Egypt was undertaken and secondary data from these sources were procured for analysis. The literature review yielded a total of 20 studies, of which 6 were multi-country and 5 were hospital-based studies. None examined risk factors such as speeding, alcohol, or seat belt use. Secondary data sources were acquired from national hospital-based injury surveillance; a community-based health survey; pre-hospital injury surveillance; the Ministry of Transport; the General Authority for Roads, Bridges and Land Transport; death certificates; and the central agency for public motorization and statistics. Risk factor data are also limited from these sources. The results of this article clearly highlight the significant burden that road traffic injuries pose on the health of the Egyptian population. The hospital-based injury surveillance system that has been established in the country and the use of International Classification of Diseases (ICD-10) coding brings the system very closely in line with international guidelines. There is, however, some considerable room for improvement, including the need to extend the coverage of the surveillance system, the inclusion of injury severity scores and disability indicators, and standardization of the sometimes rather disparate sources from various sectors in order to maximally capture the true burden of RTIs.
    Traffic injury prevention 01/2012; 13 Suppl 1:44-56.
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    ABSTRACT: Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally. A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda - researchers (8), policy makers (12) and media practitioners (12). Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages - a situation that reduced the coalition of policy champions. This study shows that effective translation of PMTCT and SMC research results demanded a "360 degree" approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.
    BMC International Health and Human Rights 03/2011; 11 Suppl 1:S13. · 1.44 Impact Factor
  • Aruna Chandran, Prasanthi Puvanachandra, Adnan A Hyder
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    ABSTRACT: Violence against children has been the least reported, studied, and understood area of child injuries. Initial awareness emerged from international conferences and resolutions, followed by national policies and statements. More effective responses around the world will require action. Although previous calls for action have pointed to important activities (gathering of baseline data, passing of legal reforms, and providing services to those who experience violence), the agenda is limited. Data collection needs to be continuous, systematic, and sustainable, and should enable ongoing evaluation of intervention programs. An inter-sectoral approach to violence against children incorporating public health, criminal justice, social services, education, non-governmental organizations, media, and businesses is imperative if the growing burden is to be mitigated. Thus we offer a framework, building on earlier recommendations, to focus on four domains: national surveillance, intervention research, legislation and policy, and partnerships and collaboration.
    Journal of Public Health Policy 02/2011; 32(1):121-34. · 1.48 Impact Factor
  • Antonio J Trujillo, Prasanthi Puvanachandra, Adnan A Hyder
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    ABSTRACT: The burden of falls amongst the elderly raises important public health concerns. Empirical evidence suggests that macroeconomic growth may not be sufficient to reduce mortality and morbidity from injuries among the elderly. This paper consolidates macro- and microeconomic evidence of the effect of income on elderly falls in Latin America. Using household databases, we estimate an empirical model to assess the relationship between income and falls. The estimations indicate that an increase in personal income reduces the probability of falling; yet, the size of the effect is negligible. A 10% increase in income reduces the probability of falling between 0.001 and 0.002% while a 20% increase reduced the probability by up to 1%. These findings are consistent with macroeconomic data where morbidity and mortality among seniors are inelastic to economic growth. Policy implications of cash transfer programs targeting the elderly are discussed.
    Geriatrics & Gerontology International 12/2010; 11(2):180-90.
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    ABSTRACT: Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research-policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes. Qualitative stakeholder analysis. Stakeholder analysis was conducted in each FHS country using a structured approach. A cross-country evaluation was performed concentrating on six key areas: chosen research topic; type of intervention considered; inclusion/exclusion of stakeholder groups; general stakeholder considerations; power level, power type and agreement level of stakeholders; and classification of and approaches to identified stakeholders. All six countries identified a range of stakeholders but each country had a different focus. Four of the six countries identified stakeholders in addition to the guidelines, while some of the stakeholder categories were not identified by countries. The mean power level of identified stakeholders was between 3.4 and 4.5 (1=very low; 5=very high). The percentage of classified stakeholders that were either drivers or supporters ranged from 60% to 91%. Three important common areas emerge when examining the execution of the FHS country stakeholder analyses: clarity on the purpose of the analyses; value of internal vs external analysts; and the role of primary vs secondary analyses. This paper adds to the global body of knowledge on the utilization of stakeholder analysis to strengthen the research-policy interface in the developing world.
    Public health 03/2010; 124(3):159-66. · 1.26 Impact Factor
  • P Puvanachandra, A Chandran, S Sarfraz, T Akhtar, A A Hyder
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    ABSTRACT: IntroductionReported annual rates of violence against Pakistani children are 1.57–3.18 per 100 000. Non-Governmental Organisations (NGOs) can be powerful resources in treatment and advocacy for child violence. There are no training programs within Pakistan regarding using data for effective advocacy against child violence.Methods Employees of NGOs focused on child violence were invited to a training focused on utilising evidence for influencing policy. Training in data collection, monitoring/evaluation, accessing literature and cost-benefit analysis was given in collaboration by Johns Hopkins Bloomberg School of Public Health, USA and Fatima Memorial System, Pakistan. Knowledge assessments were given before and after workshop participation, and a knowledge retention survey was given 4–8 weeks later.Results35 individuals were trained; two-thirds were female. Post-training tests showed that (compared with prior), 90% could name two components of the advocacy cycle (vs 30%), 75% could differentiate incidence and prevalence (vs 0%), 60% could identify two literature databases (vs 10%), 90% could identify advantages and disadvantages of qualitative research (vs 40%), and 65% could differentiate qualitative and quantitative research (vs 40%). The retention survey revealed that 50–65% recalled basic characteristics of surveillance, quantitative/qualitative research, and database access.DiscussionNGO workers demonstrated a significant increase in knowledge following training on utilizing evidence. This project demonstrates tremendous capacity building needs in grassroots workers in the country. Further study is needed to evaluate whether this increased knowledge results in changes in practice for influencing child violence policy in Pakistan.
    Injury Prevention - INJ PREV. 01/2010; 16(1).
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    ABSTRACT: Background Unintentional injuries are a leading cause of death among children and young adults. Over 875 000 children ≤18 years of age die annually in the world as a result of injuries, mostly in low- and middle-income countries.Objective To study the demographics, types and outcome of childhood unintentional injuries in Karachi, Pakistan.Methods This surveillance was conducted from February to April 2007 in emergency departments (ED) of five major hospitals of Karachi. Karachi is the largest city of Pakistan and has a population of about 9.3 million of which 43.8% are children. Care-takers of children less than 12 years of age were interviewed regarding unintentional childhood injuries.ResultsThis surveillance included 566 children out of which 67.7% were males and 60.2% were between the ages of 5–11 years. Most of the children were brought to the ED by private transport (56.9%). Injuries commonly occurred at home (48.1%) and during recreation time (45.4%). Fall (49.5%) and road traffic injuries (RTIs) (20.8%) were the commonest mechanisms of injury. Falls occurred most often from stairs/steps. Of the RTIs, 13.4% were pedestrian injuries and 11.5% were due to motorcycles. Majority of the children (79.3%) were directly discharged from the ED with short term disability (44%). There were three deaths, of which two resulted from RTIs and one from fall.Conclusion Our surveillance showed that male children were frequently injured. The frequent mechanism of injury was fall followed by road traffic injury. Most of the children were directly discharged from the ED.
    Injury Prevention - INJ PREV. 01/2010; 16(1).
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    ABSTRACT: This workshop focuses on the global road safety interventions project in 10 countries supported by the Bloomberg Philanthropies. Key to the initiative is the demonstration that established interventions on road safety make a significant impact on public health. As a result, defining the epidemiology of road injuries, monitoring the implementation of programs, and assessing the impact of the programs in an objective and scientific manner will be critical for success. It is in this regard that three important functions have to be fulfilled: (1) defining baseline conditions: a prerequisite for demonstrating any change, a good baseline analysis of road traffic injuries in countries requires a multi-disciplinary review of multiple data sources and strengthening national data systems; (2) monitoring program rollout: continuous assessment of a program in terms of process indicators, and outputs to ensure that the operational elements were consistent with the planned program is needed to both identify challenges to implementation and ensure consistency; and (3) evaluating impact: overall assessment of the change in health, economic and social outcomes due to the implementation of road safety programs. This approach will have the strengths of: (1) development of a core set of methods for each function which are standardised across all road safety projects in all countries; (2) identification of a set of indicators which are scientifically valid and yet practical to measure at country-level for road safety evaluation; and (3) internal consistency across all elements of the evaluation while allowing for flexibility in country-specific approaches.
    Injury Prevention - INJ PREV. 01/2010; 16(1).
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    ABSTRACT: Objective To determine the epidemiology and risk factors of childhood injuries in Ismailia governorate Egypt.Methods This is the Egyptian chapter of the Global Childhood Unintentional Injury Surveillance study, which employed quota sampling of children 0–11 years old presenting to the Emergency Department. This surveillance was conducted in the University Hospital of Suez Canal University Egypt, for selected months in 2007. Children with an unintentional injury of both genders were enrolled in the study.ResultsOut of a total of 551 cases, 361 were males (66%) and 478 (34%) females. The most common external causes of injuries were falls (60%), road traffic injuries (15%), burns (7%), poisoning (3%) and near drowning/drowning (2%). The most common sustained injuries were fractures (17%), cuts or open wounds (15%), sprains (14%) and burns (9%). The majority of patients were treated and discharged home without disability (67%), while 7.8% had long-term temporary disability that lasted for more than 6 weeks and more than 1% sustained permanent disability. There were five deaths (1% proportionate mortality), all were due to falls. Few families recounted using seatbelts (2%), car air bags (0.5%), helmets (1%), child restraint seats (1%). The majority of children received care via government insurance.Conclusions The burden of childhood injuries on the university hospital in Egypt is substantial. Ongoing child injury surveillance using systematic approaches is required to identify the epidemiology of injuries, their risk factors and plan for timely interventions.
    Injury Prevention - INJ PREV. 01/2010; 16(1).
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    ABSTRACT: The overall goal of this paper is to highlight the epidemiology of injury in Lithuania between 1998 and 2006. Such a situation analysis will inform the important dialogue happening in Lithuania with respect to renewal of the trauma programme and help to profile the burden of injury in the country. Review of the literature, and secondary analysis of data from the Lithuanian Health Information Center and the European Detailed Mortality database. Sixteen articles were identified as population-based studies; only incidence of burn injuries was reported as 240 per 100,000 per year. According to our analysis, the overall incidence of injury increased from 76 cases per 1,000 individuals in 1998 to 121 cases per 1,000 individuals in 2006. The total number of deaths from external causes remained similar with an average of 5,301 per year, as did the age-standardized mortality rates of 152 in 1998 and 150 per 100,000 in 2006. The mortality rate in men was four times higher than in women. Suicide was the most frequent cause of death (34% in 2006); while road traffic injuries were the second most frequent accounting for 17-19% of deaths. There were 429 deaths due to exposure to natural cold in 2006, which constituted 8% of all deaths due to injury. Injury incidence and mortality from external causes in Lithuania has not declined over an eight year time frame. New efforts should be launched in the health sector to address this major cause of deaths.
    Scandinavian Journal of Public Health 10/2009; 38(4):386-94. · 1.97 Impact Factor
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    ABSTRACT: To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged >or= 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.
    Bulletin of the World Health Organisation 05/2009; 87(5):345-52. · 5.25 Impact Factor
  • A A Hyder, P Puvanachandra, N H Tran
    Injury Prevention 03/2008; 14(1):67. · 1.76 Impact Factor
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    Prasanthi Puvanachandra, Adnan A Hyder
    Salud publica de Mexico 02/2008; 50 Suppl 1:S3-5. · 0.94 Impact Factor

Publication Stats

219 Citations
28.46 Total Impact Points

Institutions

  • 2012
    • Aga Khan University Hospital, Karachi
      • Department of Emergency Medicine
      Karachi, Sindh, Pakistan
    • Johns Hopkins University
      • Department of International Health
      Baltimore, Maryland, United States
  • 2009–2012
    • Johns Hopkins Bloomberg School of Public Health
      • Department of International Health
      Baltimore, Maryland, United States
  • 2011
    • Makerere University
      • School of Public Health
      Kampala, Kampala District, Uganda