Julie Mytton

University of the West of England, Bristol | UWE Bristol · Centre for Child and Adolescent Health

Background Road traffic crashes and injuries are increasing in Nepal, and post-crash response services are early in their development. Ambulance services are offered by multiple providers and most of them lack trained emergency medical technicians. Once an ambulance arrives at the hospital, trauma victims are transported to the emergency department...

Background Motorcycle taxis are an emerging mode of urban mobility in lower- and middle-income countries (LMICs) especially in Asia and sub-Saharan Africa. The epidemiology of injuries associated with motorcycle taxi use is unclear, and there is limited information about safe motorcycle taxi systems. Objective To systematically gather published re...

Background In Nepal, road injuries are responsible for approximately 2800 deaths and 15000 injuries each year. Road safety policies play a significant role in reducing road injuries by setting standards and regulations for road safety measures. Policy reviews may generate knowledge to inform national policy makers to prioritize and invest in road s...

Background Traumatic brain injury (TBI) is extremely common in children, with approximately 500,000 cases attending hospital in the UK each year. Over 90% are considered mild and most children recover well. However, some have persistent symptoms, though relatively few are diagnosed as post-concussion syndrome (PCS). TBI, and particularly repeated T...

Background Road traffic injuries are the twelfth leading cause of mortality globally. Nepal, one of the least developed countries in the world, has a rapidly rising rate of road traffic related morbidity and mortality. There is incomplete reporting of traffic crashes for Nepal in the last three WHO global status reports on road safety. Together wit...

Background Globally, 30% of road traffic deaths involve motorcycles rising to 43% in South-East Asia, where motorcycles are often used as taxis. Road transport provides the main mode of mobility in Nepal, and in Kathmandu valley motorcycles constitute 79.1% of the total vehicle fleet. Nepal does not have any legislation authorising the development...

Background Since 2017, Nepal has implemented a devolved system of government with 7 Provincial and 753 Local governments (known as Palikas). Palikas now have both the funding and the authority to oversee local roads and manage transportation infrastructures within their jurisdictions. Objectives Through the mobilisation of communities in 8 palikas...

Background The built environment and transport services can affect the health and well-being of people with a disability. Improving road safety while ensuring the needs of those most exposed to injury are met is fundamental to achieving Sustainable Development Goal 11.2. Research regarding mobility among people with disability is growing. However,...

Background Public transport is the primary mode of transportation in Nepal. It has a high road traffic fatality rate with bus crashes on long-distance routes accounting for 13% of fatalities and 31% of serious injuries. Only limited information is available in police records. Objective To examine the factors associated with road traffic crashes, i...

Background Road traffic crash reports in the Nepali media often lack in-depth information about the causes and impacts of these crashes. Most reports focus on the number of casualties, vehicle type, and crash location. They rarely consider factors such as road user behaviour or road and vehicle safety standards. There are seldom follow-up reports o...

Background The prehospital care system in Nepal is underdeveloped, with multiple providers, limited co-ordination of services and no national coverage. With no national ambulance service or emergency services phone number, people often call local hospitals during emergencies. Local hospital ambulances often only convey victims without providing car...

Background The prehospital care system in Nepal is poorly developed, with multiple providers, limited co-ordination of services and no national coverage. There is little published evidence reporting the prehospital care of patients with trauma, data which are important to inform the development of the prehospital care system. Objectives In order t...

This paper focuses on art productions by children participating in an art-based wellbeing intervention project in Kashmir. Drawing on feminist security studies, we conducted narrative analysis to explore how children represent in/security. The locations of in/security were the environment, the body, and the socio-political realm. Children articulat...

Background: This paper details findings from an arts intervention project that explored the role and potential for arts activities and art therapy to support the mental health and wellbeing of children living in Kashmir, an area of long-term conflict and unrest. Methods: The intervention was co-designed by an academic team, artists and art therapi...

Background/Aims Road traffic injuries are increasing in Nepal with the rapid expansion of roads and traffic and despite current road safety legislation. The aim of this study was to identify and prioritise the research needed to help Nepali agencies develop an improved road safety system. Methods Using Delphi methodology, stakeholders from governm...

Background/aims There is growing awareness of the burden of suicide in Nepal, but currently, no evidence-based suicide prevention programme is available. Methods The Delphi expert consensus method was used to elicit prioritized research questions for suicide prevention. Participants included suicide prevention experts (psychologists, psychiatrists...

Background: Routinely collected injury data can help to identify populations at risk of injury, circumstances surrounding those injuries, and can be used to develop targeted interventions. However, routinely collected injury data in Nepal are at risk of being incomplete or poorly coded and are underutilised. Therefore, this study aimed to explore...

Background: Road traffic injuries are a significant and increasing public health burden in Nepal, but there is no national coverage of regulated and standardized emergency medical service systems. Therefore, this study was designed to develop a first responder trauma training program for the Nepal traffic police and to evaluate the feasibility of...

Background Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to devel...

Objective To identify and prioritise the research needed to help Nepali agencies develop an improved road safety system. Design Delphi study. Setting Nepal. Participants Stakeholders from government institutions, academia, engineering, healthcare and civil society were interviewed to identify knowledge gaps and research questions. Participants t...

Objective: Accurate road crash reporting is essential for evaluating road safety interventions and plans. Under-reporting of road traffic crashes, injuries, and fatalities in police records has been widely described. The aim of this study was to apply and evaluate a community crash recording system, and assess the quality of the data in comparison...

Background Heavy goods vehicle drivers are an influential driving population in Nepal, with over 90% of goods in the country are transported by road. Due to the time spent on the road, drivers have long periods of exposure to the risk of crash involvement. The study explores the perceptions and experiences of heavy goods vehicle drivers and represe...

In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children...

Background: Suicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to deve...

Road traffic injuries in Nepal are increasing despite being largely preventable. Little evidence exists regarding the barriers and facilitators to a safer road system. This study aimed to explore the perspectives of professionals whose jobs had the potential to influence road safety in Nepal regarding challenges and potential solutions. Semi-struct...

Background Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely c...

Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working wit...

Injuries account for 9.2% of all deaths and 9.9% of the total disability-adjusted life years in Nepal. To date, there has not been a systematic assessment of the status of first response systems in Nepal. An online survey was cascaded through government, non-governmental organisations and academic networks to identify first response providers acros...

Background Injuries, the cause of an estimated 4.5 million deaths annually and many more disabilities worldwide each year, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and...

Objective Injuries are a global health problem. To develop context-specific injury prevention interventions, one needs to understand population perceptions of home and workplace injuries. This study explored a range of views and perceptions about injuries in a variety of settings and identified barriers and facilitators to injury prevention. Desig...

Background Injuries are an important public health issue in Nepal, contributing significantly to the burden of morbidity and mortality. There is no injury surveillance system available, however healthcare service use is routinely reported to central government using the Health Management Information System (HMIS). Methods To explore the epidemiolo...

Background Nepal is fast expanding its road network, and over 90% of goods are transported by road. Large numbers of truck drivers are therefore exposed to the risk of crashes. We explored the perceptions and experiences of truck drivers and representatives from their professional association regarding road dangers. Understanding crash risk in comm...

Background Unintentional Injuries comprise the fifth leading cause of death in Nepal in 2017, an increase of 23% compared to 1990. In Nepal, there is minimal community-derived evidence of home or occupational injuries. Our aim was to describe the epidemiology of injuries in the Makwanpur district, including the causes and risk factors associated wi...

Background When designing a logo for the Nepal Injury Research Centre a predicament arose: there is no direct Nepali translation for the word ‘injury’. A ‘loan-word’ was used, but this highlighted a broader issue – what do different stakeholders in Nepal understand when we talk about injuries, and what implications might this have for engaging them...

Background Availability of injury related mortality data can play a vital role in planning health services for injury prevention and monitoring progress towards Sustainable Development Goal 3.4. In the absence of a robust death registration system, this study explored the feasibility of a model to identify injury deaths occurring outside hospital i...

Background A number of sustainable development goals (i.e. SDGs 3, 8, 11 and 16) can be addressed by reducing injuries and incorporating injury prevention into national legislation, plans and policies. Institutions can be more effective if national laws guide prioritisation, development and implementation of plans. No comprehensive review of policy...

Background Busy and poor road infrastructure along routes to school poses high risk of traffic injury for children. Every child’s safe and healthy journey to/from school is fundamental to achieving Sustainable Development Goal 3.6. However, there is little evidence reporting children’s views about their school travel from developing countries. This...

Context Road crashes are the 7th leading cause of mortality in Nepal, but there are poorly developed nationwide emergency medical services. Contributing to achieving SDG 3.6 to reduce deaths from road crashes, we designed and evaluated the feasibility of a bespoke first-responder training programme for traffic police in Nepal. Process Interviews w...

Context There are daily media/news reports of road traffic crashes in Nepal mostly focusing on the number of people killed or injured. Few consider the causes, impacts or preventability. Media is recognised as a major stakeholder in road safety. We aimed to engage journalists in Nepal to improve the quality of their reports. Process We conducted t...

Background Injury surveillance is important for national injury control and prevention initiatives and enables monitoring of progress towards Sustainable Development Goals 3.4 and 3.6. In the absence of a national injury surveillance system in Nepal, we evaluated the feasibility of a model of hospital-based surveillance. Methods An injury surveill...

Context Through a collaboration between the University of the West of England, Bristol and Kathmandu Medical College in 2017, we established the Nepal Injury Research Centre. An innovative capacity strengthening programme underpins our ethos and activities, and contributes to SDGs 17 (Capacity development) and 4 (Education). Process Facilitated th...

Aims/Objectives/Background Globally, injuries cause more than 5 million deaths annually. Children and young people are a particularly vulnerable group and injuries are the leading cause of death in people aged 5–24 years globally and a leading cause of disability.In most low and middle-income countries where the majority of global child injury burd...

Background The World Health Organisation has estimated Nepal's road traffic fatality rate as one of the highest in South-East Asia. Road-crashes are the 7th leading cause of mortality in Nepal, but there is currently a lack of nationwide emergency medical services. We developed, designed and evaluated the feasibility of a first responder training p...

Background In the UK, Gypsy, Roma and Traveller (GRT) communities are generally considered to be at risk of low or variable immunisation uptake. Many strategies to increase uptake for the general population are relevant for GRT communities, however additional approaches may also be required, and importantly one cannot assume that “one size fits all...

Objective: This paper describes the epidemiology of home- and work-related injuries, their mechanisms, inequalities and costs associated with these injuries. Methods A household survey was undertaken in three palikas (administrative areas) of Makwanpur district between April-June, 2019. Data were collected electronically on non-fatal injuries that...

Introduction There has been little systematic study of the epidemiology of traumatic spinal cord injury (TSCI) in Nepal, South-East Asia, and low- and middle-income countries (LMICs) in general. One third of the global morbidity and mortality due to injuries is concentrated in South-East Asia. We need to better understand the circumstances leading...

Background: Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. Methods: We interviewed immu...

The evidence of the economic burden of road traffic injuries (RTIs) in Nepal is limited. The most recent study, conducted in 2008, is now considered outdated because there has been a rapid increase in vehicle numbers and extensive road building over the last decade. This study estimated the current economic costs of RTIs in Nepal, including the dir...

In recent weeks, people all over the world have been settling into a ‘new normal’ of restricted mobility, online working, social distancing and enhanced hand hygiene. As part of the global fight against the spread of COVID-19 (the illness caused by SARS-CoV-2), we are repeatedly reminded by public health authorities that frequent and thorough hand-...

Background: Globally, injuries cause more than 5 million deaths annually, a similar number to those from HIV, Tuberculosis and Malaria combined. In people aged between 5 and 44 years of age trauma is the leading cause of death and disability and the burden is highest in low- and middle-income countries (LMICs). Like other LMICs, injuries represent...

Introduction Unintentional home injury is an important cause of death and disability among children, especially those living in Low and Middle‐Income Countries (LMICs). This systematic review aimed to synthesise evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the...

Children living in special circumstances due to migration or refugee status, or being of Gypsy, Roma, or Traveller ethnicity, have extra health needs and difficulty in accessing universal and specialist health services. Migrant, refugee, and Traveller children belong to diverse ethnic and social groups, but share characteristics which increase thei...

Gypsy, Roma, and Traveller people are marginalized worldwide and experience severe health inequalities, even in comparison to other ethnic minority groups. While diverse and hard to categorize, these communities are highly cohesive and members have a strong sense of identity as a group apart from the majority population. Researchers commonly experi...

Background In 2017 work commenced to establish a Nepal Injury Research Centre. To inform our activities it was necessary to review the evidence arising from existing injury research. Objectives To identify published literature reporting incidence or outcome of injuries sustained in Nepal and explore the quantity of research, types of injuries studi...

Background In Nepal, an estimated 2.5% children suffer a non-fatal injury each year severe enough to keep them away from their usual activities for 3 or more days, and injuries are thought to comprise 34% of morbidity among children 1–17 years. Despite this, the impacts of injuries appear poorly understood. Children’s vulnerability to injuries is c...

Background Despite a range of urgent care services being available in the UK, public attendance at Emergency Departments has increased markedly, placing a significant burden on these resources. Self-care and first aid education may reduce the need to attend urgent care services. Understanding public decision-making regarding the use of such service...

Background Unintentional injuries in and around the home are an important cause of death and disability among young children globally. However, in Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries Objectives To explore the hazards assoc...

Background Unintentional home injury is an important cause of death and disability among young children in Nepal. However, there is a lack of knowledge to inform culturally appropriate interventions to reduce home injuries. Objectives To explore the potential for home environmental change at a community level to prevent unintentional home injury i...

In November 2016 the UK National Institute for Health Research launched a Global Health Research Programme to promote collaboration between UK Universities and countries eligible for receipt of UK Government Overseas Development Aid. The University of the West of England, Bristol, in collaboration with Kathmandu Medical College Nepal, and other org...

This paper considers patient and public involvement (PPI) in health economics research and how this might be facilitated. PPI refers to research carried out ‘with’ or ‘by’ members of the public and is now an important aspect of health research policies internationally. Patients and members of the public can be involved in all stages of the research...

Background Governments should be encouraged to use evidence to enact policies and legislation to prevent injuries. This requires an understanding of the status of existing legislation. Therefore, we carried out a scoping analysis of documents in Nepal to identify the policy gaps. Methods We identified policy documents via stakeholder engagement an...

The classic definition of injury, derived from Gibson (1961) and Haddon (1963) is: An acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals and ionizing radiation interacting with the body in amounts or at rates that exceed the threshold of human tolerance. 1 Injuries are an important component of non-communicabl...

Background Participation in sports as a child improves physical and psychological health. Schools need to promote sport while protecting against injury. It is not clear whether increasing evidence on injury prevention generated from professional sport is influencing school sports practices. This study reviewed policies promoting sport safety in sch...

Children and young people are considered one of the most vulnerable population groups when exposed to accidental dwelling fires. Understanding how children behave in these circumstances and the reasons for their decision making are important to support rescue and fire safety education. We undertook a systematic review of the qualitative literature...

Background Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims.1.Investigate the views of Travellers in the UK...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess and summarize critically the effects of primary prevention interventions to reduce school violence. © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Objective: To identify, critically appraise, summarise and synthesise evidence from Cost-Effectiveness Analyses (CEA) of interventions aimed at preventing Road Traffic Injuries (RTIs) in Low- and Middle-Income Countries (LMICs) by age group and road users targeted. Methods: A search strategy was applied to twelve electronic databases for studies...

Objective To investigate child developmental and behavioural characteristics and risk of burns and scalds. Design Data on burns in children up to 11 years from 12 966 participants in the Avon Longitudinal Study of Parents and Children were linked to developmental profiles measured before the burn injury. Measures Preinjury profiles of the childre...

Background Injuries sustained in the home are a significant contributor to the burden of death and disabilities among young children especially those living in Low and Middle Income Countries (LMICs). The objective of this review was to identify and evaluate the effectiveness of environmental change interventions to reduce child injuries and injury...

Background Unintentional injury (UI) is a leading cause of death in <15s. Children have less ability to process and synthesise complex sensory information. Children with sensory impairment (SI), whether visual impairment (VI) or hearing impairment (HI), are at increased risk as they have incomplete development summated with SI. Methods Medline (fr...

Background Understanding child behaviour during injury-risk events supports development of injury prevention education and interventions, but asking children to recall events may cause distress. We found an absence of published evidence on child-reported behaviour in accidental dwelling fires. Therefore we aimed to develop methods to; identify and...

Background Fire safety education for children in the UK is delivered by local Fire and Rescue Services. The aim of this study was to document the scope, format and delivery of children’s fire safety education across England, Wales and Scotland and establish the priorities and issues for such programmes. Methods A mixed-methods approach was used. I...

Background Injuries are among the leading causes of death and hospitalisation of children worldwide; 90% of all injuries are unintentional. In 2010, over 900 children aged 1–4 years died from injuries in Nepal; the extent of non-fatal injuries is unknown. Most of the injuries to younger children occur at home, and associated with lack of supervisio...

Background Non-fatal injuries are many times more common than fatal injuries and may lead to lifelong consequences in children. Lack of child injury surveillance system hinders evidence generation in a low-income setting. Children in rural Nepal are exposed to widespread injury risks and families may have little awareness of how they can be prevent...

Background Inequality in immunisation uptake in Travelling communities is well documented. We need to understand barriers and facilitators to uptake for these communities. We aimed to explore these factors and identify potential interventions. Methods A three-phase qualitative study. Phase 1: we interviewed 174 Travellers from six communities acro...

Background: Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services, including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. Aims: (1) Investigate the barriers to and facilitators of acceptability an...

Background: Injuries are a major public health problem worldwide. Despite increasing morbidity and mortality from injuries in Nepal, it is not recognised in the government's policy and programmes and few population-based studies have been published. This study describes the usefulness of hospital emergency department records to explore access to i...

Aims To investigate the barriers and facilitators to acceptability and uptake of immunisation among Gypsy/Traveller communities in the UK. Methods We interviewed 174 Gypsy/Travellers from five communities: Romanian/Slovakian Roma, English Gypsy, Irish Travellers, English Roma, Scottish Showpeople, in four UK cities: Interviews gathered views about...

Secondary sources of information indicate that the proportion of child deaths due to injuries is increasing in Nepal. This study aimed to describe the epidemiology of unintentional injuries in children, explore risk factors and estimate the burden faced by families and the community in the Makwanpur district. We conducted a household survey in Makw...

Background: Systematic reviews have highlighted that school-based diet and physical activity (PA) interventions have had limited effects. This study used qualitative methods to examine how the effectiveness of future primary (elementary) school diet and PA interventions could be improved. Methods: Data are from the Active For Life Year 5 (AFLY5)...