S. Devkota1, S. Gupta2,3, S. Ghimire1, A. Ranjit4, M. Swaroop5, A. L. Kushner3,6, B. C. Nwomeh3,7 1Chitwan Alpine Polyclinic And Diagnostic Center,Chitwan, , Nepal 2University Of California – San Francisco , East Bay,Surgery,Oakland, CA, USA 3Surgeons OverSeas,New York, NY, USA 4Johns Hopkins – Center For Surgical Trials And Outcomes Research,Baltimore, MD, USA 5Northwestern University Feinberg School Of Medicine,Surgery – Trauma/Critical Care And Center For Global Health,Chicago, IL, USA 6Johns Hopkins Bloomberg School Of Public Health,International Health,Baltimore, MD, USA 7Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OH, USA
Introduction: An estimated 424 000 fatal falls occur globally each year, making it the second leading cause of unintentional injury-related deaths after road traffic injuries. Over 80% of fall-related fatalities occur in low- and middle-income countries, with regions of the Western Pacific and South East Asia accounting for more than two thirds of deaths. Data from low-income South Asian countries like Nepal are lacking, particularly at the population level.
Methods: A nationally representative cross-sectional study was performed in 15 of the 75 districts in Nepal, randomly selected proportional to population, using the Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool. Three villages were randomly selected within each district, one urban and two rural. The SOSAS survey is divided into two portions: (1) demographic data including the household’s access to healthcare and recent deaths in the household and (2) 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 or not healthcare was sought, and if not, the reason for barrier to care. Descriptive statistics was used to analyse the data.
Results: Of the 2695 individuals from 1,350 households interviewed, 141 individuals reported injuries secondary to falls (5.2%, 95% CI 4.4% to 6.1%), with a mean age of 30.7 (SD 20.0); 58% were male. Falls represented 44.3% of total injuries (n=320) reported (95%CI 38.8% to 50.0%). The most common locations of injuries due to falls were in the extremity, 73.2% (SD 3.7%, 95% CI 65.7% to 80.8%, Table 1); the upper extremities were the most common site in the extremities that were involved (52.1%). Twelve individuals had an unmet surgical need (8.5%, 95% CI 4.5% to 14.4%). Reasons for barrier to care included: no money for healthcare (n=3), facility/personnel not available (n=7) and fear/no trust (n=2). Of the 80 recent deaths, 7 were due to injuries from falls (8.8%, 95% CI 3.6% to 17.2%), with a mean age of 46 years (SD 22.8). Surgical care was not delivered to those who died; reasons included no time (n=4), facility/personnel not available (n=1), fear/no trust (n=1) and no need (n=1).
Conclusion: This study provides population-based data on injury prevalence in Nepal, identifying injuries due to falls as a major public health problem. While health education to reduce the risk of falls remains essential, these data highlight persistent barriers to access to care for the injured and the need to improve trauma care systems in Nepal.
