Fall injuries in Baghdad from 2003 to 2014: Results of a randomised household cluster survey

Abstract

Introduction Falls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship. Results Nine hundred households totaling 5,148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15 - 64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30 – 8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%). Conclusion Falls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed.

Accidents in Iraq during the period of conflict (2003–2016)

“…A community-based household survey conducted in Baghdad estimated the case fatality rate of falls to be 5%, where 75% of the cases left those injured with some type of life-limiting disability. 34…”

Injury and depression among 212 039 individuals in 40 low- and middle-income countries

“…It has been suggested for instance, that a failure to receive immediate or appropriate treatment may increase the risk of emotional distress (Peck, 2011 ). Injury can also result in disability, chronic pain and psychological stress (Stewart et al ., 2016 ) which may lead to depression (Craig et al ., 2009 ; Falla et al ., 2016 ). Previous research has also highlighted that an injury can cause household financial hardship and food insecurity in LAMICs (Stewart et al ., 2016 ), which other research has linked to common mental disorders (Lund et al ., 2010 ).…”

“…Specifically, the other injury question asked respondents if, their injury had ‘limited [their] everyday activities’ which may have indicated that these injuries might have been more severe. Fourth, it is possible that the occurrence of injury may have been underreported given that there is some evidence that injuries may be associated with an increased risk of experiencing social stigma in LAMICs (Stewart et al ., 2016 ; Jagnoor et al ., 2018 ). Fifth, it is also possible that we lacked information on potential confounders of the observed associations.…”

Experimental Study of Thoracoabdominal Injuries Suffered from Caudocephalad Impacts Using Pigs

“…The injuries induced by caudocephalad impacts (CCI) frequently occurred in military vehicles, for example, underbelly blasts (UBB), which have led to large numbers of injuries and deaths [ 1 – 3 ]. Some civilian accidents, such as helicopter crashes and falls [ 4 – 11 ], resulted in also so many casualties owing to the CCI. For example, helicopters are being widely used worldwide nowadays due to their excellent motorization, with an estimated incidence of 2.5 helicopter crashes per 100,000 flying hours [ 9 ], and the mortality rate of the injuries involved in helicopter crashes was up to 59% [ 5 ].…”

“…For example, helicopters are being widely used worldwide nowadays due to their excellent motorization, with an estimated incidence of 2.5 helicopter crashes per 100,000 flying hours [ 9 ], and the mortality rate of the injuries involved in helicopter crashes was up to 59% [ 5 ]. Falls contributed to approximately 35 million disabilities or adjusted life years annually, showing an increase trend [ 11 ].…”