Spotlight on a Researcher: Puspa Raj Pant
Interview and editing by Emily Fisher
Qualifications: MA (Population Studies, Tribhuvan University/Nepal), MSc (Health Services and Public Health Research, Aberdeen University/Scotland), PhD (Injury Prevention – Final year/University of the West of England/England
The title of my thesis is: The level, impact and prevention of unintentional child injuries in Nepal. The aims of my PhD project are:
- To estimate the scale of the burden of injuries and injury risk factors among children (0-17 years) in the Makwanpur district of Nepal
- To assess preventive strategies used in the community
I used quantitative and qualitative approaches of data collection in order to obtain a broader picture of child injuries. For this I employed a) Systematic review of community-based studies on child injuries in South East Asia Region, b) Community-based survey of 3,500 households in Makwanpur district in Nepal c) Focus group discussion and key informant interviews with different groups of people and individuals. The field work for the study was completed in February 2011.
The first World report on child injury prevention in 2008, jointly published by the World Health Organisation and Unicef, revealed that over 2,300 children die every day from injuries worldwide. According to current information, 90% of the world’s injury burden lies on low and middle income countries. As stated in the report, limited information is available about child injuries from these countries where the burden is high. As a result, WHO/Unicef called for coordinated and concentrated efforts for research and interventions to minimise child injuries, particularly in low and middle income countries. Nepal is one of the poorest countries in the world and little research has been conducted on child injuries. This was the main trigger for me to pursue a PhD in child injury prevention. The other sources of inspiration were regular news updates about the untimely demise of Nepalese children from such injuries for which there is little attention paid either nationally or locally.
Luckily I found the calls for a PhD (by the Centre for Child and Adolescent Health — a collaboration of the universities of Bristol and the West of England, on “Child injuries in lower income country”) and scholarship (by the Royal Society for the Prevention of Accident — RoSPA). I was fortunate to have very encouraging supervisors who had experiences of working with students from third world countries.
2. During the time that you began your project until now, how have your views of the issue and the project changed?
At the time I started the project, I was a bit anxious about how I would deal with peoples’ attitudes around injuries to their children, particularly in relation to supervision and possible neglect. This was especially related to gathering information. It was difficult to convey to them that ‘injuries are preventable’. I found that there is much more to do in the direction of creating awareness about the issue. All parents have the same love and affection for their offspring; they all want their children to live in better conditions. The gap in knowledge on ‘how to’ keep children safe needs to be eliminated. When I was in the field, I felt that community people will support any activities that keep them and their children safe.
These facts have led me to reflect on ‘how to’ design and implement a feasible community-based injury prevention programme.
3. What major challenges throughout the project did you face?
It was really a challenge and opportunity to conduct a community-based study on child injuries for the first time. The aim of this research was to include all type of unintentional injuries such as falls, burns, drowning, road traffic injuries, poisoning, cut wounds, etc. All those types of injuries had to be spelled out to the respondents of the survey in order to remind them, otherwise, there were chances of underreporting of certain types of injuries. The concept of injuries as a public health problem is not developed and it is not considered to be an illness. The term “unintentional injury” in Nepali refers to a sudden and pre-destined act that is out of anyone’s control. By the term accidents, most of the people understand road or air crashes or a disaster.
Typically, some of the respondents laughed when they were asked ‘whether their child was injured’, because they thought that injuries in childhood were normal. A similar reaction was found during the focus group sessions with female community health volunteers. In the middle of the session they asked whether the issues under discussion were of relevance. It was because we were discussing how, when, and where children are injured and how such injuries could be prevented.
The challenge of meeting the cost of conducting a community-based door-to-door survey was conquered with the funding from the Department of Violence and Injury Prevention of the World Health Organisation. However, selection of the survey site was another challenge which was resolved using the institutional linkage of one of my supervisors. The collaboration with an NGO — Mother and Infant Research Activities (MIRA), for data collection was helpful because it enabled me to utilise their health research infrastructure including trained survey interviewers. In this way I was successful in acquiring a large dataset with comprehensive information around different types of child injuries on which I am studying at the moment.
4. Can you discuss some of your major discoveries?
4.1 Using a systematic review, I discovered a gap in the literature: Electronic database search, Google search, and cross-reference search strategy yielded only 26 papers (including three survey reports) on community based child injury survey from South East Asia Regional countries for the period of 2000-2009. These papers presented data from only 5 out of 11 member states of the region. Most of these papers simply presented the rates and proportions of injuries. Most of the papers presented the data by age, sex, place of residence and type of injuries. Very few papers analysed risk factors in detail.
4.2 Through my community based survey:
- The survey covered 20,346 people from 3,441 households. The proportion of children under the age of 18 years was about 39%.
- Although communicable and infectious diseases are leading causes of morbidity to Nepalese children, injuries are the next most common cause of childhood illness (see Figure 1 and 2 on page 3).
- The annual rate of nonfatal injuries for children was found to be 24.6 per 1000 children; and the rates for boys were double for girls.
- Falls were the major causes of injuries to children; slightly over half of all injured children had fall injuries followed by cuts/wounds and road traffic injuries.
- Community people identified lack of supervision as a major risk factor for injuries among small children and also expressed the wish to contribute to injury prevention if provided with knowledge about how to do so.
5. How do you see your research impacting the lives of those impacted by these issues?
By carrying out this community-based study, the issues about child injuries received attention from different groups of people in the community. For example, this was a new issue for the interviewers although they had been working in mother and child health research for years. The residents in the survey areas also became familiar about the effects of different types of injuries. During the focus group discussions, the participants discussed injuries to their children for the first time in their lives. The key informants, some of whom were working for children’s rights also became aware that child injuries are an increasing burden faced by families and communities.
6. How do you see your research impacting the field of health promotion?
Nepal has already entered into the phase of epidemiological transition where communicable and infectious diseases are decreasing while noncommunicable diseases and injuries are rising. However, Nepal’s current public health strategy is not ready to embrace the transition in population health. In this context, I am being trained to address a very relevant and important public health issue.
I am presenting my work in different forums such as conferences, workshops, newsletters, and newspapers. I have also established some linkages with injury prevention and safety promotion professionals from different parts of the world. As a result of networking, I have been invited to contribute to a book chapter on Injuries in Nepal.
7. What are your future research plans?
My long term plan is to develop a sustainable community based safety promotion and injury prevention strategy in Nepal. My short term plan is to (1) Submit three articles in injury prevention and public health journals for publication and (2) look for a post-doctoral position in order to carry out pilot projects on injury prevention.
If you are interested in contacting Puspa, you can reach him by email at email@example.com.
Published: September 2012, Health Promotion Connection