Correspondence to Professor Rebecca Q Ivers, School of Population Health, UNSW Sydney, Sydney, NSW 2052, Australia; rebecca.ivers@unsw.edu.au Close on the heels of larger societal movements seeking ...racial justice, Indigenous sovereignty and caste equity, there is growing recognition of structural inequities in the global health ecosystem and increasingly strong global moves to ensure diverse voices are represented in research, policy and advocacy to improve human health and reduce inequities.1–5 As part of this, many in the global academic community are pushing for an antiracism, decolonising shift in academic research and education. In most disciplines, the majority of published work in resource-constrained settings, and socioeconomic or politically marginalised communities uses a deficit discourse or data narrative that emphasises weakness and gaps in people and focuses on blaming of communities and systems in the context of research.12–14 Social, commercial, cultural and political determinants of health are either not recognised or offered a passing mention—the focus being on biomedical and technological interventions to ‘solve’ a problem. Ownership of data can be expressed through the creation, collection, access, analysis, interpretation, management, dissemination and reuse of Indigenous Data.17 The editorial board of Injury Prevention needs to consider the values of the journal and practices to for enacting Indigenous Data Sovereignty or Indigenous Governance of Data. ...is the issue of diversity and inclusiveness in the journal itself.
AimTo examine the burden and risk factors for fatal and non-fatal drowning in India.MethodsRelevant literature was identified through a systematic search of 19 electronic databases and 19 national ...and global, institutional, organisational and government sources of injury data. Search terms used pertained to drowning, injury, trauma, morbidity and mortality in India.ResultsA total of 16 research articles and five data sources were included in the review. Three national data sources provided counts of drowning deaths, reporting a range of 1348–62 569 drowning deaths per year. A further three national data sources provided information on drowning-related morbidity; however, each source presented different outcome measures making comparison difficult. Ten research studies investigated risk factors associated with drowning in India. Key risk factors reported were male gender, young age (0–5 years) and individuals residing in the North-Eastern part of the country who have high exposure to water sources within community settings.ConclusionDrowning-related morbidity and mortality have a significant impact on India, with risk factors identified for this setting similar to those within other low-income and middle-income countries. Regional data which look beyond routinely collected data are required to accurately investigate the burden and impact of drowning, to inform targeted, context-specific approaches for drowning reduction initiatives
Access to ongoing multidisciplinary healthcare services for children who have sustained a burn injury is critical for optimal recovery. This paper reports on barriers and facilitators to culturally ...safe and appropriate burn aftercare for Australia's First Nations children. The voices of First Nations families whose child had sustained a serious burn are central to this paper.
Eighteen families, which consisted of 59 family members, of children younger than 16 years who had sustained a burn injury were asked to describe their own journey in accessing appropriate burn aftercare. Interviews were conducted in the families' homes using yarning (dialogue) and Dadirri (deep listening) as Indigenous research methods. Data was gathered in South Australia, the Northern Territory, Queensland and New South Wales, Australia. Using a cyclic process, transcripts and emerging themes were sent back to participants, and a collaborative approach was used to conduct the final analysis.
Lack of culturally safe communication between service providers and family members, in addition to institutionalised racism, were found to be the major barriers to accessing healthcare services. Distance to medical treatment also impacted children's access to aftercare. Involvement of First Nations Health Workers and/or Liaison Officers working with health providers, the child and family members, was found to be an important facilitator in reducing miscommunication and alleviating fear and anxiety in the children and families.
There are significant barriers to access to aftercare following a serious burn including miscommunication, lack of cultural safety, distance to medical treatment and racism. However, these can be largely mitigated when First Nations families have input into the care received and the care needed for ongoing burn care to be effective and are supported by First Nations Health/Liaison Officers support.
BackgroundRoad traffic collisions contribute a significant burden of mortality and morbidity to children globally. The improper or non-use of child restraints can result in children sustaining ...significant injuries in the event of a collision. Systematic reviews on the effectiveness of various interventions to increase the use of child restraints already exist but to the best of our knowledge, there has been no qualitative evidence syntheses on the facilitators and barriers to child restraint usage. This review aims to fill that gap.MethodsWe searched for qualitative studies, which focused on perceptions, values and experiences of children, parents/caregivers or any other relevant stakeholders on the use of restraints for children travelling in motor vehicles in PubMed, EMBASE and Global Health and screened reference lists of all included studies. We assessed the quality of included studies with the Critical Appraisal Skills Programme (CASP) checklist and used the PROGRESS Plus lens for an equity focused analysis.ResultsWe identified a total of 335 records from searching the databases and five records from other sources. After screening, we identified 17 studies that met our inclusion criteria. All but one study (which had children as participants) focused on the perceptions, attitudes and barriers of parents or caregivers. The included studies were from three high-income (n=14) and one upper-middle income (n=3) country. In addition, although many focused exclusively on participants from culturally and linguistically diverse minorities, the issue of equity was not well addressed. Five major themes emerged from the analysis. (1) perceived risk for injuries and perceived safety benefits of child restraint usage varies in different settings and between different types of caregivers; (2) practical issues around the use of child restraints is a major barrier to its uptake as a child safety measure; (3) restraint use is considered as a mechanism to discipline children rather than as a safety device by parents and as children became older they actively seek opportunities to negotiate the non-usage of restraints; (4) adoption and enforcement of laws shape perceptions and usage in all settings and (5) perceptions and norms of child safety differ among culturally and linguistically diverse groups.ConclusionThe results of this systematic review should be considered when designing interventions to promote the uptake of child restraints. However, there is a need to conduct qualitative research around the facilitators and barriers to child restraint usage in low-income and middle-income countries. Furthermore, there is a need for more evidence conducted in semiurban and rural areas and to involve fathers, policy-makers, implementers and enforcement agencies in such studies.
Unintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional ...injury deaths in a nationally representative mortality survey.
Trained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the 130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates.
In 2005, unintentional injury caused 648,000 deaths (7% of all deaths; 58/100,000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185,000 deaths; 29% of all unintentional injury deaths), falls (160,000 deaths, 25%) and drowning (73,000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70 years or older (410/100,000).
These direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.
BackgroundPenalties are a key component to improve road user safety, but previous studies suggested that they might not be successful in reducing crashing in offending drivers. However, these studies ...were not able to consider important crash risk factors in the analysis that might confound the results. Using data from a large prospective cohort study of young drivers in New South Wales, Australia, we explored if novice drivers with driving offences have a higher rates of car crash and if these differences are explained by established crash risk factors.MethodsWe used data from a 2003/2004 Australian survey of young drivers, linked to police reported offence and crash data, hospital data and deaths data up to 2016. We used Poisson regression models adjusted for confounders to estimate the association between driving offences during 2003–2006 with car crash during 2007–2016.ResultsThe study cohort comprised 20 781 young drivers of whom 7860 drivers (37.8%) had at least one driving offence and 2487 (12.0%) were involved in at least one crash. After adjusting for confounders in the regression model, drivers with three or more driving offences had 2.25 (95% CI 1.98 to 2.57), 2.87 (95% CI 1.60 to 5.17) and 3.28 (95% CI 2.28 to 4.72) times higher rates of any crash, crashes that resulted in hospital admission or death and single vehicle crashes compared with drivers with no driving offences.ConclusionMeasures that successfully mitigate the underlying risk factors for both, crashes and offences, have the potential to improve road safety.
This study examines the impact of cyclist, road and crash characteristics on the injury severity of cyclists involved in traffic crashes reported to the police in Victoria, Australia between 2004 and ...2008. Logistic regression analysis was carried out to identify predictors of severe injury (serious injury and fatality) in cyclist crashes reported to the police. There were 6432 cyclist crashes reported to the police in Victoria between 2004 and 2008 with 2181 (33.9%) resulting in severe injury of the cyclist involved. The multivariate analysis found that factors that increase the risk of severe injury in cyclists involved in traffic crashes were age (50 years and older), not wearing a helmet, riding in the dark on unlit roads, riding on roads zoned 70km/h or above, on curved sections of the road, in rural locations and being involved in head-on collisions as well as off path crashes, which include losing control of vehicle, and on path crashes which include striking the door of a parked vehicle. While this study did not test effectiveness of preventative measures, policy makers should consider implementation of programs that address these risk factors including helmet programs and environmental modifications such as speed reduction on roads that are frequented by cyclists.
Indigenous research Knowledges and methodologies have existed over millennia, however it is only recently that Indigenous scholars have been able to challenge institutional Western hegemony to ...reclaim sovereignty in the research space. Despite the high volume of quantitative research describing Aboriginal and Torres Strait Islander health, there has been limited evaluation of the value added through incorporation of Indigenous Knowledges and methodologies. 'Research at the interface' has been discussed as an Indigenous research methodology for researchers to contextualise and inform their research practices, between Indigenous and Western systems of knowledge. In this article we address the significance of 'research at the interface' for Aboriginal and Torres Strait Islander research, as an exciting opportunity for innovation to ensure strength, self-determination and resilience for Aboriginal and Torres Strait Islander communities engaged in research. We also introduce weaving a methodology for 'research at the interface' as a process for conceptualising Indigenous and quantitative research methodologies at the interface.
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