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There has been global concern regarding road traffic injuries. Motorcyclists constitute a high proportion of fatalities in road traffic crashes. Commercial motorcyclists (Okadas) constitute a unique group in this regard. The purpose of this study was to evaluate driver-related risk factors in Okada accidents in Benin City, Nigeria.
Methods:
This was a prospective study. Interviewers administered questionnaires that were used to assess Okada drivers during a two-month period (November–December 2006).
Results:
A total of 996 Okada drivers were interviewed, 995 males and one female. Their ages ranged from 16–80 years with a mean age of 36.4 ±2.4 years. In the majority of cases, the maximum educational level achieved was primary or secondary. The majority of Okada drivers (82.8%) took to the Okada business as a last resort. Driver's licenses for Okada operation were possessed by 73.5% of drivers, but only 27.2% had taken a road test before being given a license. No form of training on the use of Okadas was received by 45% of drivers before they commenced operations. Crash helmets were owned by 56.4%, but they did not use them on a regular basis. Inconvenience was the reason provided for poor compliance by 52.7% of drivers. Regular intake of alcohol was present in 39.8% of drivers.
Conclusions:
Okada drivers are mainly young males with a low level of education who are ill-prepared and ill-equipped for the road. This is a recipe for traffic crash-related injuries and fatal motorcycle crashes. There is an urgent need for job creation, better licensing procedures, road safety education, national legislation, and enforcement of crash helmet laws as well as alcohol breath tests for Okada drivers in Nigeria.
While the number of humanitarian health workers has grown considerably along with the emphasis on evidence-based humanitarian practice over the last 15 years, no organization exists to ensure ongoing professionalization of this area of expertise.
Hypothesis/Problem:
To determine whether and to what degree the community of humanitarian health workers self-identify as a professional group; whether a need for a professional society exists to support such a group; and if so, what fundamental elements and activities should it encompass and provide.
Methods:
A humanitarian, listserv-based survey was undertaken to evaluate humanitarian professional self-identification, needs for and interest in professional support functions, and priorities toward developing a professional organization to provide needed services.
Results:
The resulting respondent population represented a broad distribution of age and experience with education and experience being equally important factors in defining humanitarian health professionals. Respondents viewed themselves as humanitarian professionals nearly to the extent they viewed themselves as health-specific technical experts who happen to work in humanitarian assistance; they expressed a strong desire to establish a professional society reflecting that self-identification; and that body should focus on activities of education and training, networking and dialogue, and developing and refining core competencies to support best practices.
Conclusions:
Humanitarian health workers self-identify as professionals in humanitarian assistance and as technical experts. A professional organization with specific support functions would be of interest to many humanitarian health professionals.
Information and communication technologies, especially in the forms of mobile telecommunications, satellite imaging, and geographical information systems, promise to significantly improve the practice of humanitarian relief. A working group convened at the Humanitarian Action Summit 2009, has begun investigating the challenges to implementing these technologies in field operations, keeping in mind the ethical considerations of linking people to place, and pledging to build a community of practice among academics, practitioners, and developers.
The Humanitarian Action Summit is unique in that it focuses solely on chronic, unsolved problems facing the humanitarian community. As an academically-based format, it provides an environment whereby health professionals, non-governmental organizations, donors, academic institutions, governmental agencies, advocates, and the media address and identify potential deliverables and products to improve best practices, field implementation, and policy promotion and acceleration. The Humanitarian Action Summit was preceded by year-long, online Working Groups that addressed human resource development, civilian protection in conflict, information communication and data management, collaboration and collective action in the health sector, mental health in crises and conflict, and the global burden of surgical disease. The Humanitarian Action Summit also addressed new and emerging humanitarian crises such as climate change, the influence of the military on humanitarian aid, and urbanization. This article focuses primarily on an inherent weakness of the humanitarian community—that of promoting humanitarian action into policy. The goal and process of developing a partnership relationship with a policy level institution to address this problem is described in detail.
Hospitals provide life-saving functions and emergency assistance to communities when disaster strikes. Any damage to hospitals from a disaster, either structural and non-structural, can impair these capabilities. In addition, an inaccurate estimation of the treatment capacities available at hospitals in a disaster-affected region can severely affect the success of emergency relief plans. In this paper, the impact of facility damage on hospital operations is estimated using a generic simulation model. From the simulation results, parametric models are developed for estimating hospitals' capacities and patient waiting times that could be used by emergency response teams in making casualty dispatching/routing decisions.
Few studies have examined post-disaster coping abilities of health facilities and hospitals. On 15 August 2007, a 7.9 (Richter) earthquake struck off the western coast of Peru near the Department of Ica that devastated the healthcare infrastructure. The impact of the earthquake on the health facilities in the four most affected provinces (Cañete, Chincha, Ica, and Pisco), the risk factors associated with the damages incurred, ability to provide services, and humanitarian assistance received were assessed.
Methods:
A stratified, systematic sampling design was used to interview a sample of 40 health facilities. The most senior healthcare provider at each facility was interviewed about the facility's experience with service provision following the earthquake.
Results:
Sixty percent of the facilities reported some damage due to the earthquake; four (10%) were completely destroyed. A total of 78% of the facilities reported providing medical care within the first 48 hours after the earthquake and public facilities were more likely to remain open than were private facilities (p = 0.030). Facilities with an emergency response plan were more likely to provide services than were those without a plan (p = 0.043). Six months after the earthquake, similar numbers of HIV and tuberculosis (TB) patients were receiving treatment at the sampled facilities as prior to the earthquake, and no difficulties were reported in obtaining medications. Some form of assistance, most commonly medications, was received by 60% of the facilities; receipt of assistance was not associated with the facility type, location, damage incurred, or post-disaster service provision.
Conclusions:
Response plans were an important factor in the ability to provide services immediately following an earthquake. While a facility's ability to provide services can be determined by structural impacts of the precipitating event, response plans help the staff to continue to provide services and care for affected populations, and appropriately arrange referrals when care cannot be provided at the facility. The findings suggest that health facilities in disasterprone areas should invest in developing and implementing disaster response plans in order to improve health service provision capacity during disasters.
Despite a global increase in conservative treatment of blunt liver injuries, the number of surgically treated traumas in one major trauma center in Iran has increased. The aim of this study was to unveil the reasons behind this increase in operative management by studying 228 consecutive patients at this regional center.
Hypothesis:
The increased number of liver injuries operated upon is due to the lack of a solid, well-defined trauma system.
Methods:
A retrospective review of all patients admitted for liver trauma at Bahonar Hospital, Kerman, Iran, from March 2001 until March 2006 was conducted. Patient data were collected, studied and statistically processed with regard to demographics, clinical and laboratory findings, surgical procedures, complications, and mortality.
Results:
All patients who were admitted between 30–360 minutes after injury were included. Twelve hemodynamically stable patients were treated conservatively in an ordinary surgical ward.The remaining 216 patients, 153 of whom had blunt injuries, were hemodynamically unstable. A total of 70 patients were in hemorrhagic shock at the time of arrival. Hemodynamically unstable patients with either the suspicion of associated injuries and/or who displayed clinical deterioration and could not be observed in an ordinary surgical ward were treated surgically. The majority of patients who were operated upon in this series had a grade-II liver injury. The total mortality rate in surgically treated patients was 18.1%. None of the patients treated conservatively died.
Conclusions:
Despite the low grade of their liver injuries, the high number of surgically treated patients in this series was due to the absence of a valid trauma system. This result should encourage the authorities to review current trauma systems and trauma surgical guidelines.
The World Health Organization estimates that the burden of surgical disease due to war, self-inflicted injuries, and road traffic incidents will rise dramatically by 2020. During the 2009 Harvard Humanitarian Initiative's Humanitarian Action Summit (HHI/HAS), members of the Burden of Surgical Disease Working Group met to review the state of surgical epidemiology, the unmet global surgical need, and the role international organizations play in filling the surgical gap during humanitarian crises, conflict, and war. An outline of the group's findings and recommendations is provided.
The Working Group on Mental Health and Psychosocial Support was convened as part of the 2009 Harvard Humanitarian Action Summit. The Working Group chose to focus on ethical issues in mental health and psychosocial research and programming in humanitarian settings. The Working Group built on previous work and recommendations, such as the Inter-Agency Standing Committee's Guidelines on Mental Health and Psychosocial Support in Emergency Settings.
Objectives:
The objective of this working group was to address one of the factors contributing to the deficiency of research and the need to develop the evidence base on mental health and psychosocial support interventions during complex emergencies by proposing ethical research guidelines. Outcomes research is vital for effective program development in emergency settings, but to date, no comprehensive ethical guidelines exist for guiding such research efforts.
Methods:
Working Group members conducted literature reviews which included peer-reviewed publications, agency reports, and relevant guidelines on the following topics: general ethical principles in research, cross-cultural issues, research in resource-poor countries, and specific populations such as trauma and torture survivors, refugees, minorities, children and youth, and the mentally ill. Working Group members also shared key points regarding ethical issues encountered in their own research and fieldwork.
Results:
The group adapted a broad definition of the term “research”, which encompasses needs assessments and data gathering, as well as monitoring and evaluation. The guidelines are conceptualized as applying to formal and informal processes of assessment and evaluation in which researchers as well as most service providers engage. The group reached consensus that it would be unethical not to conduct research and evaluate outcomes of mental health and psychosocial interventions in emergency settings, given that there currently is very little good evidence base for such interventions. Overarching themes and issues generated by the group for further study and articulation included: purpose and benefits of research, issues of validity, neutrality, risk, subject selection and participation, confidentiality, consent, and dissemination of results.
Conclusions:
The group outlined several key topics and recommendations that address ethical issues in conducting mental health and psychosocial research in humanitarian settings. The group views this set of recommendations as a living document to be further developed and refined based on input from colleagues representing different regions of the globe with an emphasis on input from colleagues from low-resource countries.
Surveillance is an essential component of health and nutrition information management during humanitarian situations. Changes in the nature and scope of humanitarian assistance activities have created new challenges in health surveillance, particularly outside of camp-based settings.
Objectives:
The primary aim of the Humanitarian Health Information Management Working Group was to identify challenges and areas that need further elucidation in a range of non-camp settings, including urban and rural as well as low-and middle-income countries.
Results:
Three major themes emerged: (1) standardization of measures and methodologies; (2) context in data collection and management; and (3) hidden populations and the purpose of surveillance in urban settings. Innovative examples of data collection and management in community-based surveillance were discussed, including task-shifting, health worker to community member ratio, and literacy needs.
Conclusions:
Surveillance in non-camp settings can be informed by surveillance activities in camp-based settings, but requires additional consideration of new methods and population needs to achieve its objectives.
The Summit, now in its third year, was developed to address some major points of need and controversy in the humanitarian field, to establish a dialogue among practitioners and humanitarian strategists, and to promote discussion about complex and controversial issues that face the humanitarian community. What follows in this publication is a detailed review of the goals, deliberations, and recommendations of the Working Groups, concluding with an analysis of future needs. The authors hope that the Summit, and the resulting action items, serve as a launching point for organizational, governmental, and United Nations practices and policies to advance the professionalism, quality and accountability of humanitarian intervention.