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Biomedical subjects

Adnan A Hyder

Publications and source records attributed to Adnan A Hyder.

At least 19 recordsLinked to original sources
PubMed2006

Exploring the relationship between development and road traffic injuries: a case study from India.

BACKGROUND: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. METHODS: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. RESULTS: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. CONCLUSIONS: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures.

Accidents, Traffic↗
PubMed2006

Modeling the cost effectiveness of injury interventions in lower and middle income countries: opportunities and challenges.

BACKGROUND: This paper estimates the cost-effectiveness of five interventions that could counter injuries in lower and middle income countries(LMICs): better traffic enforcement, erecting speed bumps, promoting helmets for bicycles, promoting helmets for motorcycles, and storing kerosene in child proof containers. METHODS: We adopt an ingredients based approach to form models of what each intervention would cost in 6 world regions over a 10 year period discounted at both 3% and 6% from both the governmental and societal perspectives. Costs are expressed in local currency converted into US $2001. Each of these interventions has been assessed for effectiveness in a LMIC in limited region, these effectiveness estimates have been used to form models of disability adjusted life years (DALYs) averted for various regions, taking account of regional differences in the baseline burden of injury. RESULTS: The interventions modeled in this paper have cost effectiveness ratios ranging from US $5 to $ 556 per DALY averted depending on region. Depending on local acceptability thresholds many of them could be judged cost-effective relative to interventions that are already adopted. Enhanced enforcement of traffic regulations is the most cost-effective interventions with an average cost per DALY of $64 CONCLUSION: Injury counter measures appear to be cost-effective based on models. More evaluations of real interventions will help to strengthen the evidence basis.

Journal Article↗
PubMed2006

Road traffic injuries in India: a review of the literature.

AIMS: India is the largest country in the South Asian region with all the problems faced by rapidly developing nations, especially increasing motorization. In spite of such developments, there are limited data in the literature addressing the problem of road traffic injuries. This article is an attempt to estimate the magnitude of the problem through published literature. METHODS: This article is a systematic review of the literature on road traffic injuries in India, conducted using three electronic databases and hand-searching of the selected articles. Final analyses were conducted with 22 studies. RESULTS: Road traffic injuries are a significant burden on the health care system in India. The most commonly affected group is young males. Pedestrians constitute a large majority of the victims and there is high early mortality in most cases. CONCLUSIONS: There is lack of population-based data on road traffic injuries in India and there is large heterogeneity in the published data. This is an important research agenda for the country. Immediate steps are required to curb this problem to limit the loss of life and resources.

Abbreviated Injury Scale↗
PubMed2006

A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries.

OBJECTIVES: To develop an epidemiological profile and present the burden of urban road-traffic injuries (RTI) in children and adolescents in urban Sub-Saharan Africa. METHOD: A systematic review of published and gray literature of children and adolescents < or =19 years old involved in RTI in urban regions in Sub-Saharan Africa from January 1980-December 2003. RESULTS: The mean annual incidence for urban road-traffic injuries was 109.8 per 100,000 children, and males were twice as involved as their female counterparts. Children between 10 to 14 years constitute the most frequent group involved in road crashes (36%) while pedestrians represent an average of 68% of all childhood RTI cases. Twenty Healthy Life Years per 1,000 children and adolescents are being lost annually in the region from RTI. CONCLUSIONS: There is an urgent need to develop a regional health research agenda to generate an accurate estimate of the burden of road-traffic injuries on children. This is a new challenge for child health and there is a need to raise awareness among policy makers to promote appropriate interventions.

Accidents, Traffic↗
PubMed2006

Informed consent and collaborative research: perspectives from the developing world.

INTRODUCTION: Informed consent has been recognized as an important component of research protocols and procedures of disclosure and consent in collaborative research have been criticized, as they may not be in keeping with cultural norms of developing countries. This study, which is part of a larger project funded by the United States National Bioethics Advisory Commission, explores the opinions of developing country researchers regarding informed consent in collaborative research. METHODS: A survey of developing country researchers, involved in human subject research, was conducted by distributing a questionnaire with 169 questions, which included questions relating to informed consent. In addition, six focus group discussions, eight in-depth interviews and 78 responses to open-ended questions in the questionnaire provided qualitative data. RESULTS: 203 surveys were considered complete and were included in the analysis. Written consent was not used by nearly 40% of the researchers in their most recent studies. A large proportion of respondents recommended that human subject regulations should allow more flexibility in ways of documenting informed consent. 84% of researchers agreed that a mechanism to measure understanding should be incorporated in research studies as part of the process of informed consent. DISCUSSION: This paper is an empirical step in highlighting the ethical issues concerning disclosure. Health researchers in developing countries are well aware of the importance of consent in health research, and equally value the significance of educating human subjects regarding study protocols and associated risks and benefits. However, respondents emphasize the need for modifying ethical regulations in collaborative research.

Attitude↗
PubMed2005

Exploring ethical considerations for the use of biological and physiological markers in population-based surveys in less developed countries.

BACKGROUND: The health information needs of developing countries increasingly include population-based estimates determined by biological and physiological measures. Collection of data on these biomarkers requires careful reassessment of ethical standards and procedures related to issues of safety, informed consent, reporting, and referral policies. This paper reviews the survey practices of health examination surveys that have been conducted in developed nations and discusses their application to similar types of surveys proposed for developing countries. DISCUSSION: The paper contends that a unitary set of ethical principles should be followed for surveys around the world that precludes the danger of creating double standards (and implicitly lowers standards for work done in developing countries). Global ethical standards must, however, be interpreted in the context of the unique historical and cultural context of the country in which the work is being done. Factors that influence ethical considerations, such as the relationship between investigators in developed and developing countries are also discussed. SUMMARY: The paper provides a set of conclusions reached through this discussion and recommendations for the ethical use of biomarkers in populations-based surveys in developing countries.

Journal Article↗
PubMed2005

Emergency medical systems in low- and middle-income countries: recommendations for action.

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care.

Allied Health Personnel↗
PubMed2005

Child and young adult injuries among long-term Afghan refugees.

The aim was to determine the epidemiology and risk factors of childhood and young adult injuries among long-term Afghan refugees in Pakistan. A stratified cluster study was undertaken on a random sample of refugee households from June to July 2002. The Afghan Refugee Injury Survey was administered to the head of the household and recorded all injuries among household members within the last 3 months. Crude injury incidence was 12.3 per 1000 population among those aged 0-29 years (age groups 0-4, 5-14 and 15-29 years). Those aged 15-29 years had the highest injury rate (18.3 per 1000) closely followed by those aged 5-14 (12.3 per 1000) and much higher than the 0-4 years category (2.3 per 1000). Falls accounted for most injuries (48%) with both road traffic injuries and assaults accounting for 15%. The 15-29 year age group (odds ratio = 9.1) and those educated informally or for less than 6 years (odds ratio = 2.10), were associated with injury (p < 0.05) after adjustment for age, gender, occupation and education. Occupation was not associated with injury at a statistically significant level. Afghan refugee children and young adults are disproportionately affected by injuries, especially falls, than children in developed countries. Appropriate injury prevention strategies must be implemented among refugee camps with long-term refugees as part of their health programmes.

Adolescent↗
PubMed2005

Defining standard of care in the developing world: the intersection of international research ethics and health systems analysis.

In recent years there has been intense debate regarding the level of medical care provided to 'standard care' control groups in clinical trials in developing countries, particularly when the research sponsors come from wealthier countries. The debate revolves around the issue of how to define a standard of medical care in a country in which many people are not receiving the best methods of medical care available in other settings. In this paper, we argue that additional dimensions of the standard of care have been hitherto neglected, namely, the structure and efficiency of the national health system. The health system affects locally available medical care in two important ways: first, the system may be structured to provide different levels of care at different sites with referral mechanisms to direct patients to the appropriate level of care. Second, inefficiencies in this system may influence what care is available in a particular locale. As a result of these two factors locally available care cannot be equated with a national 'standard'. A reasonable approach is to define the national standard of care as the level of care that ought to be delivered under conditions of appropriate and efficient referral in a national system. This standard is the minimum level of care that ought to be provided to a control group. There may be additional moral arguments for higher levels of care in some circumstances. This health system analysis may be helpful to researchers and ethics committees in designing and reviewing research involving standard care control groups in developing country research.

Control Groups↗
PubMed2005

The pervasive triad of food security, gender inequity and women's health: exploratory research from sub-Saharan Africa.

OBJECTIVES: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues-food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad. SETTING: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and Bagamoyo District, Tanzania. METHODS: A total of 12 in-depth interviews and 4 focus group discussions have been included in this analysis. Transcribed text from interviews and focus group discussions were coded and thematic conceptual matrices were developed to compare dimensions of common themes across interviews and settings. A thematic analysis was then performed and a framework developed to understand the nature of the triad and explore the potential for interventions within the interactions. FINDINGS: The vicious cycle of increasing work, lack of time, and lack of independent decision making for women who are responsible for food production and health of their families, has health and social consequences. Food securing activities have negative health consequences for women, which are further augmented by issues of gender inequity. CONCLUSION: The African development community must respond by thinking of creative solutions and appropriate interventions for the empowerment of women farmers in the region to ensure their health.

Agriculture↗
PubMed2004

Knowledge for better health: a conceptual framework and foundation for health research systems.

Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health.

Artificial Intelligence↗
PubMed2004

The burden of injuries in the Philippines: implications for national research policy.

Injuries cause 10% of the mortality and 15% of disability worldwide. However, there is a paucity of data on injuries in the developing world where two-thirds of all injury deaths occur. This is the first published report characterizing the overall problem of injuries in the Philippines, a developing country in southeast Asia. This report defines the burden of injuries in the Philippines and identifies priority areas for the national health research agenda. A systematic review of 35 years of published and unpublished data on injuries in the Philippines (1960-1995) was conducted. Injury fatality rates increased by 196% from 14.3 per 100,000 in 1960 to 42.3 per 100,000 in 1995, and one in 11 deaths in the Philippines are due to injuries. Intentional injuries account for 48% of all injury deaths and motor vehicle crashes for 15%. For 15-44 year old males, injuries account for 42% of all deaths, 67% of which are intentional. The proportion of all deaths attributable to intentional injuries has increased by 925% and that of motor vehicle crashes by 600% from 1960 to 1995. Improvements in injury surveillance and documentation of non-fatal injury outcomes are needed. Research into risk factors and potential interventions for the prevention of intentional injuries should be a priority in the Philippines.

Cause of Death↗
PubMed2004

The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan.

OBJECTIVES: To assess the burden of road traffic injuries in Pakistan-a developing country in South Asia. METHODS: A nationally representative household interview survey, to measure the burden of all injuries for all ages and in both genders using a three-month recall period. RESULTS: The overall incidence of injury events was 41 (CI: 39.2-43.8) per 1000 per year and for road traffic injuries 15 (CI: 13.7-16.5) per 1000 per year. The relative risk for road traffic injuries was found to be higher in males, those 16-45 years old, and those in the professional category of laborers and vendors. CONCLUSIONS: This first national survey reflects the growing impact of injuries, especially road traffic injuries in Pakistan and portends a challenge for the national health system.

Accidents, Traffic↗