Elsevier

Public Health

Volume 119, Issue 6, June 2005, Pages 466-473
Public Health

Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg

https://doi.org/10.1016/j.puhe.2004.08.022Get rights and content

Summary

Objectives

To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities.

Study design

Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months.

Methods

In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances.

Results

Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35–59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility.

Conclusions

Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.

Introduction

Unintentional injury is a major global public health issue,1 but its impact is often overlooked in poorer countries due to inadequate or inaccessible health facilities and a lack of reporting systems.2 Actual incidence thus varies considerably with recorded injuries in different settings, and statistical reports often only present the tip of the iceberg.3 Reported patterns of injury that rely on retrospective health facility data should certainly be regarded with suspicion. Furthermore, rapid development and industrialization in many countries is profoundly affecting patterns of injury as occupational and lifestyle hazards change.4

In Vietnam, injuries are an increasing problem, particularly since Doi Moi political reforms started in 1986. From 1989 to 1998, police statistics showed an increase of 274% in fatal road traffic accidents and 404% in injuries. The rate of traffic accidents increased from 7.1 per 1000 inhabitants to 24.9, and fatalities rose from 3.9 to 7.4, giving Vietnam one of the highest rates in the world.5 According to the Traffic Safety Community, there were 10,477 deaths due to traffic accidents in 2001.6 The crude injury mortality rate in Vietnam was estimated to be 189/100,000 person-years from a cross-sectional survey.7 Injury data from non-comparable sources have been variously reported from the Ministry of Health, the Ministry of Labour, Invalidity and Social Welfare, the Ministry of Transport and others.8 This makes the planning and implementation of effective injury prevention very difficult. The Ministry of Health also initiated a national programme on injury prevention and safe communities in 1996, achieving remarkable results within a short time, although further studies and improvements are needed. Therefore, a priority for policy development is epidemiological research at the household level, to establish a more complete community-based picture of injuries in Vietnam9 and thus characterize the submerged part of the iceberg.

An epidemiological field laboratory was established in Northern Vietnam in 1999. This study used that framework, building on a previously reported pilot study that presented methods and patterns of injury elicited from a single household survey using 3-month recall.10 A longitudinal picture of household injury events during the year 2000 has been compiled from four quarterly surveys to give a comprehensive picture of all types and circumstances, and to identify risk groups, hazardous environments and major causes of unintentional injury in a defined rural Vietnamese community.

Section snippets

Methods

The study took place in Bavi District, Hatay Province, 60 km west of Hanoi, in Northern Vietnam. Bavi District has 32 communes and covers 410 km2, including lowland, highland and mountainous areas, with a total population of approximately 235,000 in 1999. The commune is the lowest level of local government organization. In this mainly rural area, farming and livestock breeding are the main economic activities of 81% of the people, and the major products are wet rice, cassava, corn, soybean, green

Results

In total, 24,776 people living in the study area were surveyed. Of these, 1917 reported 2079 new non-fatal injuries during the four 3-month periods of observation. Recall of injuries diminished considerably over each 3-month period, particularly for mild injuries (defined as incapacitating the victim for less than 1 week), as shown aggregated in Fig. 2. Over the whole period, 136 people were injured twice and 13 were injured three times. This pattern of injury recurrence among individuals

Discussion

Even though this study only recorded injuries that needed care or disrupted normal activities, and despite an obvious decline in incidence between each quarterly survey, assumed to represent recall bias, an incidence approaching one in 10 of the population per annum was recorded. Since less than one in four of these injury victims used the public health services, the burden of injury in this Vietnamese community was both huge and largely unseen, truly an iceberg scenario.

Considerably higher

Acknowledgements

This study was conducted within the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in Vietnam, a collaborative research project between the Health Strategy and Policy Institute; Hanoi Medical School; Department of Planning, Ministry of Health, Hanoi; Division of International Health, Karolinska Institute, Stockholm; Umeå International School of Public Health, Umeå; and the Nordic School of Public Health, Göteborg, Sweden. Financial support from Sida/SAREC, Stockholm, is

References (27)

  • N.T.H. Tu
  • H.C. Luau et al.

    Development of a national injury prevention/safe community programme in Vietnam

    Health Promot Internation

    (2001)
  • H.M. Hang et al.

    Community-based assessment of unintentional injuries: a pilot study in rural Vietnam

    Scand J Public Health

    (2003)
  • Cited by (27)

    • Population-based incidence and cost of non-fatal injuries in Iran: A consistent under-recognized public health concern

      2015, Public Health
      Citation Excerpt :

      In this regard, fatal injuries represent the ‘tip of the iceberg’. Non-fatal injuries account for a huge proportion of the iceberg which is not typically visible.5 Knowledge of the cost of non-fatal injuries is crucial.

    • Injury incidence, healthcare consumption and avenues for prevention: a household survey on injury in rural Twiserkan, Iran

      2009, Public Health
      Citation Excerpt :

      Injury incidence was compiled using two levels of severity: hospitalization (more than 6 hours) and non-hospitalization, including those injury cases which required care by a physician in health centre, hospital or private physician; or any care in the health house. The time intervals for moderate (physician) and minor (health house) injuries were multiplied by 2 and 12 months, respectively, to compile annual incidences.11,40–43 A total of seven households reported more than one injury during the reference period (four had two injuries and three had three injuries).

    • Difficulties in getting treatment for injuries in rural Vietnam

      2009, Public Health
      Citation Excerpt :

      This surveillance site is described in detail elsewhere.6 A 50% sample of the FilaBavi surveillance population was selected, by random sampling of village clusters, and retained as the basis for the four quarterly injury incidence surveys, as described in detail elsewhere.7 Thus, each household in the sample was under quarterly longitudinal surveillance for injuries during 2000.

    View all citing articles on Scopus

    Sadly, our colleague Professor Ton That Bach died suddenly during the final stages of this study. His great contributions to the research community in Vietnam are sorely missed and we would like to dedicate this paper to his memory.

    View full text