Skip to main content

Advertisement

SpringerLink
Log in

Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Objects

There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs.

Methods

The clinical records of patients ≤18 years who presented to Tribhuvan University Teaching Hospital between April 1, 2001 and April 1, 2004 with acute neurological trauma and were subsequently admitted to hospital were retrospectively reviewed. A standard proforma was used to collect information on patient demographics, the nature and etiology of the injuries, their acute management, and outcomes.

Conclusions

Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Murray CJ, Lopez AD (1997) Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 349:1269–1276

    Article  PubMed  Google Scholar 

  2. Bartlett SN (2002) The problem of children’s injuries in low-income countries: a review. Health Policy Plan 17:1–13

    Article  Google Scholar 

  3. Ghajar J (2000) Traumatic brain injury. Lancet 356:923–929

    Article  PubMed  Google Scholar 

  4. Lam WH, Mackersie A (1999) Paediatric head injury: incidence, aetiology and management. Paediatr Anaesth 9:377–385

    Article  PubMed  Google Scholar 

  5. Schwartz L, Taylor HG, Drotar D, Yeates KO, Wade SL, Stancin T (2003) Long-term behavior problems following pediatric traumatic brain injury: prevalence, predictors, and correlates. J Pediatr Psychol 28:251–263

    Article  PubMed  Google Scholar 

  6. Faillace WJ (2002) Management of childhood neurotrauma. Surg Clin N Am 82:349–363

    Article  PubMed  Google Scholar 

  7. Arias E, MacDorman MF, Strobino DM, Guyer B (2003) Annual summary of vital statistics—2002. Pediatrics 112:1215–1230

    Article  PubMed  Google Scholar 

  8. Albright AL (2004) The past, present, and future of pediatric neurosurgery. J Neurosurg (Pediatrics) 101:125–129

    Google Scholar 

  9. Allhouse MJ, Rouse T, Eichelberger MR (1993) Childhood injury: a current perspective. Pediatr Emerg Care 9:159–164

    PubMed  Google Scholar 

  10. Bernstein E, Kellerman AL, Hargaten SW, Jui J, Fish SS, Herbert BH, Flores C, Caravati ME, Krishel S (1994) A public health approach to the twenty-first century. Acad Emerg Med 1:277–286

    PubMed  Google Scholar 

  11. Manciaux MR (1985) Accidents in childhood: from epidemiology to prevention. Acta Pediatr Scand 74:163–170

    Google Scholar 

  12. Waxweiler RJ (1994) Public health, injury control, and emergency medicine. Acad Emerg Med 1:204

    Google Scholar 

  13. World Health Organization (1996) Investing in health research and development: report of the ad-hoc committee on health research relating to future intervention options. Geneva, Switzerland

    Google Scholar 

  14. World Health Organization (2004) Country profiles: Nepal. http://www.who.int/countries/npl/en. Accessed 19/9/2004

    Google Scholar 

  15. World Health Organization (2004) Country profiles: United States of America. http://www.who.int/countries/usa/en. Accessed 27/12/2004

    Google Scholar 

  16. UNICEF (2004) At a glance: Nepal. http://www.unicef.org/infobycountry/nepal.html. Accessed 27/12/2004

    Google Scholar 

  17. Michaud C, Murray CJ (1994) External assistance to the health sector in developing countries: a detailed analysis, 1972–90. Bull World Health Organ 72:639–651

    PubMed  Google Scholar 

  18. Krug EG, Sharma GK, Lozano R (2000) The global burden of injuries. Am J Public Health 90:523–526

    PubMed  Google Scholar 

  19. Mock CN, nii-Amon-Kotei D, Maier RV (1997) Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma. J Trauma 42:504–513

    PubMed  Google Scholar 

  20. Poudyal AK, Jimba M, Murakami I, Silwal RC, Wakai S, Kuratsuji T (2003) A traditional healers’ training model in rural Nepal: strengthening their roles in community health. Trop Med Int Health 8:956–960

    Article  PubMed  Google Scholar 

  21. Rajbhandari KC (2004) Epilepsy in Nepal. Can J Neurol Sci 31:257–260

    PubMed  Google Scholar 

  22. Streefland P (1985) The frontier of modern western medicine in Nepal. Soc Sci Med 20:1151–1159

    Article  PubMed  Google Scholar 

  23. Brain Trauma Foundation (2000) Guidelines for the prehospital management of traumatic brain injury. Brain Trauma Foundation, New York

    Google Scholar 

  24. Brain Trauma Task Force (2000) Management and prognosis of severe traumatic brain injury. J Neurotrauma 17:451–553

    Google Scholar 

  25. Johnson DL, Krishnamurthy S (1996) Send severely head injured children to a pediatric trauma center. Pediatr Neurosurg 25:309–314

    PubMed  Google Scholar 

  26. Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, Rivara FP (2001) Relationship between trauma center and outcomes. JAMA 285:1164–1171

    Article  PubMed  Google Scholar 

  27. Ibbotson G (2003) Nepal: a lesson from chaos. CMAJ 169:1301–1304

    PubMed  Google Scholar 

  28. British Broadcasting Corporation (2004) Concern over Nepal rebel threat. http://www.bbc.co.uk/1/hi/world/south_asia/3540866.stm. Accessed 18/8/2004

  29. British Broadcasting Corporation (2004) Strike continues to cripple Nepal. http://www.bbc.co.uk/1/hi/world/south_asia/3703743.stm. Accessed 19/9/2004

  30. British Broadcasting Corporation (2004) Rebels cut links to Nepal capital. http://www.bbc.co.uk/1/hi/world/south_asia/4119951.stm. Accessed 23/12/2004

  31. British Broadcasting Corporation (2004) Nepal violence ‘leaves many dead.’ http://www.bbc.co.uk/1/hi/world/south_asia/4121885.stm. Accessed 23/12/2004

  32. Jimba M, Wakai S (2001) Is Gandhi’s philosophy of non-violence dead in Nepal? Lancet 358:1017–1018

    Article  Google Scholar 

  33. Singh S (2004) Impact of long-term political conflict on population health in Nepal. CMAJ 171:1499–1501

    PubMed  Google Scholar 

  34. Stevenson PC (2001) The torturous road to democracy—domestic crisis in Nepal. Lancet 358:752–756

    Article  PubMed  Google Scholar 

  35. Stevenson PD (2002) High-risk medical care in war-torn Nepal. Lancet 359:1495

    Article  PubMed  Google Scholar 

  36. Hauswald M, Yeoh E (1997) Designing a prehospital system for a developing country: estimated costs and benefits. Am J Emerg Med 15:600–603

    Article  PubMed  Google Scholar 

  37. Razzak JA, Luby SP, Laflamme L, Chotani H (2004) Injuries among children in Karachi, Pakistan—what, where and how. Public Health 118:114–120

    Article  PubMed  Google Scholar 

  38. Forjuoh S, Mock CN, Freidman D (1999) Transport of the injured to hospitals in Ghana: the need to strengthen the practice of trauma care. Pre-hosp Immed Care 3:66–70

    Google Scholar 

  39. Mock CN, Tiska M, Adu-Ampofo M, Boakye G (2002) Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma 53:90–97

    PubMed  Google Scholar 

  40. Husum H, Gilbert M, Wisborg T, Van Heng Y, Murad M (2003) Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma 54:1188–1196

    PubMed  Google Scholar 

  41. World Bank (2004) Nepal data profile. http://www.worldbank.org/cgi-bin/sendoff.cgi?page=/data/countrydata/aag/npl_aag.pdf. Accessed 9/19/2004

  42. Schwarz R, Khadkha SB (2004) Reasons for late presentation of cleft deformity in Nepal. Cleft Palate-Craniofac J 41:199–201

    Article  PubMed  Google Scholar 

  43. Shrestha MK, Thakur J, Gurung GK, Joshi AB, Pokhrel S, Ruit S (2004) Willingness to pay for cataract surgery in Kathmandu valley. Br J Ophthalmol 88:319–320

    Article  PubMed  Google Scholar 

  44. Ali J, Adam R, Butler AK, Chang H, Howard M, Gonsalves D, Pitt-Miller P, Stedman M, Winn J, Williams JI (1993) Trauma outcome improves following the advanced trauma life support program in a developing country. J Trauma 34:890–898

    PubMed  Google Scholar 

  45. Ali J, Adam R, Stedman M, Howard M, Williams JI (1994) Advanced trauma life support program increases emergency room application of trauma resuscitative procedures. J Trauma 36:391–394

    PubMed  Google Scholar 

  46. Joseph M (2003) Intracranial pressure monitoring in a resource-constrained environment: a technical note. Neurol India 51:333–335

    PubMed  Google Scholar 

  47. Ramamurthi B (2004) Appropriate technology for neurosurgery. Surg Neurol 61:109–116

    Article  PubMed  Google Scholar 

  48. Bagan M (1997) Neurosurgery in Nepal. Surg Neurol 47:512–514

    Article  PubMed  Google Scholar 

  49. Devkota UP, Aryal KR (2001) Result of surgery for ruptured intracranial aneurysms in Nepal. Br J Neurosurg 15:13–16

    Article  PubMed  Google Scholar 

  50. Shilpakar SK, Bagan M (2003) Surgical management of traumatic epidural hematoma: over seven years experience. JSSN 6:33–39

    Google Scholar 

  51. Meyer AA (1998) Death and disability from injury: a global challenge. J Trauma 44:1–12

    PubMed  Google Scholar 

  52. Tursz A (1986) Epidemiological studies of accident morbidity in children and young people: problems of methodology. World Health Stat Q 39:257–268

    PubMed  Google Scholar 

  53. Zwi AB (1996) Injury control in developing countries: context more than content is crucial. Inj Prev 2:91–92

    PubMed  Google Scholar 

  54. Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F (2004) Strengthening the prevention and care of injuries worldwide. Lancet 363:2172–2179

    Article  PubMed  Google Scholar 

  55. Adeloye A, Olumide AA, Obiang HM (1986) Acute head injuries in children in Ibadan, Nigeria. Childs Nerv Syst 2:309–313

    Article  PubMed  Google Scholar 

  56. Gedlu E (1994) Accidental injuries among children in north-west Ethiopia. East Afr Med J 71:807–810

    PubMed  Google Scholar 

  57. Janson S, Aleco M, Beetar A, Bodin A, Shami S (1994) Accident risks for suburban pre-school Jordanian children. J Trop Pediatr 40:88–93

    PubMed  Google Scholar 

  58. Yagmur Y, Güloğlu C, Aldemir M, Orak M (2004) Falls from flat-roofed houses: a surgical experience of 1,643 patients. Injury 35:425–428

    Article  PubMed  Google Scholar 

  59. Reichenheim ME, Harpham T (1989) Child accidents and associated risk factors in a Brazilian squatter settlement. Health Policy Plan 4:162–167

    Google Scholar 

  60. Istre GR, McCoy MA, Stowe M, Davies K, Zane D, Anderson RJ, Wiebe R (2003) Childhood injuries due to falls from apartment balconies and windows. Inj Prev 9:349–352

    Article  PubMed  Google Scholar 

  61. Spiegel CN, Lindaman FC (1977) Children can’t fly: a program to prevent childhood morbidity and mortality from window falls. Am J Public Health 67:1143–1147

    PubMed  Google Scholar 

  62. Abantanga FA, Mock CN (1998) Childhood injuries in an urban area of Ghana: a hospital based study of 677 cases. Pediatr Surg Int 13:515–518

    Article  PubMed  Google Scholar 

  63. Shokunbi T, Olurin O (1994) Childhood head injury in Ibadan: causes, neurologic complications and outcome. West Afr J Med 13:38–42

    PubMed  Google Scholar 

  64. Kobusingye OC, Guwatudde D, Owor G, Lett RR (2002) Citywide trauma experience in Kampala, Uganda: a call for intervention. Inj Prev 8:133–136

    Article  PubMed  Google Scholar 

  65. Poudel-Tandukar K, Nakahara S, Poudel KC, Ichikawa M, Wakai S (2004) Traffic fatalities in Nepal. JAMA 291:2542

    Article  Google Scholar 

  66. Pokhrel S, Sauerborn R (2004) Household decision-making on child health care in developing countries: the case of Nepal. Health Policy Plan 19:218–233

    Article  PubMed  Google Scholar 

  67. Berger LR, Mohan D (1996) Injury control: a global view. Delhi, India

    Google Scholar 

  68. Roberts I, Power C (1996) Does the decline in child injury mortality vary by social class? A comparison of class specific mortality in 1981 and 1991. BMJ 313:784–786

    PubMed  Google Scholar 

Download references

Acknowledgements

K.M. gratefully acknowledges the support of the Foundation for International Education in Neurological Surgery that sponsored travel to Kathmandu and Dr. Merwyn Bagan and Dr. Richard Perrin who facilitated K.M.’s Volunteer for International Neurosurgical Education experience in Nepal.

Author information

Authors and Affiliations

  1. Division of Neurosurgery, University of Toronto, Toronto, Canada

    Karim Mukhida

  2. Cell Restoration Laboratory, Departments of Anatomy & Neurobiology and Surgery (Neurosurgery), Dalhousie University, 5850 College Street, 12th Floor, Sir Charles Tupper Medical Building, Halifax, Nova Scotia B3H 4H7, Canada

    Karim Mukhida

  3. Division of Neurosurgery, Tribhuvan University Institute of Medicine, Kathmandu, Nepal

    Mohan R. Sharma & Sushil K. Shilpakar

Authors
  1. Karim Mukhida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohan R. Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sushil K. Shilpakar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karim Mukhida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mukhida, K., Sharma, M.R. & Shilpakar, S.K. Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control. Childs Nerv Syst 22, 352–362 (2006). https://doi.org/10.1007/s00381-005-1235-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-005-1235-0

Keywords

Search

Navigation