The history of Demographic Surveys goes back to 1976. It used to be conducted in different names–Fertility Survey, Family Health Survey, and Demographic and Health Survey. The current edition is the 10th of such series but sixth comprehensive survey conducted as part of the global Demographic and Health Surveys (DHS) which started in 1996. Primary objective of these studies were to obtain key indicators related to fertility, maternal and child health, nutrition and immunization. These surveys conducted in Nepal have kept pace with demographic and epidemiologic transition and include contemporary health issues such as migration, sexual health, domestic violence, and water and sanitation.
In the past, when only a few health surveys and researches used to be conducted in Nepal, the findings of NDHS were used in monitoring and evaluating related development programs and used to inform key development strategic documents such as five-year plans, and health plans.
The Demographic Health Survey (2006) reported some information about injuries for the first time but for young children only. DHS 2006 showed that injuries caused 11 percent of total deaths amongst children aged 1-59 months. In this survey, “injury was assigned as the cause of a death if the respondent said that the child suffered an injury that resulted in death, including a motor vehicle accident, fall, poisoning, drowning or other accident.”
However, the information for different types of injuries was not available. Below is the table from NDHS 2006.
The Ministry of Health and Population and DHS Program published the “Nepal Demographic and Health Survey 2022” on June 23. This has gone a few steps ahead and included accidents and injuries, mental health, and disability. With an objective of providing an up-to-date estimate of basic health indicators the NDHS 2022 collected additional information on fistula, smoking, knowledge of tuberculosis, cervical and breast cancer, and prevalence of hypertension. In addition, this edition of the NDHS describes the characteristics of the respondents for health insurance coverage, tobacco and alcohol consumption, and migration status. This is commendable as nearly 80 percent of the national burden of disease comprised of noncommunicable diseases (NCDs) and injuries.
According to the survey findings, mortality for road traffic injury is reported to be 14 per 100,000 population, which roughly equates to over 4,000 deaths annually, whereas the current police records show less than 3,000 fatal road traffic injuries. The nonfatal road traffic injury rate was found to be 1,088 per 100,000 or over 325,000 injuries in a year. Another very important finding analyzing fatal and nonfatal road injury rates is that for every death caused by road traffic crash nearly 80 persons survive injuries ranging from minor to severe. With no surprise two-wheeler motorized vehicle users comprise 68 percent of total road traffic casualties followed by bicyclists and pedestrians.
The amount of population affected due to road traffic crashes is revealed by this report and indicates strikingly high economic burden of road injuries in Nepal. General observation can gauge the impact on society and the economy. The number of deaths and injuries of people belonging to richest wealth quintile is 2.5 times higher than the people from the poorest wealth quintiles. There is a steep gradient directly proportional to wealth quintile. This shows that people will be killed or injured from road injuries as they rise to socioeconomic status.
Injury comprises a broad range of conditions, though fractures and road injuries are frequently mentioned during general conversations. NDHS 2022 has tried to convey a clear message that there are several other conditions that are actually the injuries and comprise a larger proportion than road injuries. The term “non-road traffic accidents” is used in the report to indicate “unintentional injuries” which includes falls, animal bites, fires/burns, agricultural, industrial, cut/stabs, hit by an object, electrical injuries and some others. The fatal and nonfatal injury rates for these unintentional causes are 38 and 1,525 per 100,000 population. This means for every death caused by these unintentional causes (except road injury) 40 persons survive injuries of various severities. It is not surprising that a huge percentage of injuries are caused by falling from a height or the same level. Agricultural occupational injuries comprise five percent of the total.
The detailed review of the survey can be done after looking into the datasets and performing additional analysis with an aim to provide inferential estimates. However, the survey findings create obvious suspicion for a couple of reasons. Firstly, it is of great surprise that this survey covering over 14 thousand households, covering entire geographical and political clusters of the country, did not find a single fatal or nonfatal case of drowning. Drowning is a serious cause of deaths among children below the age of 10. Roughly a total of 1,500 drowning deaths occur in Nepal each year.
Secondly, this survey also did not report any poisoning or accidental consumption or inhalation of poisonous substances. Thirdly, the child age group is chosen to be “<15 years” in the tables generated to accidents and injuries which doesn’t clearly say what the rates among infants were, and children below 5 years. It is understandable that the small sample size may not allow to separately present each of the injury type for all age categories, but it could have grouped into a broad category on “injury” as it was done in NDHS 2006. This would have enabled a comparison of child injury levels for the past 15 years.
Above all, the report has engaged public health community at largest scale than ever and it will be of interest to sociologists and scholars/researchers of other disciplines.
Dr Puspa Raj Pant is a researcher affiliated to the West of England Bristol University (UK) and Nexus Institute for Research & Innovation (NIRI), Nepal.