Code sources at case in nvivo 12
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About 35,000 animal bites were reported through the Hospital Management Information System in 2017/18, of which 33,000 (94%) were dog bites. Stray dogs are very common in Nepal, and rabies is endemic. Snakebites are more common in warmer and wetter months, particularly in terai (plains) regions. Stings from wasps and bees mostly affect working-age farmers in rural Nepal. Many rural families keep domestic animals (e.g., buffalo, goats) and may be injured whilst tending them. In Nepal, about 83% of the population is dependent on agriculture and livestock farming for their livelihood, and they reside in rural areas. In such cases, clinical staff provided support to approach family members and supported in the data collection. Data collection with a family member of the deceased was also found to be challenging in the majority of fatal cases, because they were in grief over the loss of a loved one. Some of the patients were hesitant while answering questions about their caste, educational background, and use of any alcohol or drugs. A similar difficulty was found when approaching patients who were either drunk or aggressive. The main challenges reported by the participants were collecting the data during busy periods in the ED, in cases that required immediate referral to another hospital, and when there were no relatives or friends to provide information on behalf of severely injured or unconscious patients. Identified difficulties in collecting injury data: While we were successful in establishing a surveillance system and collecting injury data over a one-year period, the data collection presented some challenges. All data collection was conducted in the Nepali language. A standardised data collection form was developed from existing tools, adapted for the Nepal context, and piloted prior to data collection. The injury severity was classified as ‘minor’ (superficial injury such as bruises or cuts), ‘moderate’ (injures requiring skilled treatment), or ‘severe’ (injures requiring intensive management), depending on the level of requirement for skilled emergency care intervention. Data included the demographics of the patient and details of the injury event and outcome (date of injury, place of occurrence, activity at the time of injury, mechanism causing the injury, severity of the injury, and disposition). Data were collected using a questionnaire on handheld computers pre-installed with Research Electronic Data Capture (REDCap), Vanderbilt University, Nashville, TN, USA) software. To obtain consent and record the information, data collectors approached the patients (or caregivers, where appropriate) once clinical care had been provided.
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In Nepal, hospital-based injury surveillance is feasible, and rich injury data can be obtained by embedding data collectors in EDs. Most injured patients were discharged after treatment (80%) with 9.1% admitted to hospital, 8.1% transferred to other hospitals, and 2.1% died. The most common causes were road traffic accidents (32.8%), falls (25.4%), and animal/insect related injuries (20.1%). Males had twice the rate of ED presentation compared with females (40.4 vs. The median age of adult patients was 33 years (IQR 25–47). Most injuries (6434, 86%) were unintentional, with smaller proportions due to assault (616, 8.2%) and self-harm (408, 5.5%). Of patients with injuries, 7458 (73.4%) were adults aged 18 years and over. The total number of patients with injuries over one year was 10,154, representing 30.7% of all patients visiting the EDs. To evaluate the model’s sustainability, clinical leaders, senior managers, data collectors, and study coordinators were interviewed. Data were collected electronically for patients presenting to emergency departments (EDs) with injuries between April 2019 and March 2020. One-year prospective surveillance was conducted in two hospitals in Hetauda, Nepal. This study aimed to develop and evaluate a model of hospital-based injury surveillance and describe the epidemiology of injuries in adults.