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The need for public health interventions to prevent head and other injuries

HEALTH STANDARDS: The standards of health in Sri Lanka measured by any conventional guideline is very satisfactory. The rates of infant mortality at 14 per 1000 live births, and an expectation of life at birth of 73 years are indicators any developing county can be proud of. However, the existence of high levels of malnutrition, in spite of being a socialist democratic State and an increased incidents of traumatic injuries, both of which are easily preventable is disappointing.

The government's initiatives and attempts to avert malnutrition such as through school health programmes is commendable. All governments that come to power within the next 10-15 years should keep their obligation towards prevention of malnutrition among children and should continue with efficient and effective nutritional programmes for children. State support should always go into such programmes, especially as 25% of our population live below the poverty line.

Leaving nutrition to be taken care of by existing promrammes, today I focus on the need for Sri Lanka to have a comprehensive multi-sectoral public health programme towards preventing of injuries. I also take this opportunity to inform the public on some aspects of injuries that are most damaging - head injuries.

Traumatic injuries were the leading causes of hospitalization in Sri Lanka in 2002. They are usually the result of intentional and non intentional violence. Non intentional injuries are mostly accidental and road traffic accidents, burns, industrial accidents, falls from heights, sports injuries, war injuries and electrical injuries are some common examples. Intentional injuries follow assault, attempted homicide and attempted suicide.

While the public health directorate of the central Ministry of Health should take the leadership in the comprehensive multi-sectoral public health programme, there should be close links with other partners.

These include the Provincial Ministries of Health, World Health Organization, accident and emergency services, the judicial medical services, the traffic police, schools, NGOs involved in law and society as well as the legislature. The role of legislators with vision and intelligence is especially important (e.g. to implement a obligatory bicycle helmet law) for any public health strategy.

Leading five causes of Hospitalization in 2002.

Causes of Hospitalization Rate (%)

1. Traumatic injuries 14.5
2. Diseases of the respiratory system excluding diseases of upper respiratory tract, pneumonia and influenza 9.7
3. Viral diseases 6.4
4. Symptoms, signs and abnormal clinical and laboratory findings 6.3
5. Diseases of the gastro-intestinal tract 5.5

Source: Samarage, Ministry of Health

Most of the deaths following injuries are due to trauma on the head.

Fractures of the skull and crushing of the brain as well as bleeding inside the confined space within the skull causing compression of the brain often cause death. There are times when a person dies due to aspiration of blood while he or she is concussed following head injury.

As with many health problems, the best way to protect oneself from head injuries is to prevent them from happening in the first place.

The public can do many things to minimize head injuries. Wearing a seat belt when driving or travelling in a motor vehicle, buckling children in safety seats and stop driving after consuming alcohol or other medicines that cause drowsiness are effective.

Some of the deadly head injuries I have investigated as a practitioner of forensic medicine, have been of push bicyclists. Many of them could have saved their lives if they wore a helmet. But we have no culture in Sri Lanka of cyclists wearing helmets. I do not think that there are many manufacturers or importers of cyclist helmets (which are much lighter than motor cycle helmets) in Sri Lanka. it is up to the legislators to introduce this practice by making cycle helmet as well as to give incentives to local manufacturers.

Many people sustain injuries by falls at home, office or public places. Using a long grabbing tool to reach objects on high shelves, rather than climbing on unstable chairs, installing handrails on stairways, using safety gates at the top and bottom of staircases when young children are around, removing tripping hazards such as small rugs and loose electrical cords out of the way, putting grab bars in bathrooms where elders bathe, getting your eyes checked and wearing correct glasses if necessary, are simple ways of avoiding falls.

If a person you know has knocked his or her head somewhere and has no pain or other complaints, it is often not a case to worry.

However, if there is persistent headaches or neck pain, trouble with such mental tasks as remembering, concentrating, or decision making, slow thinking, speaking, acting or reading, getting lost or easily confused, mood changes, feeling light-headed, dizzy, or losing balance, having an urge to vomit, having an increased sensitivity to lights, sounds, or distractions, having blurred vision or ringing in the ears, it is advisable to see a doctor.

(The writer is Attorney-at-Law, Fellow, Harvard School of Public Health, Boston.)

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