The burden of injuries in Nepal: findings from the NIHR Global Health Research Group

Workstream 1 (engaging stakeholders)

Three primary publications and three related publications were produced under this workstream. A description of the aim and main findings of the three primary publications is followed by a description of the three related publications.

1. Injuries in Nepal: a neglected public health burden and ways forward 20

   This editorial was published early in our award with the aim to inform other academics in Nepal that we had established the NIRC and that our intention was to strengthen the evidence available to inform policy and practice change. We highlighted the preventability of unintentional injuries, how injuries occur unequally across society and the current burden of injuries on the health-care system. To reach our intended audience, the editorial was published in one of the well-known Nepali medical journals.

2. Views of professional stakeholders on readiness for a safe road system in Nepal; an exploratory qualitative study 21

   This study was completed early in our programme and designed to be small scale and exploratory in nature so that it could inform future road safety research activities. We aimed to explore the perspectives of diverse professionals whose jobs had the potential to influence the development of a safe road system in Nepal. Semistructured interviews with eight key informants were analysed thematically. The three themes identified were: the need to modify the behaviour of road users; the role of road planning, construction and maintenance; and the importance of good governance of roads. Areas for further inquiry and action were identified. Evidence from countries that have some of the lowest crash rates in the world indicates that creating a road system where the environment promotes safer driving and which is forgiving when drivers make mistakes is more effective in reducing road injuries and deaths than changing individual driver behaviour. 9 This illustrates the cultural shift necessary in Nepal from an assumption that individual behaviour change and improvements in an individual’s knowledge are more effective than environmental and legislative change. The participants acknowledged that there is already legislation in Nepal that could make the roads safer, but that this is often not implemented or enforced.

3. Identification of research priorities for suicide prevention in Nepal: a Delphi study 22

   The initial 3-year funding for our NIHR GHRG award focused on unintentional injuries. During the first 2 years of our award, stakeholder feedback, secondary analysis of routine injury data and our own primary data collection indicated the significant and largely unacknowledged burden of suicide and self-harm in Nepal. When bidding for a further year of funding, we argued that a study to better understand the research priorities for suicide prevention in Nepal was justified. We conducted a Delphi study involving 42 participants including suicide prevention experts (psychiatrists, psychologists, psychiatric nurses, researchers and advocates) and individuals and families with experience of attempted suicide. Individual interviews yielded potential research questions which were then subjected to two rounds of ranking for importance. Prioritised research questions fell into three groups: studies to inform a better understanding of the epidemiology of suicide in Nepal; studies to strengthen evidence-based practice in prevention and response; and studies to better understand the needs of those at risk of self-harm and their families.

The related publications are summarised below.

1. Engaging Nepali journalists in good road safety reporting: evaluation of the impact of training workshops 23

   In many low-income countries, Nepal included, media reports of road traffic crashes tend to be sensationalist, focusing on the number of dead or injured and frequently failing to provide information on their cause or preventability. Recognising journalists as stakeholders with the ability to influence public opinions and perceptions of safety, the World Health Organization (WHO) has developed two resources for journalists: a good reporting guide and a set of story ideas to encourage journalists to consider responsible reporting of crashes and injuries. Working with the WHO Nepal office, we were able to get these resources translated into Nepali and subsequently held three workshops for journalists from across a range of different media formats (print, radio, television and internet). Thirty-one journalists attended at least one of three workshops that were held over 9 months. Additional funding from UWE facilitated an evaluation of the workshops using a survey and a critical review of participating journalists’ outputs before and after participation. Participants responded positively to the opportunity to participate in the workshops, and there was an increase in the use of story ideas subsequent to attendance.

2. Nuancing the need for speed; temporal health system strengthening in low-income countries 24

   This editorial was written by authors from NIHR GHRGs with a focus on injuries who met at a NIHR meeting early in 2019. The paper discusses the multiple factors that influence the ability to deliver timely quality care to patients experiencing trauma in low-resource settings. It describes how a robust understanding of the context (social, political, historical, cultural) is as important as an understanding of the underlying health-care system to generate improvements in health outcomes.

   A third related publication reporting a Delphi study to identify the research priorities for road safety in Nepal is described in Related work.

Workstream 2: evidence through data

Workstream 3: effective and cost-effective interventions

Injuries on the road

Our research found that the current evidence base for road safety in Nepal is poor,25 with much of the evidence based on small or single-hospital case series or on traffic police data. A review of policy and legislation supporting injury prevention in Nepal41 showed that only a proportion of WHO-recommended interventions are currently supported by legislation and that even where legislation exists, it is frequently not fully implemented. An analysis of the economic burden of RTIs found that the costs to the country had increased by more than threefold between 2007 and 2016. 35 Typically, road safety decision-making in Nepal depends on data from the traffic police. Our studies have shown that, while valuable to indicate which types of road users are at greatest risk of being involved in a collision,37 by engaging local shopkeepers to record road crashes in their community, we illustrated the potential degree of under-reporting of crashes to the police40 and that the current systems do not facilitate accurate coding. 28 Our qualitative studies showed that communities,45 commercial drivers46 and adolescents44 all perceive their road environment to be dangerous and want action to address this. Interviews with professionals with the authority to improve road safety21 indicated a tendency to blame individuals’ road behaviour, rather than recognising that environmental and legislative change to promote a road system that is forgiving of individual error has been shown to lead to the greatest reductions in RTIs and deaths.

First response to injuries

Our studies exploring the post-crash care system in Nepal showed that there is a lack of co-ordination of first-response provider services, together with poor standardisation of training for first responders and first aiders, resulting in variable care provided at the scene of a crash. 47 Training the traffic police in first response to RTIs is feasible,48 as is training members of the public to provide first aid to crash victims,49 but a major barrier is the lack of a Good Samaritan Law which protects first aiders, first responders and emergency department staff from blame or prosecution should the injured patient have a poor outcome. Interviews with current ambulance staff highlighted significant challenges when trying to handover RTI patients to hospital emergency department staff. Issues included an apparent lack of understanding of each other’s roles, differing expectations of care provision, and reluctance to accept patients when ability to pay cannot be clarified. 29

Injuries at home and work

Our studies enhance our understanding of the epidemiology of injuries sustained at home and work. Our systematic review of publications reporting injuries in Nepal25 illustrated how current evidence reporting the epidemiology of injuries was dependent on studies at high risk of bias (predominantly case series). We also observed that inequalities in injury occurrence were seldom reported except to report injuries by age and sex. Case series reporting episodes of suicide and of poisoning were relatively common but may have just reflected researcher interests rather than reflecting the true burden of harm. We conducted a household survey33 covering over 17,500 residents which illustrated inequalities by income level (those in the lowest income categories experiencing greater numbers of injuries) and by ethnic group. A concurrent qualitative study43 showed that injuries were largely seen as occurring by chance and that individuals had little agency or access to safety equipment or systems to keep themselves safe. While there was a tendency to blame individuals for being ‘careless’, there was also an acknowledgement that the government had a responsibility to enact and enforce safety legislation. A hospital surveillance study illustrated that collecting injury surveillance data via emergency departments was feasible with adequate staffing and that such systems were perceived as valuable to clinicians and managers as well as epidemiologists. Over the course of a year, more than 30% of attendances were due to injuries, predominantly falls, RTIs and animal-related injuries (often bites by dogs). 31,32 We noted that 5.5% of attendances were for self-harm, particularly pesticide/insecticide/rodenticide self-poisoning or hanging. This finding, together with our study showing that two-thirds of community-based fatal injuries were due to suicide,34 led us to complete a Delphi study of research priorities for suicide prevention. 22 This study identified that future self-harm research should focus on a better understanding of the epidemiology of suicide in Nepal, evidence-based practice in prevention and response, and research to understand the needs of those at risk of suicide and the needs of their families.

Injury data collection systems

A qualitative study that mapped injury data across four routine data systems improved our understanding of the strengths and limitations of routinely available injury data. 28 This study reinforced our concerns regarding the completeness and coding of injury data that had been suggested through our analysis of HMIS data27 and hospital31,32 and community32 surveillance studies. At present, any intervention studies to reduce injuries are going to need to include their own data collection systems, as routine data are not accurate or complete enough to monitor the effectiveness of any intervention.

Changes of government/federalisation

During our NIHR GHRG award (2017–21), there was significant reform to the structures of government in Nepal. The constitution of Nepal was enacted in 2018, 9 months after our award commenced. The constitution facilitated a move away from a unitary government to a federalised republic with three levels: a single federal government, 7 provincial governments and 753 local governments. 50 Provinces now have their own legislature, and local governments have their own elected representatives and governing body. Devolution of power and budgets to provinces and local governments, and appointments of representatives to posts, have been incremental since 2018. Delegation of responsibilities has been slow, though the priority area was the delivery of universal health coverage and the provision of basic health care services. The impact on our studies has been modest. We have engaged with local government where appropriate and feasible, particularly to gain permission for studies at the local level. Most legislation with the potential to impact on injury prevention was written during the period of unitary government and has yet to be updated to reflect the federalised system. Therefore, our advocacy to date has primarily been at the federal level of government. Budgets and remits are now more clearly understood. In the future, we will work more closely with local governments to facilitate local change and develop evidence and guidance with the potential to be rolled out widely across local government areas. We will continue to advocate centrally, specifically for legislative change and enforcement of existing legislation.

Ethnic groups

Nepal is a country with many ethnic groups, including those descended from Chinese and Indian heritage. The epidemiology of injuries is known to be socially patterned, and through our systematic review of studies reporting injuries in Nepal25 we found no reporting of injury occurrence by ethnic group. During our studies we captured ethnic group when collecting demographic data, though this required us to include 102 ethnic groups on our data collection form. Analysis of so many ethnic groups required collation of groups into categories. We identified different classification systems used by different organisations, and through discussion agreed to report our ethnic group data using the six-category system used by the Ministry of Health and Population in its guidelines for the reporting of HMIS data. We were able to show that injury occurrence was more frequent in the ethnic group categories with the lowest socioeconomic status. We also noted that the classification system used included a mixture of castes, ethnic groups and religions. In Nepal, some ethnic groups are associated with specific occupations, and different occupations are associated with different levels of income and risk of injury. Therefore, a comprehensive understanding of the association between ethnicity and injury is complex and fell outside the scope of our award.

COVID-19

The COVID-19 pandemic hit when we were 2 years 8 months into our 4-year programme of research. We were fortunate that most of the data for studies agreed in our original 3-year award had already been collected and were being analysed. Our hospital surveillance study was required to close early, 1 week before the completion of a year of injury surveillance, and the collection of the second year of traffic police RTI data needed to be delayed until the initial lockdowns were over. Following a period of transition, as all researchers started to work from home, we were able to continue with our analyses remotely. We were fortunate that our researchers had access to good internet connections, making remote working feasible. At the time the pandemic started, we were preparing protocols and ethics applications for four studies to be conducted during a 1-year extension period. One of these new studies was no longer feasible; therefore, it was replaced with an alternative study. The other three studies were all qualitative and we redesigned them so that focus groups were replaced by one-to-one interviews that could occur remotely (by phone or video call) rather than face to face. Dissemination activities were significantly delayed until late in 2021 when it was feasible to travel to present findings to communities, practitioners and decision-makers.

Partner engagement

The primary strategic partner in the NIHR GHRG award was KMC. We worked towards an equitable partnership with KMC and created a team culture where individual voices could be heard and respected. Strategic decisions were made together and discussed at monthly Project Delivery Group meetings which were chaired by one of the co-directors. Online meetings took place at 15 or 45 minutes past the hour in the UK, so they occurred on the hour or half hour in Nepal. We developed the NIRC website so that content was in both Nepali and in English where feasible. To develop stronger links between UWE and KMC, Professor Sunil Kumar Joshi was invited to be a Visiting Professor at UWE, Bristol and Professor Julie Mytton was made a Visiting Professor at KMC. All component studies in our programme of research had a Nepali lead who was based either in Kathmandu or in the UK. Mother and Infant Research Activities (MIRA), a research NGO, were a partner who facilitated much of our field research. We worked with two other NGOs: the Nepal Red Cross Society and Swatantrata Abhiyan. In the spirit of working in equitable partnerships, we invited them to join our programme as research partners. Neither organisation had previously worked as a research partner, and this generated additional work for both parties that did not necessarily enhance the outputs. Engaging them as stakeholders in future collaborations may enable them to contribute in a way that they are more used to and may be less onerous administratively.

Stakeholder engagement

To establish our stakeholder network, we held a launch event on 6 September 2018 attended by over 100 stakeholders, including representatives of the Ministry of Health and Population, the Parliamentary Committee for Health and Education, the National Planning Commission, Department of Health Sciences, WHO Nepal Office, Department for International Development Nepal, KMC and Kathmandu University. We held two injury research events to raise awareness of the burden of injuries and the potential for prevention and to disseminate findings of our research. The first event, in April 2019, was attended by 135 participants and was opened with keynote speakers from the Health Emergency and Disaster Management Unit of the Ministry of Health and Population and the Department of Roads. It was attended by six members of our International Steering Committee. The second event, held online due to the COVID-19 pandemic, was in September 2021 and attended by 76 participants. Ministers from the Ministries of Health and Transport in the Government of Nepal attended both events, together with representatives of NGOs and advocacy organisations.

In addition to having them attend our launch event and injury research showcase events, we engaged with policy-makers through multiple routes. We established two stakeholder engagement groups: a Road Danger Reduction Forum and a First Response Reference Group. The purpose of these groups was to gain understanding of the local and national context, to provide a forum for advice to improve the ability to deliver our studies and to feed back after study completion to improve the likelihood of impact. At the first meeting of these two fora, we completed a rapid prioritisation process to identify a ranked list of issues to inform the development of our studies. We invited policy-makers and those with awareness of the provider landscape to participate. We successfully advocated for the establishment of a cross-governmental National Advisory Committee for Injury Prevention and Control at the end of 2018. In February 2020, Mytton, Joshi and Pant attended the WHO third Global Ministerial Conference on Road Safety in Stockholm and supported the Minister for Transport from Nepal and his delegation. Swatantrata Abhiyan organised a preconference briefing event in Nepal on 6 February 2020, which NIRC supported and to which government officials participating in the conference were invited. At a local level, we engaged with municipality mayors in the areas where we conducted fieldwork. Mayors gave us permission to conduct our studies within their jurisdiction, and we disseminated findings back to them at the end of the studies to support them to make strategic decisions at a local government level.

In 2020, Khadka attended a workshop on road safety organised by the World Bank, and Gautam participated in the second Kathmandu Road Safety Film Festival organised by Safe School Zone Nepal, the National Road Safety Alliance and the Nepal Automobiles Association. In May 2020, Pant was a panellist in an online event organised by the Brain Gain Centre, the Nepal Government’s initiative for diaspora engagement, and in June 2020 moderated a webinar hosted by the Nepal Road Safety Alliance on safer mobility during COVID-19, involving a Member of the Nepal National Assembly. The NIRC participated in a consultation event to identify research gaps and views on the theme of ‘disability and safety’ that was attended by the Spinal Injury Rehabilitation Centre, the National Federation of the Disabled Nepal (NFDN) and government officials working on disability from the Department of Health Services (Ministry of Health and Population).

We collaborated with educational institutions in Nepal throughout the award. We developed and ran two interprofessional short courses on road safety, where we invited students from different disciplines and different higher education institutions across Kathmandu to develop their knowledge and skills in road safety together, emphasising the necessity for cross-sector collaboration. We developed a collaboration with the Kathmandu School of Arts (Kathmandu University) to develop injury prevention messages for the public. Dr Sudhamshu Dahal and a mass communication student at the School of Arts supported the delivery and evaluation of the workshops with journalists and our subsequent publication. 23 We collaborated with Professor Subedi at Tribhuvan University to develop a workshop and qualitative study to explore the conceptualisation of injuries in Nepali society.

Economy

Through funding from the NIHR GHRG award, supplemented by other external grant income, we grew the team of researchers at the NIRC. All appointments were considered successful, and we retained all staff through to the end of the award. Rates of pay for the research team were relatively good for Nepal, and this was reflected in the high-calibre candidates who applied for our advertised positions.

Our study of the economic burden of RTIs in Nepal35 showed the increasing and significant financial impact of these injuries on the Nepali economy. This impact has increased in real terms since the previous estimates were published using data from the 2006 to 2007 financial year. The modelling used to underpin the new published estimate needed to use proxy measures for several variables and therefore may underestimate the true impact of RTIs on the country.

Efficiency

The cultural norm for evidence dissemination in Nepal would be through face-to-face meetings and events; failure to do so may risk being considered disrespectful to those in decision-making positions. The COVID-19 pandemic significantly limited our ability to meet with people, and a shift to online dissemination was both necessary and swift. We worked hard to establish and extend networks of stakeholders and senior decision-makers and to share with them, primarily electronically, the evidence we have generated. This appears to have been largely successful, as evidenced by the fact that Professor Joshi is now quite frequently invited to attend meetings with decision-makers and offer his expertise.

Effectiveness

Our research has been epidemiological, qualitative or policy-focused, and our programme has not included the evaluation of effectiveness or cost-effectiveness of interventions. Our outputs are enabling Professor Joshi to have conversations with decision-makers regarding evidence-based policy, the need for complete and well-coded data and multiagency approaches to injury prevention. We completed a study to examine the feasibility of delivering first aid training to traffic police officers which indicated that this intervention could potentially be formally evaluated using an experimental design in the future.

Equity

We demonstrated the ability to recruit a gender-balanced team of early-career researchers through this award (see also Equality, diversity and inclusion). We showed that previously published literature on injuries in Nepal had rarely explored inequalities in injury occurrence and we therefore prioritised this during the epidemiological studies we completed, particularly with regard to inequalities by ethnic group.

Environmental impact

Our GHRG award did not have any direct impacts upon the environment. The rapidly increasing vehicle fleet is significantly contributing to deteriorating air quality, particularly in Kathmandu Valley, where Kathmandu City is now considered to have some of the highest air pollution levels in the world. Interventions to reduce the risk of RTIs – such as improved traffic management, legislation to improve the roadworthiness of vehicles and road infrastructure changes that separate vehicles from other road users – all have the potential to contribute to improved air quality.

Road safety

1. Research to address the gap in translating evidence into legislation that is then effectively implemented. Examples include the lack of enforcement of the use of helmets for pillion passengers on motorcycles or of seatbelts for passengers in vehicles.

2. Research to reduce the risk of injury for those most vulnerable on the roads, including pedestrians, those using public transport and those travelling by motorcycle.

First response to injury

1. Research to support the development of an effective first-response system across Nepal.

2. Research that leads to the standardisation of effective first-response care. Examples include the development of effective interprofessional working between prehospital and emergency department care providers, and the establishment of legislation that protects from prosecution those trying to support injured patients.

Staying safe at home and work

1. Research that further describes the epidemiology of injuries occurring at home and at work and identification of the risk factors that could be addressed. Examples include reducing the incidence of dog bites, and consequent rabies risk.

2. The development of either targeted or universal interventions that address risk factors for injuries at home or at work.

Injury data systems

1. The establishment of injury surveillance, either through surveillance systems or through improved recording of routine health care use, to better understand injury trends and enable the monitoring of interventions to prevent injuries.

2. Research to understand the association between ethnic group and injury incidence, exploring the interplay of caste and occupation, thereby identifying vulnerable groups suitable for targeted action.

Suicide and self-harm

1. Research to understand the needs of those at risk of self-harm and their families.

2. Research to understand the epidemiology of suicide in Nepal.

3. Studies to strengthen culturally competent and evidence-based approaches to suicide prevention and response.

Publications

Joshi SK, Pant PR, Banstola A, Bhatta S, Mytton J. Injuries in Nepal: a neglected public health burden and ways forward. Kathmandu Univ Med J 2018;15. https://doi.org/10.17613/9fw0-ta32

Bashford T, Joannides A, Phuyal K, Bhatta S, Mytton J, Harrison R, et al. Nuancing the need for speed: temporal health system strengthening in low-income countries. BMJ Glob Health 2019;4(4):e001816. https://doi.org/10.1136/bmjgh-2019-001816

Mytton JA, Bhatta S, Thorne M, Pant PR. Understanding the burden of injuries in Nepal: a systematic review of published studies. Cogent Med 2019;6(1):1673654. https://doi.org/10.1080/2331205X.2019.1673654

Banstola A, Kigozi J, Barton P, Mytton J. Economic burden of road traffic injuries in Nepal. Int J Environ Res Public Health 2020;17(12):4571. https://doi.org/10.3390/ijerph17124571

Magnus D, Bhatta S, Mytton J, Joshi E, Bird EL, Bhatta S, et al. Establishing injury surveillance in emergency departments in Nepal: protocol for mixed methods prospective study. BMC Health Serv Res 2020;20(1):433. https://doi.org/10.1186/s12913-020-05280-9

Pant PR, Banstola A, Bhatta S, Mytton JA, Acharya D, Bhattarai S, et al. Burden of injuries in Nepal, 1990–2017: findings from the Global Burden of Disease Study 2017. Inj Prev 2020;26(Suppl. 2):i57–66. https://doi.org/10.1136/injuryprev-2019-043309

Banstola A, Smart G, Raut R, Ghimire KP, Pant PR, Joshi P, et al. State of post-injury first response systems in Nepal – a nationwide survey. Front Publ Health 2021;9. https://doi.org/10.3389/fpubh.2021.607127

Bhatta S, Magnus D, Mytton J, Joshi E, Bhatta S, Adhikari D, et al. The epidemiology of injuries in adults in Nepal: findings from a hospital-based injury surveillance study. Int J Environ Res Publ Health 2021;18(23):12701. https://doi.org/10.3390/ijerph182312701

Bhatta S, Mytton J, Joshi E, Bhatta S, Adhikari D, Manandhar SR, et al. Development and evaluation of a community surveillance method for estimating deaths due to injuries in rural Nepal. Int J Environ Res Public Health 2021;18(17):8912. https://doi.org/10.3390/ijerph18178912

Gautam P, Mytton JA, Joshi SK, Pilkington P. Adolescent’s perception of road risk on their routes to school in Makwanpur, Nepal; a qualitative study. J Transp Health 2021;20:101009. https://doi.org/10.1016/j.jth.2021.101009

Joshi E, Bhatta S, Deave T, Mytton J, Adhikari D, Manandhar SR, et al. Perceptions of injury risk in the home and workplace in Nepal: a qualitative study. BMJ Open 2021;11(3):e044273. https://doi.org/10.1136/bmjopen-2020-044273

Khadka A, Gautam P, Joshi E, Pilkington P, Parkin J, Joshi SK, et al. Road safety and heavy goods vehicle driving in LMICs: qualitative evidence from Nepal. J Transp Health 2021;23:101247. https://doi.org/10.1016/j.jth.2021.101247

Magnus D, Bhatta S, Mytton J, Joshi E, Bhatta S, Manandhar S, et al. Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance. Arch Dis Child 2021;106(11):1050–5. https://doi.org/10.1136/archdischild-2020-321198

Pant PR, Deave T, Banstola A, Bhatta S, Joshi E, Adhikari D, et al. Home-related and work-related injuries in Makwanpur district, Nepal: a household survey. Inj Prev 2021;27(5):450–5. https://doi.org/10.1136/injuryprev-2020-043986

Pant PR, Mytton J, Dharel MR, Dangi A, Rai WB, Joshi SK. The prevention of – and first response to – injuries in Nepal: a review of policies and legislation. Health Research Policy and Systems [Internet]. 2021 Apr 14 [cited 2023 May 19];19(1):65. Available from: https://doi.org/10.1186/s12961-021-00686-1

Bhatta S, Bhatta S, Mytton J, Joshi SK. Improving estimates of injury burden in Nepal: a qualitative study. J Nepal Health Res Council 2022;20(2). https://doi.org/10.33314/jnhrc.v20i02.3929

Joshi E, Bhatta S, Joshi SK, Mytton J. Identification of research priorities for suicide prevention in Nepal: a Delphi study. BMC Psychiatr 2022;22(1):429. https://doi.org/10.1186/s12888-022-04074-z

Joshi E, Gautam P, Khadka A, Pilkington P, Parkin J, Joshi SK, et al. Experience of living near a highway in Nepal: community perceptions of road dangers in Makwanpur district. J Transp Health 2022;24:101337. https://doi.org/10.1016/j.jth.2022.101337

Khadka A, Parkin J, Pilkington P, Joshi SK, Mytton J. Completeness of police reporting of traffic crashes in Nepal: evaluation using a community crash recording system. Traff Inj Prev 2022;23(2):79–84. https://doi.org/10.1080/15389588.2021.2012766

Pandey B, Khadka A, Joshi E, Joshi SK, Parkin J, Pilkington P, et al. Views of professional stakeholders on readiness for a safe road system in Nepal; an exploratory qualitative study. Int J Inj Contr Safe Promot 2022;29(2):217–25. https://doi.org/10.1080/17457300.2021.1983845

Pant PR, Rana P, Pradhan K, Joshi SK, Mytton J. Identifying research priorities for road safety in Nepal: a Delphi study. BMJ Open 2022;12(4):e059312. https://doi.org/10.1136/bmjopen-2021-059312

Smart G, Banstola A, Raut R, Ghimire K, Mytton J, Joshi E, et al. Post-crash first response by traffic police in Nepal: a feasibility study. Int J Environ Res Public Health 2022;19(14):8481. https://doi.org/10.3390/ijerph19148481

Pandey B, Banstola A, Smart G, Joshi SK, Mytton J. Barriers and facilitators to learning and using first aid skills for road traffic crash victims in Nepal: a qualitative study [published online ahead of print XXXX XX 2024] Global Health Res 2024. https://doi.org/10.3310/UTKW7640

Bhatta S, Pathak P, Khadka A, Parkin J, Pilkington P, Joshi SK, Mytton J. Injury risks for different road users in Nepal: a secondary analysis of routinely collected crash data [published online ahead of print XXXX XX 2024] Global Health Res 2024. https://doi.org/10.3310/DWTR9883

Amrit Banstola, Preeti Gautam, Gary Smart, Sunil Kumar Joshi and Julie Mytton.Banstola A, Gautam P, Smart G, Joshi SK, and Mytton J. Prehospital emergency care for trauma victims in Nepal: a mixed-methods study [published online ahead of print July 10 2024]. Global Health Res 2024. https://doi.org/10.3310/TMTG2437

Pandey B, Bray I, Joshi SK, Mytton JA. Utility of routine data reporting injuries requiring hospitalisation in Nepal: a secondary data analysis [published online ahead of print May 22 2024]. Global Health Res 2024. https://doi.org/10.3310/ATAE3098

Conference papers

Mytton J, Pant P, Ellis M, Baset K ul, Joshi SK. PW 1641 Establishing an injury research centre in Nepal; challenges and opportunities. Inj Prev 2018;24(Suppl. 2):A178–9. URL: https://injuryprevention.bmj.com/content/24/Suppl_2/A178.3 (accessed 19 May 2023).

Bhatta S, Magnus D, Mytton J, Adhikari D, Manandhar SR, Joshi E, et al. 5E.002 Feasibility of hospital-based injury surveillance in Nepal: a prospective study. Inj Prev 2021;27(Suppl. 2):A44–5. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A44.3 (accessed 19 May 2023).

Bhatta S, Mytton J, Adhikari D, Manandhar SR, Joshi E, Bhatta S, et al. P4.011 Community-level estimates of death due to injuries in Makwanpur district, Nepal. Inj Prev 2021;27(Suppl. 2):A70. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A70.2 (accessed 19 May 2023).

Deave T, Pant P, Manandhar SR, Adhikari D, Joshi E, Joshi S, et al. 3F.005 The epidemiology of home and workplace injuries in Nepal: a household survey. Inj Prev 2021;27(Suppl. 2):A28–9. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A28.4 (accessed 19 May 2023).

Gautam P, Mytton J, Pilkington P, Joshi S. 7A.001 Adolescent’s perception of road risk on their routes to school in Makwanpur, Nepal; a qualitative study. Inj Prev 2021;27(Suppl. 2):A55–6. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A55.3 (accessed 19 May 2023).

Khadka A, Gautam P, Joshi E, Pilkington P, Parkin J, Joshi S, et al. 3F.006 Truck drivers’ perception of road danger in Nepal: a qualitative study. Inj Prev 2021;27(Suppl. 2):A29. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A29.1 (accessed 19 May 2023).

Mytton J, Ellis M, Manhandar S, Joshi SK. 6C.004 Using capacity strengthening to enable effective injury prevention in Nepal. Inj Prev 2021;27(Suppl. 2):A52. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A52.3 (accessed 19 May 2023).

Mytton J, Joshi SK. Identification of research priorities for a safe systems approach to road safety in Nepal. Sixth Global Symposium on Health Systems Research. 13 January 2021 URL: www.youtube.com/watch?v=7gvi43STDi8&list=PL3-x3r4b6RFHOQPRTDPLzBCR2OMJ0CGN3&index=7 (accessed 14 December 2023).

Pandey B, Mytton J, Bray I, Joshi S. 5E.003 Epidemiology of injuries among in-patients in Nepal: a secondary data analysis. Inj Prev 2021;27(Suppl. 2):A45. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A45.1 (accessed 19 May 2023).

Pant PR, Dahal S, Krishnaswamy K, Joshi SK, Mytton J. 3C.006 Enabling journalists to contribute to the road safety system: experience from Nepal. Inj Prev 2021;27(Suppl. 2):A25. URL: https://injuryprevention.bmj.com/content/27/Suppl_2/A25.2 (accessed 23 May 2023).

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