The epidemiology of moderate and severe injuries in a Nicaraguan community: a household-based survey.

Although injuries constitute a major public health problem worldwide, the magnitude and nature of this problem is difficult to establish in low-income settings due to the lack of valid and representative data. In Nicaragua, several parallel studies have been carried out attempting to assess levels and patterns of injury using various sources of information. The objective of this study was to describe the magnitude and profile of moderate and severe injuries in a well-defined community in Nicaragua. The study was conducted using a household-based survey design. Randomized cluster sampling provided information from 10,797 households (63,886 inhabitants). The outcomes included fatal and non-fatal injuries registered during a recall period of 6 weeks. Seven percent of all injuries were classified as moderate or severe. The estimated annual incidence rate of moderate/severe injuries was 27.6 per 1000 [95% confidence intervals (CI): 26.4-29.2], while the mortality and impairment rates were 108.9 (95% CI: 83.5-134.4) and 95.3 (95% CI: 71.4-119.2) per 100,000 inhabitants, respectively. Home and traffic areas were the main environments associated with injury occurrence. The most affected groups were the elderly, children and males. No differences were found between urban and rural areas. Only 9% of all cases, including minor injuries, sought hospital treatment. The main causes of non-fatal injuries were falls, traffic and cuts, whereas fatalities were largely associated with intentional injuries. For every death due to injury, there was one permanent disability, 25 moderate/severe injuries and 354 minor injuries. This study provides a broad description of injury magnitudes and patterns in a defined Nicaraguan community, and demonstrates the aggregate injury pyramid of the same community. It also identifies the issue of severity and concludes with a recommendation to apply different criteria of severity. Our results support the call for a careful evaluation of injury data sources and severity scores when planning injury prevention programmes.