Fatal and non-fatal injuries due to intentional explosions in Nepal, 2008-2011: analysis of surveillance data

Abstract

BackgroundNepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and to describe time trends and epidemiologic patterns for these events.MethodsWe analyzed surveillance data on fatal and non-fatal injuries due to intentional explosions in Nepal that occurred between 1 January 2008 and 31 December 2011. The case definition included casualties injured or killed by explosive devices knowingly activated by an individual or a group of individuals with the intent to harm, hurt or terrorize. Data were collected through media-based and active community-based surveillance.ResultsAnalysis included 437 casualties injured or killed in 131 intentional explosion incidents. A decrease in the number of incidents and casualties between January 2008 and June 2009 was followed by a pronounced increase between July 2010 and June 2011. Eighty-four (19.2%) casualties were among females and 40 (9.2%) were among children under 18 years of age. Fifty-nine (45.3%) incidents involved one casualty, 47 (35.9%) involved 2 to 4 casualties, and 6 involved more than 10 casualties. The overall case-fatality ratio was 7.8%. The highest numbers of incidents occurred in streets or at crossroads, in victims’ homes, and in shops or markets. Incidents on buses and near stadiums claimed the highest numbers of casualties per incident. Socket, sutali, and pressure cooker bombs caused the highest numbers of incidents.ConclusionsIntentional explosion incidents still pose a threat to the civilian population of Nepal. Most incidents are caused by small homemade explosive devices and occur in public places, and males aged 20 to 39 account for a plurality of casualties. Stakeholders addressing the explosive device problem in Nepal should continue to use surveillance data to plan interventions.

Deaths due to Intentional Explosions in Selected Governorates of Iraq from 2010 to 2013: Prospective Surveillance

“…25 Those injured or killed by intentional explosions in Nepal (2008–2011) were also disproportionately male, with males representing 78.0% of the 437 casualties. 26 Among males, the data suggest that explosions disproportionately affected those 20–39 years of age; this group accounted for 61.5% of deaths among those with known age in this study, despite accounting for only 15.6% of the Iraqi population. 21 While global estimates have limited age disaggregated data, available studies have consistently shown this age group to be at increased risk.…”

“…An increasing number of injuries also occurred at workplaces. Compared with explosions occurring on roads and other open-air spaces, those in enclosed spaces have been found to result in a higher number of those injured and increased severity and mortality 27 28 In open-air explosions, the explosion is likely to be fatal only if the victims are in close proximity to the device when it detonates 27 …”

Blast injuries in children: a mixed-methods narrative review

“…A wide range of paediatric mortality is reported following mine strikes, ranging from 4% from 46% 24–29 31 32 55 56. Shuker57 suggested that approximately half of paediatric victims die within minutes of mine explosion, likely due to penetrating head injury, and catastrophic haemorrhage causing non-survivable injuries, in keeping with adult literature 53 54.…”

“…Similarly, prevalence of lower limb injuries shows variation between studies on blast affecting 25%–86% of children,19 22–24 35 45 46 59 65 68 69 82 with landmine strikes particularly associated with lower limb injury22–24 ; 20%–29% required operative amputations, normally at the transtibial plane 23 34 65. Lower limb injuries were less common in children compared with adults,25 27–29 56 with incidence lowest in 0–3 year olds,16 while increasing in adolescents to mirror adults 25. Traumatic amputations were less frequent compared with the upper limb, occurring in 14%–35% of lower limb injuries 24 35 69…”

Maxillofacial Injury due to Pressure Cooker Explosion in a 13-year-old child: Surpassing The Obvious

“…2 Injuries due to the improvised explosive devices (IED) were also common during the 13 years conflict period in Nepal and still prevail. [5][6][7] The most common form of IED included Socket, Sutali, and Pressure cooker bombs. 5 Literature regarding accidental domestic pressure cooker injuries mostly include ocular injuries, penetrating facial injuries and traumatic brain injuries.…”