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Lightning Injury Is a Disaster in Bangladesh?

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Lightning Injury Is a Disaster in Bangladesh? F1000Research 2016, 5:2931 Last updated: 01 FEB 2017 RESEARCH ARTICLE Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs [version 1; referees: 3 approved, 1 approved with reservations] Animesh Biswas1, Koustuv Dalal2, Jahangir Hossain1, Kamran Ul Baset1, 1 1 Fazlur Rahman , Saidur Rahman Mashreky 1Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh 2School of Health Sciences, Örebro University, Örebro, Sweden v1 First published: 29 Dec 2016, 5:2931 (doi: 10.12688/f1000research.9537.1) Open Peer Review Latest published: 29 Dec 2016, 5:2931 (doi: 10.12688/f1000research.9537.1) Referee Status: Abstract Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are Invited Referees most affected by lightning. Bangladesh is one of the countries at particular risk, 1 2 3 4 with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still version 1 unknown and therefore this study investigates the epidemiology of lightning published report report report report injuries in Bangladesh, using a national representative sample. 29 Dec 2016 Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly 1 Mohammad Delwer Hossain Hawlader, selected districts. In the survey, a total of 819,429 respondents from 171,336 North South University Bangladesh households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international 2 Aziz Rahman , La Trobe University newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016. Australia Results: The annual mortality rate was 3.661 (95% CI 0.9313–9.964) per 3 Kazi Md Noor-ul Ferdous, Dhaka Shishu 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 (Children) Hospital Bangladesh, Ashfaq people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased Nabi, Bangladesh Institute of Child Health risk compared with females (RR 1.46, 95% CI 1.06–1.99). Rural populations Bangladesh were more vulnerable, with a 8.73 times higher risk, than urban populations Kh. Ahasanul Kabir, Dhaka Shishu (RR 8.73, 95% CI 5.13–14.86). About 43% of injuries occurred between 12 (Children) Hospital Bangladesh noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh. 4 Mithila Faruque, Bangladesh University of Conclusions: The current study indicates that lightning injuries are a public Health Sciences (BUHS) Bangladesh health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden Discuss this article in Bangladesh. Comments (0) F1000Research Page 1 of 11 F1000Research 2016, 5:2931 Last updated: 01 FEB 2017 Corresponding author: Animesh Biswas ([email protected]) How to cite this article: Biswas A, Dalal K, Hossain J et al. Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs [version 1; referees: 3 approved, 1 approved with reservations] F1000Research 2016, 5:2931 (doi: 10.12688/f1000research.9537.1) Copyright: © 2016 Biswas A et al. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Grant information: The BHIS was funded by UNICEF, Bangladesh. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: No competing interests were disclosed. First published: 29 Dec 2016, 5:2931 (doi: 10.12688/f1000research.9537.1) F1000Research Page 2 of 11 F1000Research 2016, 5:2931 Last updated: 01 FEB 2017 Introduction international media websites was retrieved and reviewed (Table 1). Lightning injury is a global public health problem representing Qualitative data related to lightning injury in Bangladesh were col- the leading cause of weather-related death after tornadoes, flash lected to explore the magnitude of lightning injuries in Bangladesh floods and hurricanes. The incidence rates of lightning injury are during 13–15 May 2016. probably higher than registered since there is no referral and information centre where data are collected and stored1. Quantitative method Lightning strikes the earth more than 100 times each second, total- A large cross-sectional study was conducted during January ling 8 million times every day. An estimated 50,000 thunderstorms to December 2003 in twelve randomly selected districts in occur each day, causing fires and injuries2. Worldwide, mortality Bangladesh and also in Dhaka Metropolitan City. Multi-stage from lightning is estimated at between 0.2 and 1.7 deaths/1,000,000 cluster sampling was employed to select 171,366 households people, affecting mainly the young and people who work (88,380 in rural areas and 45,183 in urban areas in the twelve outdoors3,4. Lightning injuries are the highest during the summer districts, and 37,803 in Dhaka Metropolitan City). The current months. However, in some countries such as India and Vietnam, study is part of this larger study. Each district consists of several lightning mostly occurs during the rainy season5,6. Lightning inju- upazilas (subdistricts). From each district, one upazila was cho- ries and related deaths mostly affect individuals who work outside sen. The upazilas contain smaller units called “union”. A union is or participate in outdoor recreational activities. Worldwide, men the lowest administrative unit, with a population of approximately are five times more likely than women to be struck by lightning3,7. 20,000. In this study, two unions from each of the upazilas were The most vulnerable age for lightning injury is estimated to be selected. Similarly, in urban settings, the mohalla is the lowest between 10 and 29 years3. unit of the City Corporation. Systemic random sampling was per- formed of a certain number of households in selected mohallas. Lightning injuries cause high mortality and significant long- term morbidity. A previous study reports that in Bangladesh, the Prior to data collection, 48 trained interviewers had visited the incidence of lightning fatalities is 0.9 per 1,000,000 people per selected households and explained the study objectives and ethi- year, which is higher than in high-income countries6. In 2016, the cal issues. They then conducted the questionnaire survey. As well, country had a lightning event with several strikes, causing 81 deaths, 819,429 people of all age groups from 171,336 households in those which is particularly high. However, underreporting of lightning twelve districts were selected and interviewed using face-to-face strikes is common, as the majority of lightning occurs in rural interviews. areas. People used to seek treatment from the local village doc- tor, pharmacist or traditional healer rather than seeking health care Persons who were injured by lightning and received treatment from government facilities, unless the community health provider or who were unable to perform their usual activities for at least failed to manage the injuries. Moreover, only a few cases are 3 days because of lightning injury were enrolled in the study. reported to the police and government hospital records only have We also interviewed the next of kin of people who had died from information on those who seek treatment. Therefore, studying the lightning injuries. About 2.7% of households could not be inter- epidemiology of lightning injuries in Bangladesh is very important. viewed because of unavailability of respondents in the households. This study explores the epidemiology of lightning injury, using A total of 166,766 households were included in the study. The data from a nationwide survey and newspaper reports on lightning methodology has been described elsewhere8,9. deaths on 13–15 May 2016. Review of the newspapers and electronic media subjected Methods to content analysis The study was a mixed method study using both quantitative and Daily national popular Bangladeshi and English-language elec- qualitative data. A cross-sectional study was conducted to under- tronic newspapers were searched for reports on lightning injuries. stand the epidemiology of the lightning injuries in Bangladesh Two Bengali and three English-language national newspapers (see below). In addition, we searched two of the most popular which are widely read in Bangladesh were selected. In addition, Bengali and another three national, English-language newspapers we searched international online news sites. Three international in Bangladesh. Furthermore, lightning news reported in another English-language newspapers and three purposively selected three international English-language daily newspapers and on three international online news sites were also included in the search. Table 1. National and international newspapers and electronic media used in the data search. Type of newspapers/electronic media Name of the newspapers/electronic media National Bengali newspapers Prothom Alo, The Samakal National, English-language
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