ARTICLE INFO

Article Type

Original Research

Authors

Ganjparvar   Z. (1 )
Mousavi   B. (1 )
Khateri Sh.   (1 )
Soroush   M.R. (1 )
Masoumi   M. (* )
Shokoohi   H. (2 )






(* ) Janbazan Medical and Engineering Research Center, Tehran, Iran
(1 ) Janbazan Medical and Engineering Research Center, Tehran, Iran
(2 ) Emergency Medicine Department, George Washington University, Washington DC, USA

Correspondence

Article History

Received:  May  14, 2014
Accepted:  May 26, 2014
ePublished:  July 20, 2014

BRIEF TEXT


… [1-4]. The massive usage of landmines during Iran-Iraq war, resulted in injuries among near four thousand people [5, 6]. According to the results the studies, injuries due to landmines and unexploded ordnances include blindness, spinal cord injury, amputation, injury in head, neck, chest, abdomen, and PTSD [1, 5, … 6, 7-9]. … [10, 11]. Independency in personal activities and participate in entertainments are of the most important aims of rehabilitation programs for patients with amputations [12]. Environmental and social hindrances, personal factors (age, sex, educational level, and ability to adapt to existing conditions), level of amputation, and presence of comorbidities are effective to decrease the performance level of a person with amputation [12-16].

Non-declared

The aim of this study was to evaluate performance and dependence level in under 18-year victims of landmines and unexploded ordnances on activities of daily living (ADL).

This is a cross-sectional analytical descriptive study.

8 to 18 years old adolescents, injured by landmines and unexploded ordnances in Iran’s west border provinces including Kurdestan, Ilam, Kermanshah, West Azarbayjan, and Khuzistan, were studied in 2009-10 at Mazandaran and Tehran Provinces, Iran.

78 persons were selected, using census method.

Data were collected, using demographic and Barthel Index questionnaires. Demographic questionnaire contained questions on ‘age in the study and accident times’, ‘sex’, ‘province of residence’, ‘educational level’, ‘activity type at accident time’, ‘injury type’, and ‘injury percentage’. Barthel Index questionnaire was used to assess daily activity information. It assesses 10 domains of daily activities and scores them. Each domain takes 10 scores. Maximum given score is 100 and Minimum given score is zero, showing the highest and the lowest personal independence in daily activities, respectively. … [17] The 10 domains include ‘eating’, ‘bathing’, ‘personal hygiene’, ‘clothing’, ‘stool control’, ‘bladder control’, ‘using the toilet’, ‘transferring from bed to chair and vice versa’, ‘transportation and mobility on uneven surfaces’, and ‘using the stairs’ [18]. The questionnaire’s validity and reliability has been reported 90% [19]. SPSS 18 software was used to analyze data. Pearson Correlation test (in order to assess the correlation between age in the study and accident times and average daily activity score) and Independent-T test (in order to assess the correlation between sex, educational level, and injury percentage and average daily activity score) were used. In addition, One-way ANOVA test (in order to assess the correlation between the five border provinces and average activity score) was used.

The average age was 16.11±1.99years, and their average age at accident time was 8.23±3.12years. 67 persons (85.9%) were male. 29 persons (37.2%) were resident in Kurdestan Province. Amputations, blindness, and ear damage were of the most common injuries caused by landmines and unexploded ordnances. Injury length was between 2 and 15 years (Table 1). 26 persons (33.3%) were fully independent in their own daily activities and they were received the whole score (100). The daily activity average score was 84.28±17.22, totally. On ADL level assessment, the highest needs for help were in ‘clothing’ and ‘transportation and mobility on uneven surfaces’; and the lowest disabilities were in ‘eating’ and ‘stool control’ (Table 2). There was no significant correlation between age at the study and accident times and daily activity score. There was a significant difference between average scores of females (92.73±7.86) and males (83.13±17.83). There was a significant difference between average ADL scores of educating children (79.28±17.97), and non-educatin children (87.71±15.80). In addition, there was a significant difference between average ADL scores of children with 50% injury and more (78.63±16.70) and children with less than 50% injury (86.78±16.82). There was no significant correlation between the five border provinces and daily activity score.

… [20] According to the present study, there was no significant correlation between ages of the children injured by landmines and daily activity score. The more the children’s accident ages, the more the children’s problems [21]. … [22-26] Results of the present study showed that, females were more independent than males which is consistent with other similar studies [27, 28].

… [29-41]. More studies on injured children due to landmines and unexploded ordnances can address their problems [42] and can help planners and officials to provide better health services.

Research in two separate camps was one of the limitations of the present study.

Daily activities of victims injured by landmines are in a good level and most of them are able and independent to perform many daily activities. The highest dependency of the adolescents’ is related to ‘clothing’, ‘transportation and mobility on uneven surfaces’, and ‘using the stairs’.

The researchers feel grateful to the adolescents, who participated in the study, and the agents of Foundation of Martyrs and Veterans’ Affair in the border provinces.

Non-declared

All procedures were approved by Ethics Committee of Janbazan Medical and Engineering Research Center.

Janbazan Medical and Engineering Research Center funded the study.

TABLES and CHARTS

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CITIATION LINKS

[1]Kakar F, Bassani F, Romer C, Gunn S. The consequence of land mines on public health. Prehosp Disaster Med. 1996;11(1):2-10.
[2]Walsh NE, Walsh WS. Rehabilitation of landmine victims: The ultimate challenge. Bull World Health Organ. 2003;81(9):665-70.
[3]Kinra S, Black M. Landmine related injuries in children of Bosnia and Herzegovina 1991-2000: Comparisons with adults. J Epidemiol Community Health. 2003;57(4):264-5.
[4]Levy BS, Sidel VW. War and public health. 2nd ed. Oxford: Oxford University Press; 2007.
[5]Soroush A. The human costs of landmine and UXOs. 1st ed. Tehran: Janbazan Medical and Engineering Research Center; 2007. [Persian]
[6]Soroush A, Falahati F, Zargar M, Soroush M, Khateri S, Khaji A. Amputations due to landmine and unexploded ordnances in post-war Iran. Arch Iran Med. 2008;11(6):595-7.
[7]Boyce W. Adaptation of community based rehabilitation in areas of armed conflict. Asia Pac Disabil Rehabil J. 2000;11(1):17-20.
[8]Coupland R, Korver A. Injuries from antipersonnel mines: The experience of the International Committee of the Red Cross. Br Med J. 1991;303(6816):1509-12.
[9]Simper L. Below knee amputation in war surgery: A review of 111 amputations with delayed primary closure. J Trauma.
[10]Hoshino J. Changes in the activities of daily living (ADL) in relation to the level of amputation of patients undergoing lower extremity amputation for arteriosclerosis obliterans (ASO). Circ J. 2008;72(9):1495-8.
[11]Vijayakumar V, Datta D, Karthika A, Thulasiraj RD, Nirmalan PK. Utilisation of community-based rehabilitation services for incurably blind persons in a rural population of southern India. Indian J Ophthalmol. 2003;51(3):273-7.
[12]Geertzen J, Martina J, Rietman H. Lower limb amputation. Part 2: Rehabilitation- a 10 year literature review. Prosthet Orthot Int. 2001;25(1):14-20.
[13]Greive A, Lankhorst G. Functional outcome of lower-limb amputees: A prospective descriptive study in a general hospital. Prosthet Orthot Int. 1996;20(2):79-87.
[14]Kohler F, Cieza A, Stucki G, Geertzen J, Burger H, Dillon M, et al. Developing core sets for persons following amputation based on the international classification of functioning, disability and health as a way to specify functioning. Prosthet Orthot Int. 2009;33(2):117-29.
[15]Kerstein M, Zimmer H, Dugdale F, Lerner E. Rehabilation after bilateral lower extremity amputation. Arch Phys Med Rehabil. 1975;56(7):309-11.
[16]Schoppen T, Boonstra A, Groothoff J, Vries Jd, Göeken L, Eisma W. Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees. Arch Phys Med Rehabil. 2003;84(6):803-11.
[17]Law M, Finkelman S, Hurley P, Rosenbaum P, King S, King G, et al. Participation of children with physical disabilities: Relationships with diagnosis, physical function, and demographic variables. Scand J Occup Ther. 2004;11(4):156-62.
[18]Mahoney FI, Barthel DW. Functional Evaluation the barthel index. Md State Med J. 1965;14:61-5.
[19]Habibi Sola A, Nikpour S, Seyed Alshohadaei M, Haghani H. Quality of life and status of physical functioning among elderly people in west region of Tehran: A cross-sectional survey. Iran J Nurs. 2008;21(53):29-39. [Persian]
[20]Tyc VL. Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clin Psychol Rev. 1992;12(3):275-91.
[21]Nagarajan R, Neglia JP, Clohisy DR, Yasui Y, Greenberg M, Hudson M, et al. Education, employment, insurance, and marital status among 694 survivors of pediatric lower extremity bone tumors: A report from the childhood cancer survivor study. Cancer. 2003;97(10):2554-64.
[22]Bilukha O, Brennan M. Injuries and deaths caused by unexploded ordnance in Afghanistan: Review of surveillance data, 1997-2002. BMJ. 2005;330(7483):127-8.
[23]Bilukha O, Brennan M, Anderson M, Tsitsaev Z, Murtazaeva E, Ibragimov R. Seen but not heard: Injuries and deaths from landmines and unexploded ordnance in Chechnya, 1994-2005. Prehosp Disaster Med. 2007;22(6):507-12.
[24]Hussein EM, Waller EJ. Landmine detection: The problem and the challenge. Appl Radiat Isot. 2000;53(4-5):557-63.
[25]Peel M. The occupational health of de-miners of Afghanistan. J R Sco Med. 1995;88(12):683-5.
[26]Andersson N, da Sousa CP, Paredes S. Social cost of land mines in four countries: Afghanistan, Bosnia, Cambodia, and Mozambique. BMJ. 1995;311(7007):718-21.
[27]Holmes GE, Baker A, Hassanein RS, Bovee EC, Mulvihill JJ, Myers MH, et al. The availability of insurance to long‐time survivors of childhood cancer. Cancer. 1986;57(1):190-3.
[28]Rauck AM, Green DM, Yasui Y, Mertens A, Robison L. Marriage in the survivors of childhood cancer: A preliminary description from the Childhood Cancer Survivor Study. Med Pediatr Oncol. 1999;33(1):60-3.
[29]Karacostas DD, Fisher GL. Chemical dependency in students with and without learning disabilities. J Learn Disabil. 1993;26(7):491-5.
[30]Centomo H, Amarantini D, Martin L, Prince F. Muscle adaptation patterns of children with a trans-tibial amputation during walking. Clin Biomech. 2007;22(4):457-63.
[31]Law M, King G, King S, Kertoy M, Hurley P, Rosenbaum P, et al. Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Dev Med Child Neurol. 2006;48(5):337-42.
[32]Breslau N, Staruch KS, Mortimer EA Jr. Psychological distress in mothers of disabled children. Am J Dis Child. 1982;136(8):682-6.
[33]Duarte YA, Lebrão ML, Lima FD. The contribution of living arrangements in the provision of care for elderly persons with functional impairments in São Paulo, Brazil. Rev Panam Salud Publica. 2005;17(5-6):370-8. [Portuguese]
[34]Gill TM, Robison JT, Tinetti ME. Difficulty and dependency: Two components of the disability continuum among community-living older persons. Ann Intern Med. 1998;128(2):96-101.
[35]keqel B, Carpenter ML, Burgess EM. Functional capabilities of lower extremity amputees. Arch Phys Med Rehabil. 1978;59(3):109-20.
[36]Njegovan V, Hing MM, Mitchell SL, Molnar FJ. The hierarchy of functional loss associated with cognitive decline in older persons. J Gerontol A Biol Sci Med Sci. 2001;56(10):638-43.
[37]Newman RD, Mercer MA. Environmental health consequences of land mines. Int J Occup Environ Health. 2000;6(3):243-8.
[38]Wind WM, Schwend RM, Larson J. Sports for the physically challenged child. J Am Acad Orthop Surg. 2004;12(2):126-134.
[39]Somasundaram DJ, Renol KK. The psychosocial effects of landmines in Cambodia. Med Confl Surviv. 1998;14(3):219-36.
[40]Varni JW, Setoguchi Y. Effects of parental adjustment on the adaptation of children with congenital or acquired limb deficiencies. J Dev Behav Pediatr. 1993;14(1):13-20.
[41]Varni JW, Setoguchi Y, Rappaport LR, Talbot D. Psychological adjustment and perceived social support in children with congenital/acquired limb deficiencies. J Behav Med. 1992;15(1):31-44.
[42]Champion HR, Holcomb JB, Young LA. Injuries from explosions: Physics, biophysics, pathology, and required research focus. J Trauma. 2009;66(5):1468-77.