Upper-middle-income and high-income countries should continue investing on injury prevention in children and adolescents and further decrease the rate of injuries by taking the best country example. High-income countries need to focus on the interventions for occupants of motor vehicles and may have potential to benefit from graduated driver license program which aims for all new drivers to limit driving by many strategies until the driver gains experience. The program have been shown to be successful in reducing crashes in young drivers (154).
The inequalities in injury mortality underscore the need for creating political will for injury prevention in adolescents by presenting it as a public health problem in the low and middle-income countries. It may be practical to integrate evidence based proven strategies into existing policies and/or legislation. The low and middle-income countries need to revamp legislations, enforcement and built environment for vulnerable road users, pedestrians and motorcyclists.
The interventions such as slow speeding around schools, eliminating one-way streets around schools, installing walkways in school routes, volunteer traffic wardens for schools, and walking buses for schools, helmet use and seat belt for the adolescents.
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In Pakistan, the legislations for injuries specific to children are not comprehensive and enforcement of existing legislations is very low. The findings from this thesis will help making public health case of injury prevention in children and adolescents. The involvement of pediatricians and public health advocates in creating political will for injury prevention in children and adolescents will be valuable.
The findings of study in Karachi make the strong case of safe built environment for adolescents who can be mobile in roads without supervision. Therefore, number of known road safety strategies can be recommended such as proper walkways for pedestrians, pedestrian signals, road crossings, pedestrian right of crossing the road, seat belt use, designated bus stops, and regulations for public transport. Helmet use and the regulation of drivers’ training and licensing for motorcyclists are the two important policy points for adolescents in Karachi, Pakistan.
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9 ACKNOWLEDGEMENTS
I am indebted to my supervisor Martin Gerdin Warnberg, who was able to synergize my abilities. I had a wonderful learning time with him. I learnt to control perfectionist in me because of two advices that he gave me when we started our journey together. I remember he told me to adhere to timelines strictly and write the first draft and don’t try to master it.
Ever since, I am just following this wonderful trip. Many a times, he, put me into new learning challenges which might have felt burden at that time, but I knew I was going to be grateful for this experience. I learnt superb way of supervising with a fixed schedule for short weekly meetings that worked tremendously for me and I want to do the same for my future students. His unplanned discussions and questions related to my work were cherishing and intellectually motivating. It was because of him that I was able to publish all my papers and write the thesis in parallel to my employment responsibilities. I think space here is limited and I can go on and on. Martin, I am grateful!.
I want to thank my co-supervisor who is my ultimate mentor all those years of my employment from year 2007. He is Junaid A. Razzak. I distinctly remember that in my job interview with him, he asked me what do you want to do? I told him PhD. I worked with him all those years and got all types of learning exposure. From desk to community research, applying for research grants, policy talks, arranging conferences and workshops, networking/collaboration, developing courses, capacity building, mentoring and working with international agency such as WHO. We have done it all. I didn’t realize that I have absorbed so much from him and became an independent researcher. He has been a guiding source throughout this journey and the one who motivated me to pursue PhD from KI.
There are many names from Department of Global Health, Karolinska Institutet that I would like to mention for acknowledging their roles in my PhD. Lucie Laflamme, Marie Hasselberg, Cecilia Stålsby Lundborg, Emilie Agardh, Bo Lindblad and Bo Burstrom for all the guidance. I am grateful for all the experience that I got from you and I learnt so much from it. The first student who I got to know in the Department was Lisa Blom. She is the epitome of kindness and she helped me in many ways. I also want to thank Helle and Constance. Then my house mates Helga, Lien and Tumaini with whom I had wonderful time discussing day to day issues, cooking and eating together. We even had a fun trip to Denmark and Latvia. I also like to mention Muslima, colleague from my country, we travelled together many times back and forth for PhD.
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If I have to name one person who was the biggest support in Stockholm was Anna-Berit Ransjö-Arvidson, who not only provided the best homely accommodation but her sweetness is incredible. She used to discuss our progress and kept sharing her wisdom. She went out of the way to support me in tough times. She is like a family and I wish her all the happiness ever. Thanks to two important guides for my first visit to Sweden; Tazeen Saeed Ali and Saima Hamid.
I would like to thank colleagues from my country who have been part of my journey in many ways, Ahmed,Shumaila, Rubaba, Nukhba, Nazia, Ambreen, Jawed, Asher, Abid, Saleem, Ahmed, Salman, Shafiqa, Umer, Shahan, Noman, my statistics teacher Sir Iqbal Azam, Dr Jabeen, Dr Surraiya and Asrar. Special mention of Safia, my friend who was always there to hear me out. I would like to express my deep gratitude to Dr Nadeem for believing in me and giving me independence to use my creativity while working with him.
I would like to thank Dr Asad Mian and Dr Fazal Hameed, my reporting supervisors at my work for letting me pursue my dreams without any interruption.
I would like to thank Junaid Bhatti for all the advices that I seek for my subject related queries and Ali Abidi for bringing new perspective to lifestyle to de-stress.
I would like to thank few entities Aga Khan University and its Department of Emergency Medicine in Pakistan, Department of Global Public Health, Karolinska Institutet, Sweden.
My family members, my dad who passed away due to COVID. It is for your hard work abbu!
My mom for the fearless attitude that I acquire from her. My sisters especially Afshan for listening to me despite of different time zone, and other supportive family members. My nephew and nieces for all the lovely talks and prayers from Waleed, the eldest to Eileen, the youngest. Love you all my babies.
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