Evaluation of nature and extent of injuries during Dahihandi festivalP Nemade, R Wade, AR Patwardhan, S Kale
Department of Orthopaedics, Seth G. S. Medical College and K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0022-3859.105445
Source of Support: None, Conflict of Interest: None
Background: Injuries related to the Hindu festival of Dahihandi where a human pyramid is formed and a pot of money kept at a height is broken, celebrated in the state of Maharashtra, have seen a significant rise in the past few years. The human pyramid formed is multi-layered and carries with it a high risk of injury including mortality. Aims: To evaluate the nature, extent and influencing factors of injuries related to Dahihandi festival. Settings and Design: We present a retrospective analysis of patients who presented in a tertiary care center with injuries during the Dahihandi festival in the year 2010. Materials and Methods: 124 patients' records were evaluated for timing of injury, height of the Dahihandi pyramid, position of the patient in the multi-layered pyramid, mode of pyramid collapse and mechanism of an injury. A binary regression logistic analysis for risk factors was done at 5% significance level. Statistical Analysis: Univariate and multi-variate binary logistic regression of the risk factors for occurrence of a major or minor injury was done using Minitab™ version 16.0 at 5% significance. Results: Out of 139 patients presented to the center, 15 were not involved directly in the formation of pyramid, rest 124 were included in the analysis. A majority of the patients were above 15 years of age [110 (83.6%)]. 46 (37.1%) patients suffered major injuries. There were 39 fractures, 3 cases of chest wall trauma with 10 cases of head injuries and 1 death. More than half of the patients [78 (56.1%)] were injured after 1800 hours. 73 (58.9%) injured participants were part of the pyramid constructed to reach the Dahihandi placed at 30 feet or more above the ground. 72 (51.8%) participants were part of the middle layers of the pyramid. Fall of a participant from upstream layers on the body was the main mechanism of injury, and majority [101 (81.5%)] of the patients suffered injury during descent phase of the pyramid. Conclusions: There is a considerable risk of serious, life-threatening injuries inherent to human pyramid formation and descent in the Dahihandi festival. Safety guidelines are urgently needed to minimize risk and prevent loss of human life.
Keywords: Dahihandi , human pyramid, injury, Indian festivals
Dahihandi is a popular aspect of Janmashtami, a Hindu festival, marking the birth of Lord Krishna. It is celebrated amidst great revelry and essentially involves the construction of a human pyramid to break the curd pot that is hung at a considerable height above the ground. The pot, unlike mythological lore, contains prize money, and several groups attempt to break it. The festival promotes teamwork and the importance of physical fitness, agility, concentration, and psychomotor skills.  The event in recent years has also gained considerable political mileage. Large numbers of teams participate in this venture and it is estimated that hundreds of teams compete each year for prizes in multiple events all over the city of Mumbai. The human pyramid formed is multi-layered and carries with it a high risk of injury including mortality. These injuries have become a major source of concern in recent years, and various measures such as restricting the height of the pot, preventing children from participation, use of safety gear including helmets, and padding have been suggested. None of these measures, however, have been implemented. No scientific data has been published evaluating the injuries related to this festival. We present in this paper, findings of a cross-sectional study carried out on patients who presented with injuries related to Dahihandi festival in September 2010.
The study protocol was approved by the Institutional Review Board, and consent waiver for data analysis was granted. Confidentiality of data was maintained using unique identifiers. Data on 139 patients who presented with injuries was analyzed. 15 patients were excluded from the analysis as the injuries were considered unrelated and thus data on 124 patients was eventually analyzed. Injuries such as sprains, lacerated wounds, and abrasions were classified as minor injuries; whereas injuries such as fractures, chest injuries, abdominal injuries, head injuries, and fatalities were classified as major injuries. The timing of the injury was divided as pre-noon, noon-1800 hours, and after 1800 hours. The height of the pyramid, number of layers in the pyramid, patient position in the layer, whether the injury occurred during ascent or descent, and whether the injury was the result of a direct fall or impact of other participants falling from the layers above was obtained from source notes where available. Both univariate and multivariate binary logistic regression of the risk factors for occurrence of a major or minor injury was done using Minitab™ version 16.0 at 5% significance levels.
Age and sex: The median age of the patients was 23 years (7- 50), and a large majority of them were male (122, 98.4%). Both females were aged 10 years. A majority of the participants [86 (69.3%)] were between 15-30 years of age, 24 (19.4%) were above 30 years of age, and 14 (11.3%) were less than 15 years of age [Table 1].
Classification of injuries: There were 46 (37.1%) major injuries, and the rest were minor. There were total 39 patients diagnosed with fractures. Among them, 19 patients had long bone fractures, 3 patients had spine fractures (2 cervical and 1 dorso lumbar), and 1 of them presented with paraplegia. There were 3 patients with chest wall trauma and 10 patients with head injury, 1 of who died [Table 2].
Injuries and time of the day: More participants were injured as the day progressed. 15 (10.8%) were injured pre noon, 46 (33.1%) between noon and 1800 hours and the vast majority after 1800 hours [78 (56.1%)].
Injuries and the layer of the pyramid: Majority of participants were part of middle layers. The 2 nd , 3 rd and 4 th layer together constituted almost half of the total number of patients [72 (51.8%)] who presented to the hospital.
Injuries and mode of pyramid collapse: Injuries were seen mostly during descent from the pyramid. A total of 101 (81.4%) were injured during the descent while only 23 (18.6%) were injured during formation of pyramid.
Injuries and mechanism of injury: A total of 40 (32.2%) had direct impact injuries due to fall from height, 82 (66.2%) were injured when a person/s from a layer above fell on them. 2 (1.6%) sustained both direct and indirect injuries.
Injuries and the height of the pyramid: More than half of the injured participants 73 (58.9%) were attempting to break pyramids placed over 30 feet height and the rest attempted pyramids smaller than 30 feet.
Univariate and binary logistic regression analysis
The time of the day when the injury occurred, height of the pot, layer of the pyramid to which the patient belonged and whether the injury occurred during formation or descent were all analyzed in a univariate and binary logistic regression model with the outcome of interest being major or minor injuries. None were found to be statistically significant. The variable that came closest to significance was the layer to which the patient belonged (P=0.086, Wald statistic 2.957).
Dahihandi festival is an injury-prone venture, and the median age of 23 years indicates that the vast majority of those affected are young adult males. Occurrence of injuries later in the day could possibly be the result of the fatigue that may set in due to waiting for a long period to break the bigger pots that incur bigger money. Also, as the day progresses, more errors may be induced due to progressive reduction in illumination. Not only formation but also descending down the pyramid after breakage of the pot is also a skilful act and thus loss of concentration and the excitement after breaking the pot can introduce error and lapse of judgment. Height of the pot is a key determinant of injury as is the fall of the participants from top layers onto the participants in basal and middle layers. The latter are those who are more prone to injuries.
Many religious festivals and traditions are associated with injuries. The Holi festival that is celebrated with colors is known to cause dermatosis, eye injuries, and methaemoglobinemia. ,,[ 4] The kite flying festival causes neck and electrical injuries , while Deepavali, the festival of lights and firecrackers, leads to burns and eye injuries. , Traditional bullfighting in Spain is known to cause a wide range of injuries.  The festival of Dahihandi, as evident from the results of this study, leads to a wide spectrum of musculoskeletal injuries in young population.
Dahihandi festival is celebrated on a mega scale in the state of Maharashtra. Increase in commercialization and political interest in this festival has seen a rising trend in injuries related to this festival. The number of injuries treated at a single center gives an idea about the enormous extent of injuries in this festival. It is likely that we did not reach a statistically significant association with any of the variables due to the small numbers used in the analyzes. Nonetheless, safety measures such as restricting the height of the pot, use of helmets, padding, and turf will help reduce the number of injuries and minimize morbidity and mortality related to this festival. Special emphasis on safe descent techniques during practice session will also minimize the injuries. Local first-aid centers would also be useful in providing first aid for the injured and will reduce the patient load on hospitals.
[Table 1], [Table 2]