1.World report onchild injury prevention

2. World report onchild injury preventionEdited byMargie Peden, Kayode Oyegbite, Joan Ozanne-Smith, Adnan A Hyder, Christine Branche, AKM Fazlur Rahman, Frederick Rivara and Kidist Bartolomeos 3. WHO Library Cataloguing-in-Publication Data:World report on child injury prevention/ edited by Margie Peden [et al].1.Wounds and injures - prevention and control. 2.Accident prevention.3.Child welfare. I.World Health Organization. ISBN 978 92 4 156357 4(NLM classification: WA 250) World Health Organization 2008All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia,1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce ortranslate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press, at the above address (fax:+41 22 791 4806; e-mail: permissions@who.int).The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the partof the World Health Organization or UNICEF concerning the legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World HealthOrganization or UNICEF in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietaryproducts are distinguished by initial capital letters.All reasonable precautions have been taken by the World Health Organization or UNICEF to verify the information contained in this publication.However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretationand use of the material lies with the reader. In no event shall the World Health Organization or UNICEF be liable for damages arising from its use.Cover design by INIS.Graphics by minimum graphics and LIV Com Srl.Printed in Switzerland. 4. CONTENTSContents Foreword vii Contributorsix Acknowledgementsxiii Introduction xvChapter 1. Child injuries in context1 Background1What is an injury? 1Who is a child?1Why is child injury important? 1How does child injury relate to other child health concerns? 2Childrens injuries and the changing world 3 The characteristics of child injury 5The child-injury pyramid 5Fatal child injuries 5Non-fatal child injuries 7Child injury and age 8Child injury and gender9Child injury and socioeconomic factors 9 The preventability of child injury 12The principles of injury prevention 12Learning from places with good safety records 16Which approaches work?16Universal and targeted interventions18Cost and cost-effectiveness 20Overcoming the obstacles20 Conclusion 22 References 22Chapter 2. Road traffic injuries31 Introduction 31 Epidemiology of road traffic injuries31Mortality 31Morbidity 33Types of road user34Economic impact of road traffic injuries36Limitations of data 36 Risk factors 36Child-related factors 36Vehicle-related factors 41Environmental factors 41Lack of prompt treatment41 Interventions42Engineering measures42Vehicle design43Safety equipment43 WORLD REPORT ON CHILD INJURY PREVENTION III 5. Legislation and standards46 Developing education and skills47 Emergency and trauma care48 Potentially harmful interventions49 Evaluating interventions 49Conclusion and recommendations49 Recommendations49References51Chapter 3.Drowning59Introduction59Epidemiology of drowning59 Mortality59 Morbidity62 Economic impact of drowning62 Limitations of data63Risk factors63 Child-related factors63 Agent factors65 Environmental factors66 Access to treatment and rehabilitation 66Interventions 66 Engineering measures 67 Environmental measures 67 Legislation and standards68 Developing education and skills69 Managing drowning71 Adapting interventions 72 Further research on interventions72Conclusions and recommendations 72 Recommendations72References73Chapter 4.Burns 79Introduction79Epidemiology of burns 80 Mortality80 Morbidity81 Limitations of data84Risk factors84 Child-related factors85 Agent factors86 Environmental factors86Protective factors86Interventions 87 Engineering measures 87 Environmental measures 88 Laws and regulations 88 Educational approaches 89 Combined strategies89 Managing burns 90 Adapting interventions 93 Evaluating interventions 93IV WORLD REPORT ON CHILD INJURY PREVENTION 6. Conclusions and recommendations93Recommendations 93 References 94Chapter 5. Falls 101 Introduction101 Epidemiology of falls 101Mortality102Morbidity102Cost of fall-related injury105Limitations of data106 Risk factors106Child-related factors106Agent factors107Environmental factors109Lack of treatment and rehabilitation 110 Interventions 110Engineering measures 110Environmental measures 110Laws and regulations 111Educational approaches 111Combining strategies 112Adapting interventions 113Involving a range of sectors 114 Conclusions and recommendations 114Recommendations114 References115Chapter 6. Poisonings123 Introduction123 Epidemiology of poisoning 123Mortality123Morbidity125Types of poison125Cost of poisoning-related injury 127Limitations of data127 Risk factors129Child-related factors129Agent factors130Environmental factors131Lack of prompt treatment 132 Interventions 132Engineering measures 132Environmental measures 134Laws and regulations 134Educational approaches 135Managing poisoning 135Involving a range of sectors 137Evaluating interventions 137 Conclusions and recommendations 137Recommendations138 References138 WORLD REPORT ON CHILD INJURY PREVENTION V 7. Chapter 7.Conclusions and recommendations 145Introduction145Main messages from the report 145 Child injuries are a major public health issue 145 Injuries directly affect child survival145 Children are more susceptible to injuries145 Child injuries can be prevented146 The cost of doing nothing is unacceptable147 Few countries have good data on child injuries 148 Research on child injuries is too limited148 There are too few practitioners in child injury prevention 149 Child injuries is the responsibility of many sectors 150 Child injury prevention is underfunded 150 Awareness needs to be created and maintained 150Recommended actions 151Translating recommendations into reality153Conclusion154References155Statistical annex 157Index 203VI WORLD REPORT ON CHILD INJURY PREVENTION 8. FOREWORDForewordEvery day around the world the lives of more than 2000 families are torn apart by the loss of a child to an unintentionalinjury or so-called accident that could have been prevented. The grief that these families suffer mothers, fathers,siblings, grandparents and friends is immeasurable and often impacts entire communities. Such tragedy can changelives irrevocably. Once children reach the age of five years, unintentional injuries are the biggest threat to their survival. Unintentionalinjuries are also a major cause of disabilities, which can have a long-lasting impact on all facets of childrens lives:relationships, learning and play. Among those children who live in poverty, the burden of injury is highest, as thesechildren are less likely to benefit from the protective measures others may receive. Child injuries have been neglected for many years, and are largely absent from child survival initiatives presently onthe global agenda. Through this World report on child injury prevention, the World Health Organization, the UnitedNations Childrens Fund and many partners have set out to elevate child injury to a priority for the global public healthand development communities. The knowledge and experience of nearly two hundred experts from all continents andvarious sectors were invaluable in grounding the report in the realities faced in many countries. Childrens maturity and their interests and needs differ from adults. Therefore, simply reproducing injury preventionstrategies that are relevant to adults does not adequately protect children. There are proven interventions such as childcar seats, cycling helmets, child-resistant packaging for medications, fencing around swimming pools, hot water taptemperature regulation and window guards, to name a few. Ministries of Health can play a central role in prevention, advocacy and research and in the care and rehabilitation ofchildren with disabilities. Other key sectors include education, transportation, environment and law enforcement. This World report on child injury prevention should be seen as a complement to the UN Secretary-Generals study onviolence against children released in late 2006. That report addressed violence-related or intentional injuries. Both reportssuggest that child injury and violence prevention programmes need to be integrated into child survival and other broadstrategies focused on improving the lives of children. Evidence demonstrates the dramatic successes in child injury prevention in countries which have made a concertedeffort. These results make a case for increasing investments in human resources and institutional capacities. This wouldpermit the development, implementation and evaluation of programmes to stem the tide of child injury and enhance thehealth and well-being of children and their families the world over. Implementing proven interventions could save morethan a thousand childrens lives a day.Margaret Chan Ann M VenemanDirector-GeneralExecutive DirectorWorld Health Organization United Nations Childrens FundWORLD REPORT ON CHILD INJURY PREVENTION VII 9. VIII WORLD REPORT ON CHILD INJURY PREVENTION 10. CONTRIBUTORSContributorsEditorial guidanceEditorial CommitteeMargie Peden, Kayode Oyegbite, Joan Ozanne-Smith, Adnan A Hyder, Christine Branche, AKM Fazlur Rahman,Frederick Rivara, Kidist Bartolomeos.Executive EditorMargie Peden.Advisory CommitteeChair of Advisory Committee: Ala Din Abdul Sahib Alwan.Advisory Committee: Ileana Arias, Sebastian van As, Martin Eichelberger, Mehmet Haberal, Saad Houry, Etienne Krug,Douglas Pete Peterson, Joy Phumaphi, Wim Rogmans, Fernando Stein, Alan Whelpton, Fan Wu.Contributors to individual chaptersIntroductionWriter: Alison Harvey.Box: Alison Harvey, Amaya Gillespie.Chapter 1. Child injuries in contextWriters: Elizabeth Towner, Ian Scott.Boxes: Margie Peden, Tony Kahane (Juans story), Margie Peden (1.1), Anuradha Bose (1.2), David Sleet, BarbaraMorrongiello (1.3), Charles Mock (1.4), Karen Ashby, Ken Winkel, Julie Gilchrist (1.5).Chapter 2. Road traffic injuriesWriters: Kate McMahon, Gururaj Gopalakrishna, Mark Stevenson.Working group members: Nicola Christie, Wilson Odero, Krishnan Rajam, Junaid Razzak, Eugnia Maria SilveiraRodrigues, Chamaiparn Santikarn, Isabelle Svd-Bardem, Jean van Wetter.Boxes: David Blanchard (Deanas story), AKM Fazlur Rahman (2.1), Flaura Winston (2.2), Mirjam Sidik (2.3).Chapter 3. DrowningWriters: Gitanjali Taneja, Ed van Beeck, Ruth Brenner.Working group members: Alfredo Celis, Steve Beerman, Julie Gilchrist, Olive Kobusingye, Jonathon Passmore, LindaQuan, Aminur Rahman, Carolyn Staines, Birut Strukcinskiene, Li Yang.Boxes: Safekids New Zealand (Rubys story), Alfredo Celis, Frederick Rivara (3.1), Erin Cassell (3.2), Ruth Brenner,Gitanjali Taneja (3.3), Joan Ozanne-Smith (3.4), Frederick Rivara (3.5).Chapter 4. BurnsWriters: Samuel Forjuoh, Andrea Gielen.Working group members: Carlos Arreola-Rissa, Mohamoud El-Oteify, Alison Macpherson, Ashley van Niekerk, MichaelPeck, Andrs Villaveces.Boxes: Children of Fire (Vusis story), Samuel Forjuoh (4.1), Reza Mohammadi, Homayoun Sadeghi-Bazargani, MohammadMehdi Gouya (4.2), Wijaya Godakumbura (4.3), Pam Albany (4.4), Junaid Razzak (4.5), Rene Albertyn, Sebastian vanAs, Heinz Rode (4.6). WORLD REPORT ON CHILD INJURY PREVENTION IX 11. Chapter 5. FallsWriters: Shanthi Ameratunga, Huan Linnan, Shaheen Sultana.Working group members: Francis Abantanga, Abdulbari Bener, Rieneke Dekker, Adisak Plitapolkarnpim, Shauna Sherker,Wendy Watson.Boxes: Aminur Rahman (Sohels story), Kidist Bartolomeos, Baltazar Chilundo, Orvalho Joaquim (5.1), Caroline Finch(5.2), Joan Ozanne-Smith (5.3), Margie Peden (5.4).Chapter 6. PoisonsWriters: Yvette Holder, Richard Matzopoulos, Nerida Smith.Working group members: Mick Ballesteros, Anuradha Bose, Jenny Pronczuk de Garbino, Marisa Ricardo, Dinesh Sethi,Nelmarie du Toit.Boxes: Debbie Scott (Harrisons story), Ken Winkel, Karen Ashby, Julie Gilchrist (6.1), Richard Matzopoulos (6.2), YvetteHolder (6.3), Fernando Ravindra (6.4).Chapter 7. Conclusions and RecommendationsWriters: Margie Peden, Adnan A Hyder.Boxes: Anupama Kumar (Anupamas story), Lucie Laflamme (7.1), Adnan A Hyder, Nhan Tran, Abdulgafoor Bachani,David Bishai (7.2), Susan McKenzie (7.3), David Meddings (7.4), Veronika Beneov (7.5), Margie Peden (7.6).Statistical AnnexKidist Bartolomeos, Colin Douglas Mathers, Karen Oldenziel, Mike Linnan, Adnan A Hyder.Peer reviewersPam Albany, Rene Albertyn, Ruth Barker, Chris Brewster, Mariana Brussoni, Marie Nol Brune, Erin Cassel, KerryChausmer, Chrissy Cianflone, Ann Dillenger, Moira Donahue, Jacquie Dukehart, Martin Eichelberger, Robert Flanagan,Lucie Laflamme, Abdul Ghaffar, Rosa Gofin, Robin Ikeda, Denise Kendrick, Shyan Lall, Jacques Latarjet, EdilbertoLoaiza, Morag Mackay, Alison Macpherson, Candida Moshiro, Milton Mutto, Anthony Oliver, Luciana OReilly, DavidParker, Eleni Petridou, Dragoslav Popovic, Aminur Rahman, Shumona Shafi naz, David Silcock, David Sleet, HamidSoori, Joanna Tempowski, Maria Vegega, Andrs Villaveces, Joanne Vincenten, Diane Wigle.Additional contributorsRegional ConsultantsWHO African Region / Eastern Mediterranean RegionFrancis Abantanga, Hala Aboutaleb, Wahid Al-Kharusi, Jamela Al Raiby, Sebastian van As, Abdulbari Bener, HeshamEl-Sayed, Mahmoud El-Oteify, Mouloud Haddak, Lara Hussein, Syed Jaffar Hussain, Olive Kobusingye, RichardMatzopoulos, Candida Moshiro, Junaid Razzak, Jamil Salim, Babatunde Solagberu, Hamid Soori, Dehran Swart.WHO Region of the AmericasCarlos Arreola-Rissa, Simone Gonalves de Assis, Yadira Carrer, Alfredo Celis, Sara Diaz, Ann Dellinger, SamuelForjuoh, Andrea Gielen, Maria Isabel Gutierrez, Yvette Holder, Debra Houry, Sylvain Leduc, Luciana OReilly, MichaelPeck, Maria Fernanda Tourinho Peres, Eugnia Maria Silveira Rodrigues, Maria Ines Romero, Gitanjali Taneja, AndrsVillaveces, Billie Weiss, Elizabeth Ward.WHO South-East Asia Region / Western Pacific RegionPamela Albany, Shanthi Ameratunga, Nguyen Trong An, Anuradha Bose, Rafael Consunji, Yoshikazu Fujisawa, WijayaGodakumbura, Gopalakrishna Gururaj, Huan Linnan, Michael Linnan, Hisashi Ogawa, Joan Ozanne-Smith, JonathonPassmore, Adisak Plitponkarnpim, AKM Fazlur Rahman, Aminur Rahman, Krishnan Rajam, Marisa Ricardo, SiriwanSantijiarakul, Chamaiparn Santikarn, Ian Scott, Isabelle Svd-Bardem, Richard Tan, Tetsuro Tanaka.X WORLD REPORT ON CHILD INJURY PREVENTION 12. WHO European RegionEd van Beeck, Veronika Beneov, Christine Branche, Gudula Brandmayr, Murat Derbent, Olivier Duperrex, Rosa Gofin,Loek Hesemans, Rupert Kisser, Lucie Laflamme, Jacques Latarjet, Morag Mackay, Alison Macpherson, Kate McMahon,Eleni Petridou, Dragoslav Popovic, Olga Poyiadji-Kalakouta, Francesca Racioppi, Ian Roberts, Wim Rogmans, Maria SeguiGomez, Dinesh Sethi, Birut Strukcinskiene, Elizabeth Towner, Iva Truellova, Joanne Vincenten, Michael Watson.None of the experts involved in the development of this report declared any conflict of interest. WORLD REPORT ON CHILD INJURY PREVENTION XI 13. XII WORLD REPORT ON CHILD INJURY PREVENTION 14. ACKNOWLEDGEMENTSAcknowledgementsThe World Health Organization and UNICEF would like to thank the more than 180 contributors (editors, lead authors,working group members, regional consultation participants and peer reviewers) to this report from 56 countries aroundthe world. In addition, the support and guidance offered by the report advisors, WHO regional advisors and UNICEFstaff are acknowledged. Without their dedication, support and expertise this report would not have been possible. The report also benefited from the contribution of a number of other people, in particular, Tony Kahane whoedited the final text of the main report and Angela Burton who edited the summary version. Joanne Vincenten andMorag Mackay prepared the final text for the summary and fact sheets. Thanks are also due to the following: KidistBartolomeos and Ian Scott for the day-to-day coordination of the project; Mike Linnan for the UNICEF/TASC dataanalysis; Kidist Bartolomeos, Colin Mathers and Karen Oldenziel for analysis and interpretation of WHO data; AdnanHyder and Prasanthi Puvanachandra for data analysis from the multicountry study; Laura Sminkey and Steven Lauwersfor communication and advocacy; Susan Kaplan for proofreading and Liza Furnival for indexing; Susan Hobbs, LIVCom Srl and Aaron Andrade for graphic design; Pascale Broisin and Frederique Robin-Wahlin for coordinating theprinting; and finally, Pascale Lanvers-Casasola for her administrative support and for coordinating the translation of thedifferent versions of this report. The World Health Organization and UNICEF also wish to thank the following for their generous financial support forthe development, translation and publication of the report: the Arab Gulf Programme for United Nations DevelopmentOrganizations (AGFUND); the Public Health Agency of Canada, the Governments of Belgium, Mexico, the Netherlands,Norway, Sweden, and the United Kingdom; the Global Forum for Health Research; the United States Centers for DiseaseControl and Prevention, National Center for Injury Prevention and Control.WORLD REPORT ON CHILD INJURY PREVENTION XIII 15. XIV WORLD REPORT ON CHILD INJURY PREVENTION 16. INTRODUCTIONIntroductionChild injuries are a growing global public health problem.The World report on child injury prevention is directedThey are a significant area of concern from the age of at researchers, public health specialists, practitioners andone year, and progressively contribute more to overall academics. A summary of the report containing the mainrates of death until children reach adulthood. Hundredsmessages and recommendations and a set of fact sheetsof thousands of children die each year from injuries orare available for policy-makers and development agencies.violence, and millions of others suffer the consequences A version aimed at children to create awareness andof non-fatal injuries. For each area of child injury there are provide children with a sense of ownership of the issues proven ways to reduce both the likelihood and severity ofand a set of posters have also been produced.injury yet awareness of the problem and its preventability,as well as political commitment to act to prevent childAimsinjury, remain unacceptably low. The overall aims of the report are: to raise awareness about the magnitude, risk factors and impacts of child injuries globally;Main causes of death among children, World, 2004 to draw attention to the preventability of child injuries 100 and present what is known about the effectiveness of80 intervention strategies;Percentage of deaths to make recommendations that can be implemented by60 all countries to reduce child injuries effectively.4020 Definition of childhood There is no universally agreed age range for what constitutes0childhood a concept that varies considerably across Under 1 14 59 10141519Age (years)cultures. This report uses the definition of a child specified in the Convention on the Rights of the Child (3), and thus Injuries Noncommunicable diseasesCommunicable diseasesa focuses on injuries occurring in children under the age ofa 18 years. However, it has not always been possible to reflect Includes communicable, maternal, perinatal and nutritional conditions. this age cut-off in analysing data. The reader will notice,Source: WHO (2008), Global Burden of Disease: 2004 update. for instance, that in some cases WHO data could not be disaggregated to