Dr hanan abbas Assistant professor of family medicine

CHILDHOOD INJURIES

Scope of the Problem

Injuries are responsible for 10% of all deaths worldwide.
Someone dies from an injury every five seconds. More than 15,000 people die as a result of injuries every day.

About 5.8 million people die from injuries every year.

Injuries kill 32% more people around the world than malaria, tuberculosis, and HIV/AIDS combined.

5-24 years of age: 2001 Rank

5-9 Age group 10-14 15-19 20-24

1
1,283

Unintentional Injury
1,553 6,646 7,765

Malignant Neoplasms

Homicide
1,899 3,398

3
4 5

Congenital Anomalies
Homicide
137

272

Suicide
1,611

2,360

Heart Disease

Congenital Anomalies Homicide

189

Malignant Neoplasms

Heart Disease

Source: CDC, NCHS Vital Statistics System-Mortality.

Highlights 157,078 deaths due to injuries-all ages (13,806 of these were 5-19 years of age) Unintentional injuries were the leading cause of death for children and adolescents 5-19 years of age The five leading mechanisms of injury deaths for those 5-19: Motor vehicle traffic (48%) Firearm (21%) Suffocation (7%) Drowning (5%) Poisoning (5%)

njury death rates* according to intent among ersons 5-19 years of age: 1990 and 2001
Ages 5-14 Ages 15-19

1990 2001 All injury Unintentional Suicide Homicide Undetermined

*Rate per 100,000 population

1990
71.5 42.5 11.1 17.0 0.7

2001
50.9 32.8 7.9 9.4 0.7

12.7 10.3 0.8 1.5 0.2

8.5 6.9 0.7 0.8 0.1

Sources: CDC, NCHS Vital Statistics System-Mortality, U.S. Bureau of the Census- decennial census population counts for 1990, 2001 population estimates based on the 2000 census.

Burden of injury among persons 5-19 years of age, 1998-2001

Rate per 100,000 population

100,000

Injury-related emergency department visits-(1998-2001)

10,000

1,000

Injury-related hospitalizations-(1998-2001)

100

10

Injury Deaths-(2001)

1 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Age

Note: Data are plotted on the log scale, data for 1998-2000 are an average. Sources: CDC, NCHS-National Hospital Ambulatory Care Survey, National Hospital Discharge Survey, National Vital Statistics SystemMortality.

among persons under 18 years of age: 1999-2000

Emergency dept. visits per 1,000 population

160 140 120 100 80 60 40 20 0

Male Female

Unintentional injuries

Falls

Struck object/person

Motor vehicle traffic

Cut/pierce

Intentional injuries

Cause (unintentional injuries)

Note: Data are a two-year average for 1999-2000. Source: CDC, NCHS-National Hospital Ambulatory Care Survey.

Annual rate of medically attended injury and poisoning episodes by place of occurrence and by selected characteristics: 2001
Place of occurence School/ Sport facility/ child care Street/ recreation Selected Home Home center/ highway/ area/ characteristic inside outside preschool parking lot lake/river/pool
Episodes per 1,000 population

Male:
Under 12 years 12-17 years 37.3 *10.0 18.3 19.1 9.9 38.3 *4.0 19.7 10.1 44.6

Female:
Under 12 years 12-17 years 30.0 12.3 12.4 13.6 8.4 24.8 *4.3 *13.3 6.5 18.5

Note: *Data do not meet standard of reliability and precision.

Source: CDC, NCHS-National Health Interview Survey.

The Road Environment

Pedestrian Cyclist Car occupants

CHILDHOOD INJURIES

The Leisure Environment

Drowning Playground Injuries Sports Injuries

The Home Environment

Falls Burns and scalds House Fires

The School/ Work Environment

Falls

Poisoning
Lacerations Suffocation Drowning

Burns
Scalds Lacerations Poisoning

Risk Groups
Some groups are more vulnerable to injuries than others. The scope of the problem varies considerably by: Age: Injuries are one of the top three causes of death among people between the ages of 5 and 44 years. Sex: Nearly twice as many men as women die from injuries each year. Income group: Within countries, poorer people have higher rates of injury-related deaths than wealthier people. Region: More than 90% of all injury-related deaths occur in lowand middle-income countries.

Nonfatal Consequences
Tens of millions of people who suffer nonfatal injuries require hospitalization, emergency department or general practitioner care, or treatment outside the health system. In addition to direct physical harm, those affected by injuries and violence may also experience a range of other mental and physical health consequences, including:
Anxiety and depression Risky behaviors (e.g. alcohol, tobacco, and other drug use;

unsafe sexual practices)

HIV, STDs, and unwanted pregnancies

Economic Costs
Along with the significant and often devastating physical, mental, and emotional consequences of injuries, those affected also experience considerable economic losses resulting from:
Cost of treatment

Reduced or lost productivity (e.g. in wages)

Road traffic crashes cost most countries between 1% 2% of their gross national product. The economic costs of road traffic crashes worldwide has been estimated at US$ 518 billion.

Guidelines for conducting community surveys on injuries and violence. WHO; 2004

VERBAL AUTOPSY
A two step procedure
Data collection : interview of bereaved relatives to

collect information on symptoms experienced by deceased before death, using some form of survey instrument
COD assignment : methods include physician review of VA data ICD certification, coding, and tabulation computerised algorithms for population fractions

Creating Safe Environments

A caregiver should
Know applicable safety practices for child care

Screen environment for hazards and remove

Use safety devices, where applicable Monitor for environmental hazards

 Know developmental levels of children Promote safety through action, word, and deed Role model safety practices to children and parents Be aware of conditions that contribute to injury Closely observe children, especially during

at-risk

conditions

Type of Environment
Child Care Centers

Child care centers governed by licensing Child care centers that are multi-use facilities Child care centers that are not subject to rules and regulations Family Child Care Homes In-Home Child Care

Behavior
By Child
Developmental level Emotions

Stress
Imitation

By Adult
Inattention
Lack of knowledge Lack of communication

Lack of safety precautions

Emotions Stress

Conditions
Where
Place Indoors/Outdoors

When
Time of day Tired, hungry, in a hurry

Modifications
Removal of hazards and use of safety devices Modify behavior using feedback, positive

reinforcement, diversion, role playing through practice drills

Monitoring
Ongoing process
Formalized Use checklists Study injury reports Observation is foremost activity monitoring

in

Implications for Caregivers

Role Modeling
Safe practices

Education
Caregivers Children Parents

Reality Check: Child Care Safety Checklist for Parents

Safe staff to child ratio

Child care training

Pay attention Avoid conflict

 Understand and avoid risks to health, safety, and

nutrition Use developmental appropriate practice Facility licensed or registered, if required Open door policy for parents