UNICEF's child injury league tables: a bag of mixed messages

Preventing unintentional childhood injury at home: injury circumstances and interventions

New Zealand's (NZ) preschoolers carry the greatest injury burden among children aged 0-14 years. These injuries commonly occur at home. To identify how NZ addresses child injury the 1990s national injury datasets and associated free text were examined retrospectively, NZ injury circumstances and interventions were compared to internationally recognised hazards and best practice, and whether NZ interventions addressed common circumstances of injury was assessed. Certain injuries, often associated with activities of daily living, were not addressed by interventions, although most interventions advocated internationally are implemented in NZ. Possible reasons for main injuries not being addressed were the specificity and variable effectiveness of interventions, normality of many injury circumstances, difficulties in evaluating complex environments, and the need for active intervention. There is considerable scope for NZ to improve its child safety. It is unlikely that simple solutions will be found for complex circumstances in which injury events occur. Strategies to address multifaceted problems requiring changes to personal, social and societal factors are required, with evaluation methods able to match their complexity.

Leadership, infrastructure and capacity to support child injury prevention: can these concepts help explain differences in injury mortality rankings between 18 countries in Europe?

BACKGROUND

Mortality and morbidity rates, traditionally used indicators for child injury, are limited in their ability to explain differences in child injury between countries, are inadequate in capturing actions to address the problem of child injury and do not adequately identify progress made within countries. There is a need for a broader set of indicators to help better understand the success of countries with low rates of child injury, provide guidance and benchmarks for policy makers looking to make investments to reduce their rates of fatal and non-fatal child injury and allow monitoring of progress towards achieving these goals. This article describes an assessment of national leadership, infrastructure and capacity in the context of child injury prevention in 18 countries in Europe and explores the potential of these to be used as additional indicators to support child injury prevention practice.

METHODS

Partners in 18 countries coordinated data collection on 21 items relating to leadership, infrastructure and capacity. Responses were coded into an overall score and scores for each of the three areas and were compared with child injury mortality rankings using Spearman's rank correlation.

RESULTS

Overall score and scores for leadership and capacity were significantly negatively correlated to child injury mortality ranking.

CONCLUSIONS

Findings of this preliminary work suggest that these three policy areas may provide important guidance for the types of commitments that are needed in the policy arena to support advances in child safety and their assessment a way to measure progress.

How exposure information can enhance our understanding of child traffic "death leagues"

OBJECTIVES

To explore whether population-based fatality rates and measures of traffic exposure can be combined to provide a more comprehensive measure of safety. To illustrate how this could be achieved using surveys from a range of Organisation for Economic Cooperation and Development (OECD) countries. To discuss why exposure is important.

DESIGN AND SETTING

Fatality data were obtained from the International Road Traffic and Accident Database and travel data from surveys among government transport administrations in each country.

METHODS

Comparable exposure data were obtained for children aged 10-14 years from the UK, the USA, Germany, The Netherlands, Norway, Sweden, Switzerland and New Zealand. Fatality rates for children travelling as pedestrians, cyclists and car occupants were calculated based on (1) per head of population and (2) a combination of rate per head population and per kilometre travelled.

RESULTS

In this study, exposure-based fatality rates suggest a more polarized distribution rather than a graduated league. The USA and the UK were at the lower end of the table for child pedestrian safety; Germany for car-occupant safety, Sweden and New Zealand performed less well. For cycling, the inclusion of exposure data considerably changes positions within the table. Countries with higher cycling levels like The Netherlands perform better than those with low levels like the UK and New Zealand.

CONCLUSIONS

Exposure-based fatality rates can help us to understand whether policies reduce exposure or whether they increase safety, given a similar level of exposure. Data need to be harmonized across OECD countries for a better understanding of the risks and links between health and sustainable travel.

Incidence and Nature of Farm-related Injuries among Children Aged 6-15 during a 10-year Period in One Region in Poland

The health risks among children in "new" and "old" members of the European Union seem to be different. Farms are the most frequent place of injuries among children living in rural areas in Poland. Our aim is to present data on the farm-related injuries conditions among children aged 6-15 in one large region in Poland. The analysis has been made on the basis of information collected from the Farmers' Insurance Fund in Włocławek, which registers all farm-related injuries reported within the Włocławek Province. Over the 10-year study period 449 injuries were recorded (1.29 injuries per 1000 person-years). Among all victims there were 132 girls (29.4% of the total) and 317 boys. 14-year-old children fell victims of injuries most frequently (20.0% of all injuries). The highest number of injuries was recorded during the summer season. The injuries resulted mainly from falls or slips (47.2%) and falling from high altitudes (22.9% of all injuries). Individual and unattended works accounted for 37.5% of cases while 30.4% of all injuries happened while children were assisting in the work performed by adults. The sites were farm facilities (29.0%), farmyard (23.8%), around farm facilities (13.1%), pastures and meadows (11.1%), fields (9.1%), roads leading to houses or farm facilities (7.6%) and home (6.2%). We conclude that 13-15-year-old boys falling during an individual unattended work or while assisting in the work performed by adults, inside and around farm facilities, and during summer months, were the most frequent victims of injuries on farms. Information obtained in this study may be helpful in developing and implementing injury prevention strategies tailored to the Central-Eastern European agricultural realities.

Paediatric trauma at an adult trauma centre

BACKGROUND

Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).

METHODS

A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.

RESULTS

A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks-15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1-75) and there were three deaths. Forty-two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.

CONCLUSIONS

The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long-term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.

UNICEF's child injury league table. An analysis of legislation: more mixed messages

This paper presents a summary table and discussion of legislation related to child injury prevention in member countries of the Organisation for Economic Cooperation and Development. The table is an expanded version of the one which appeared in the UNICEF Report Card "Child Deaths by Injury in Rich Countries" (2001). A commentary is provided on the variations in legislation between countries in terms of range and form of measures and an estimate of degree of enforcement. As legislation is generally considered a powerful tool in injury prevention, the paper examines whether those countries with the widest range of legislation and the strongest enforcement have made the most progress in reducing child injury deaths since the 1970s. It also considers whether a commitment to extensive legislation is reflected in a country's position in the UNICEF league table of injury death. The initial conclusion to these two basic issues is that no clear picture can be seen and we thus need to know far more about the relationship between legislation and societies and cultures as they vary from place to place. This paper hopes to stimulate more widespread debate about the role of legislation in different countries.