Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Home safety hazards associated with unintentional poisoning among children aged 0-5 years in Mongolia: A case-control study

OBJECTIVE

To examine the association between home safety hazards and unintentional poisoning in children in Mongolia.

METHODS

We conducted a case-control study using structured questionnaires to investigate safety behaviours, safety equipment use, and home hazards in households with or without children aged 0-5 years who had suffered from poisoning at home (i.e., cases and controls). We recruited 190 cases (105 medicinal and 84 non-medicinal poisonings, and one each) at the National Center for Maternal and Child Health and 379 controls in the communities between 1 March and 30 October 2021.

RESULTS

There were large differences between cases' and controls' households in safety behaviours and home hazards: the failure to store all medicines out of reach of children (68% of cases vs. 25% of controls), the failure to store all medicines safely (out of reach, locked or non-existent) (61% vs. 22%), the failure to put all medicines away immediately after use (77% vs. 43%), the presence of things that a child could climb on to reach high surfaces (82% vs. 67%), the presence of medicines transferred into different containers (28% vs. 9%) and the presence of household products transferred into different containers (28% vs. 16%). These home safety hazards were strongly associated with poisoning after controlling for confounders.

CONCLUSION

Children's risk of unintentional poisoning was strongly associated with the unsafe storage of potentially poisonous agents by caregivers and home hazards. Since unsafe storage is widespread, a fail-safe approach such as child-resistant closure of medicines and household products should be considered.

Effectiveness of systematically delivered evidence-based home safety promotion to improve child home safety practices: a controlled before-and-after study

OBJECTIVE

Evaluate the effectiveness of systematically delivered evidence-based home safety promotion for improving child home safety practices.

DESIGN

Controlled before-and-after study.

SETTING

Nine electoral wards in Nottingham, UK.

PARTICIPANTS

361 families with children aged 2-7 months at recruitment living in four intervention wards with high health, education and social need; and 401 in five matched control wards.

INTERVENTION

Evidence-based home safety promotion delivered by health visiting teams, family mentors and children's centres including 24 monthly safety messages; home safety activity sessions; quarterly 'safety weeks'; home safety checklists.

OUTCOMES

Primary: composite measure comprising having a working smoke alarm, storing poisons out of reach and having a stairgate. Secondary: other home safety practices; medically attended injuries. Parents completed questionnaires at 12 and 24 months after recruitment plus optional three monthly injury questionnaires.

RESULTS

At 24 months there was no significant difference between groups in the primary outcome (55.8% vs 48.8%; OR 1.58, 95% CI 0.98 to 2.55) or medically attended injury rates (incidence rate ratio 0.89, 95% CI 0.51 to 1.56), but intervention families were more likely to store poisons safely (OR 1.81, 95% CI 1.06 to 3.07), have a fire escape plan (OR 1.81, 95% CI 1.06 to 3.08), use a fireguard or have no fire (OR 3.17, 95% CI 1.63 to 6.16) and perform more safety practices (β 0.46, 95% CI 0.13 to 0.79).

CONCLUSIONS

Systematic evidence-based home safety promotion in areas with substantial need increases adoption of some safety practices. Funders should consider commissioning evidence-based multicomponent child home safety interventions.

TRIAL REGISTRATION NUMBER

ISRCTN31210493.

Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review

INTRODUCTION

Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value.

SOURCE OF DATA

Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science.

AREAS OF AGREEMENT

The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health.

AREAS OF CONTROVERSY

The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges.

GROWING POINTS

The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money.

AREAS TIMELY FOR DEVELOPING RESEARCH

Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.

Aspiring toward Pae Ora: Values and strengths-based child safety messaging in Aotearoa/New Zealand

On-going inequities in rates of fatal and non-fatal injury between tamariki Māori (Indigenous children) and non-Māori children in Aotearoa (New Zealand) are unacceptable and highlight breaches by the Crown in their obligations to Māori, outlined in Te Tiriti o Waitangi (The Treaty of Waitangi). Safekids Aotearoa, a national organisation tasked with reducing unintentional injuries to children (0-14 years), is shifting the focus of its programmes and resources to better align with Te Tiriti o Waitangi and to honour Māori knowledge, ideas and principles to eliminate inequity and support the pursuit of Pae Ora: Māori health aspirations for flourishing whānau (families) and tamariki. We provide an overview of Te Tiriti o Waitangi and its relevance to child injury prevention and the Te Tiriti-led response by Safekids Aotearoa, particularly around approaches to developing values and strengths-based safety messages. In doing so, we challenge and counter pervasive barriers to achieving equity and Pae Ora and describe how identifying and incorporating shared Māori values in a Te Tiriti-led agenda supports the work, ethos, programmes and relationships of Safekids Aotearoa in its journey toward equitable outcomes and Pae Ora for all. We highlight the importance of embedding prevention efforts and advocacy within a holistic framework of tamariki and whānau well-being embracing capability and strengths-based approaches.

Contribution of the Technical Efficiency of Public Health Programs to National Trends and Regional Disparities in Unintentional Childhood Injury in Japan

To achieve the Sustainable Development Goals, strengthening investments in health service inputs has been widely emphasized, but less attention has been paid to tackling variation in the technical efficiency of services. In this study, we estimated the technical efficiency of local public health programs for the prevention of unintentional childhood injury and explored its contribution to national trend changes and regional health disparities in Japan. Efficiency scores were estimated based on the Cobb-Douglas and translog production functions using a true fixed effects model in a stochastic frontier analysis to account for unobserved time-invariant heterogeneity across prefectures. Using public data sources, we compiled panel data from 2001 to 2017 for all 47 prefectures in Japan. We treated disability-adjusted life years (DALYs) as the output, coverage rates of public health programs as inputs, and caregivers' capacity and environmental factors as constraints. To investigate the contribution of efficiency to trend changes and disparities in output, we calculated the predicted DALYs with several measures of inefficiency scores (2001 average, yearly average, and prefecture-year-specific estimates). In the translog model, mean efficiency increased from 0.62 in 2001 to 0.85 in 2017. The efficiency gaps among prefectures narrowed until 2007 and then remained constant until 2017. Holding inefficiency score constant, inputs and constraints contributed to improvements in average DALYs and widened regional gaps. Improved efficiency over the years further contributed to improvements in average DALYs. Efficiency improvement in low-output regions and stagnated improvement in high-output regions offset the trend of widening regional health disparities. Similar results were obtained with the Cobb-Douglas model. Our results demonstrated that assessing the inputs, constraints, output, and technical efficiency of public health programs could provide policy leverage relevant to region-specific conditions and performance to achieve health promotion and equity.

Safety Education for Children Cannot Stop for a Pandemic: Transitioning an Injury Prevention Program to a Virtual Format

In-person safety programs for pre-kindergarten children were not able to go on in their usual way during the summer of 2020 due to the Covid-19 pandemic. While some communities opted to cancel the programs, one organization in Northwest Ohio chose to reformat it, knowing that this education is a critical introduction to lifelong safety habits. Through social media, video-taped education from community safety professionals, and activity packets given to registrants, "Safety City" was able to go on. The new format incorporated all of the childhood safety topics normally presented in the live version of the program. The efforts described here indicate that it is feasible to alter presentation formats from in-person to virtual to connect even young children with important education. As such, similar programs needing to make this transition while the world continues to adjust to pandemic precautions may benefit from understanding the strengths, limitations, and insights from the process.