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18/04/231
UNINTENTIONAL CHILDHOOD INJURIES
Children's Health and the EnvironmentWHO Training Package for the Health Sector
World Health Organization
www.who.int/ceh
TRAINING FOR THE HEALTH SECTORTRAINING FOR THE HEALTH SECTOR [Date …Place …Event…Sponsor…Organizer] [Date …Place …Event…Sponsor…Organizer]
Unintentional childhood injuries
18/04/232
LEARNING OBJECTIVESLEARNING OBJECTIVES
1. What are childhood injuries?
2. Injuries and their classification
3. Burden of injuries among children
4. Environmental risk factors/settings
5. Why has so little action been taken?
6. The public health approach to injury prevention: Haddon’s matrix
7. What are effective interventions/measures to prevent unintentional child injury?
8. What can the health sector do?
Unintentional childhood injuries
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Injury is the main cause of death and a major Injury is the main cause of death and a major cause of ill health and disability in childhood cause of ill health and disability in childhood
Unintentional childhood injuries
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SOMESOME GENERAL PRINCIPLESGENERAL PRINCIPLES
Injuries are preventable:• “accident” versus “injury event”
Unintentional versus intentional injury
Injury prevention and control
Unintentional childhood injuries
18/04/235
INJURIES AND THEIR CLASSIFICATIONINJURIES AND THEIR CLASSIFICATION
UNINTENTIONAL
Road traffic injuries Poisoning Falls
Fires and burn injuries
Drowning
Other
INTENTIONAL
Interpersonal – Family/partner Intimate partner
Child abuseElder abuse
Interpersonal – community
AcquaintanceStranger
Self-directed -Suicidal behaviourSelf-harm
Collective violence – social, economic, political (war, gangs)
Unintentional childhood injuries
18/04/236
CATEGORIZINGCATEGORIZING INJURYINJURY
Severity (level of medical treatment required)
Setting (e.g. home, school, workplace, road)
Activity (e.g. sport, recreation, work)
Mechanism (e.g. fall, burn, dog bite, motor vehicle crash, drowning)
Intent (intentional, unintentional)
Nature of injury (e.g. fracture, burn)
Unintentional childhood injuries
18/04/238
GLOBAL FIGURESGLOBAL FIGURES
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
18/04/239
INJURIES AND "ACCIDENTS“INJURIES AND "ACCIDENTS“
Global figuresGlobal figures
Unintentional Unintentional injuries: injuries:
•About 2270 children About 2270 children die every day as a die every day as a result of an result of an unintentional injuryunintentional injury
•Survivors may Survivors may remain disabled remain disabled foreverforever
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
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MAGNITUDE OF THE PROBLEMMAGNITUDE OF THE PROBLEM
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
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INJURYINJURY PYRAMIDPYRAMID
Deaths
Injuries resulting in hospitalization
Injuries resulting in ambulatory and
emergency treatment
Injuries resulting in treatment inPrimary care settings
Injuries treated by paramedics only(school nurse, physiotherapist, first aid)
Untreated injuries or injuries which werenot reported
Unintentional childhood injuries
18/04/2313
INJURYINJURY DATA SOURCESDATA SOURCES
Source: adapted from Krug et al., eds., 2002.
Types of data and potential sources of information on violent events
Data category Potential data source
Mortality Death certificates, verbal autopsies, vital statistics registries, reports from mortuaries, medical examiners or coroners
Morbidity and health-related Hospital, clinic and medical recordsSelf-reported Surveys, focus groups, mediaCommunity-based Demographic records, local government
recordsLaw enforcement Police records, judiciary records, prison
records, crime laboratoriesEconomic-social Institutional or agency records,
special studiesPolicy or legislative Government and legislative records
Unintentional childhood injuries
18/04/2314
1) SurveillanceWhat is the Problem?
2) Risk FactorIdentification
What are the causes?
4) ImplementationHow is it done?
3) Develop andEvaluate interventions
What works?
PUBLIC HEALTH APPROACH TO INJURY PREVENTIONPUBLIC HEALTH APPROACH TO INJURY PREVENTION
Unintentional childhood injuries
18/04/2316
INJURYINJURY PREVENTIONPREVENTION
Types of injury and violence prevention:
Temporal - primary, secondary and tertiary
Targeted - universal, selective, indicated
Passive versus active
Unintentional childhood injuries
18/04/2317
Defining characteristics of the public health approach
Population-based Multidisciplinary Evidence-based Collective action Prevention
THE PUBLIC HEALTH APPROACH
Unintentional childhood injuries
18/04/2318
HADDON'S 10 BASIC STRATEGIESHADDON'S 10 BASIC STRATEGIES
1. Prevent creation of hazard2. Reduce amount of hazard3. Prevent release of hazard4. Modify the rate or distribution of hazard5. Separate (in space or time) hazard from that to be
protected6. Separate hazard from that to be protected with barrier7. Modify relevant basic qualities of hazard8. Make that to be protected more resistant to damage9. Counter damage already done by hazard10. Stabilize, repair and rehabilitate the object of the damage
Unintentional childhood injuries
18/04/2319
Host
(person)
Agent (vehicle or product)
Physical
environment
Socio-economic
environment
Pre-event
Is the person pre-disposed or overexposed to risk?
Is the agent hazardous?
Is the environment hazardous?Possibility to reduce hazards?
Does the environment encourage or discourage risk-taking and hazard?
Event
Is the person able to tolerate force or energy transfer?
Does the agent provide protection?
Does the environment contribute to injury during event?
Does the environment contribute to injury during event?
Post-event
How severe is the trauma or harm?
Does the agent contribute to the trauma?
Does the environment add to the trauma after the event?
Does the environment contribute to recovery?
THE HADDON MATRIXTHE HADDON MATRIX
Unintentional childhood injuries
18/04/2320
THETHE HADDON MATRIX APPLIEDHADDON MATRIX APPLIED FACTORS
PHASE Human Vehicles and equipment
Environment
Pre-crash Crash prevention
Information Attitudes
Impairment Police
enforcement
Roadworthiness Lighting Braking Handling
Speed management
Road design and layout
Speed limits Pedestrian
facilities
Crash Injury prevention
during crash
Use of restraints
Impairment
Occupant restraints Other safety devices
Crash-protective design
Crash-protective roadside objects
Post-crash
Life sustaining treatment
First aid skills Access to
medics
Ease of access Fire risk
Rescue facilities
Congestion
Source: WHO, 2004.
Unintentional childhood injuries
18/04/2321
INJURIES FROM ENVIRONMENTAL RISK FACTORSINJURIES FROM ENVIRONMENTAL RISK FACTORS
Road trafficRoad trafficFallsFallsBurnsBurnsDrowningDrowningPoisoningPoisoningAnimal-relatedAnimal-related
Unintentional childhood injuries
18/04/2322
ROAD TRAFFIC INJURIES ROAD TRAFFIC INJURIES DEFINITIONDEFINITION
Traffic-related injuries or road traffic injuries (RTI) are injuries due to any crash originating, terminating or involving a vehicle partially or fully on a public highway.
Unintentional childhood injuries
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INJURIES – ROAD TRAFFICINJURIES – ROAD TRAFFIC GLOBALGLOBAL BURDENBURDEN
Road traffic injuries are the
leading cause of death
among 10 to 19 year olds
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
18/04/2324
INJURIES – ROAD TRAFFIC - INJURIES – ROAD TRAFFIC - GLOBAL BURDENGLOBAL BURDEN
Unintentional childhood injuries
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• Environmental speed- unsafe roads- no signalisation- high density- multiple users
RISK FACTORS ASSOCIATED RISK FACTORS ASSOCIATED WITH ROAD TRAFFIC INJURIESWITH ROAD TRAFFIC INJURIES
• Individual- male gender, youth- substance abuse (youth)- speeding- not wearing seat-belts or helmets- sleep disorders- mobile phones- non-conspicuity of vulnerable road users- lack of experience
• Vehicle- absence of seat-belts- roadworthiness- vehicle size and centre of gravity- poor conspicuity
Unintentional childhood injuries
18/04/2326
ROAD TRAFFIC INJURIES CAN BE REDUCEDROAD TRAFFIC INJURIES CAN BE REDUCED
A rapid and significant reduction in road injuries can be achieved with political will and commitment
Requires a scientific approach:
the provision, careful analysis and interpretation of good data;
the setting-up of targets and plans; the creation of national and regional
research capacity;
institutional cooperation across sectors.
WHO
Unintentional childhood injuries
18/04/2327
INJURIES – FALLSDEFINITION
A fall is an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.
Within the WHO database fall-related deaths and non-fatal injuries exclude those due to assault and intentional self-harm. Falls from animals, burning buildings and transport vehicles, and falls into fire, water and machinery are also excluded.
www.who.int/violence_injury_prevention/unintentional_injuries/falls/falls1/en/WHO
Unintentional childhood injuries
18/04/2328
INJURIES DUE TO FALLS
WHO. World report on child injury prevention. 2008
Injury pyramid for fall-related injuries
among children 0–17 years
Unintentional childhood injuries
18/04/2329
HORSE – – RELATED INJURIES
Deaths are relatively uncommon
Hospital admission rate for equestrian injuries is 14/100,000 population, Victoria Australia
Highest hospital admission rate for equestrian injuries in Victoria is 68/100,000 for girls aged 10 -14
Hospital admitted paediatric rates are also high in the UK
Most serious injuries are to the head
UK horse-racing deaths per 100,000 rides: flat racing 419/100,000 rides; jumps racing 646/100,000 rides
Equestrian event riding has higher serious injury rates than general riding
Unintentional childhood injuries
18/04/2330
HORSE-RELATED INJURIES
Reduce risk factors by:
Use of correctly designed helmets, stirrups, shoes and tack
Adult supervision of young childrenAvoid standing where the horse may kickTraining of horses, riders and horse handlers
Unintentional childhood injuries
18/04/2331
CHILD DEVELOPMENT CHARACTERISTICS RELATED TO RISK OF INJURY
Age
groupDevelopmental characteristics* Link to injury area
Birth to 1 year
Reflexive & cannot control body movements
Reaches & mouths objects & imitates others
Becomes mobile, but with poor balance
Has limited ability to obey verbal commands
Can wiggle off tables and other surfaces; can get head or body stuck
Can choke, poison, cut, bruise, scald themselves; can get electric shock
Can fall, reach dangerous objects that can choke, cut, bruise, scald, shock
Cannot rely on verbal commands to avoid accidents
1 to 3 years old
Balance improves, learns to climb and run
Asserts independence Can play alone or with others &
engages in make believe play Can follow only simple directions
Can fall into unprotected accumulations of water, trip, reach dangerous objects that can choke, cut, bruise, scald, shock
Can attempt dangerous activities that are beyond their skill level
Cannot leave unsupervised Cannot rely only on verbal commands or
instruction to avoid accidents
*http;//childrenshosp-richmond.org/families/developmental
http://allpsych.com/psychology101/development.html
Unintentional childhood injuries
18/04/2332
CHILD DEVELOPMENT CHARACTERISTICS RELATED TO RISK OF INJURY
Age
groupDevelopmental characteristics* Link to injury area
3 to 4 years old
Increased mobility, climbing, running, more outdoor play
Asserts independence Curious, asks many questions Plays interactively with others, enjoys
make believe Improved cognitive & language skills Begins to understand relationships
between things
Can fall off playground equipment or other surface; can get head or body stuck
Tries to do more dangerous activities independently and during play with others, such as climbing, running (e.g., into street)
Can begin to understand danger and respond to warnings or commands; can learn routines (e.g., buckling up)
Caregivers may reduce supervision inappropriately (e.g. both working in fields)
5 to 14 years old
Continues developing independence Interacts with more adults (e.g., teachers)
in new settings Can think in concrete terms, and begins
developing abstract thinking skills Improves understanding of relationships
between things Experiences more new environments,
sports & recreation activities
Can fall off playground equipment or other surface; can get head or body stuck
Tries to do more dangerous activities independently and during play with others, such as climbing, running (e.g., into street)
Understands specific risks, but may not generalize to new situations
Supervision may vary across caregivers Can learn safety practices best through direct experience Inexperience with sports and inappropriate safety practices can
lead to injury (e.g., fractures, head injury)
*http;//childrenshosp-richmond.org/families/developmental
http://allpsych.com/psychology101/development.html
Unintentional childhood injuries
18/04/2333
Environmental Risk Factors of Fall Injuries in ChildrenLocation Environment factors
Stairs, furniture, outdoors
- Open access to top and bottom of stairs, balconies-Lack of protective railings on stairs, bridges- Use of baby walkers with wheels- Lapses in supervision
Windows - Windows left open in warm weather - Windows opened from the bottom instead of the top- Windows left open more than two inches- Expectation that screens will keep child from falling out
- Lapses in supervision and expectation that child cannot open window
Sports and recreation areas
-Equipment that is inappropriate for age of child- Safety equipment not available or not required - Unsafe, slippery, broken equipment - Unprotected rooftops used for playing- Streets with deep ditches and construction areas accessible to children- Hard/unforgiving surfaces- Lapses in supervision and unrealistic expectations about child’s ability
Bicycles - Lack of safe riding paths and lack of availability of bicycle helmets- Poor quality or poorly maintained bicycles- Lack of mandatory or universal helmet use- Hard/unforgiving surfaces
National Safe Kids, CDC/NCIPC, Barss et al,1998
Unintentional childhood injuries
18/04/2334
Prevention Strategies for Fall Injuries in Children
Injury cause
Prevention
countermeasure Stairs, furniture
Ensure stairs are well lit, have rails, maintained Use carpeting on flooring and buffer sharp edges on
furniture Never use baby walkers with wheels Closely supervise children on stairs; elevated
surfaces (e.g. dressing infants) Use straps to secure child in high chairs and on
changing tables
Windows Use window guards Open windows from the top only Move furniture away from windows Closely supervise children
Play areas Closely supervise children Install protective railings on roofs Avoid unsafe playgrounds with concrete, soil or
grass surfaces or broken equipment Use playground equipment appropriate for age of
child Fix and maintain unsafe ditches and surfacing
Bicycle Require helmet use Maintain bicycle in good working order Establish and maintain safe bike paths Enforce traffic safety laws related to bicycles
Barriers Facilitators
Inadequate knowledge
Unsupportive beliefs and myths
Time and inconvenience of addressing safety
High cost of products and equipment
Lack of product safety regulations
Inadequate social support
Lack of resources in the community
+ Provide free information and counter myths
+ Lower cost of safety products and improve access
+ Assist with installation of safety products
+ Organize community members to take action
+ Educate policy makers and decision makers
+ Advocate for funding and action
National Safe Kids, AAP, CDC/NCIPC, Barss et al,1998
Unintentional childhood injuries
18/04/2335
www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/
According to the International Society for Burn Injuries, a burn occurs when some or all of the different layers of cells in the skin are destroyed by a hot liquid (scald), a hot solid (contact burns) or a flame (flame burns).
Skin injuries due to ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage resulting from smoke inhalation, are also considered to be burns.
INJURIES – BURNS DEFINITION
Unintentional childhood injuries
18/04/2336
GLOBAL BURDEN OF BURNS
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
18/04/2337
By reducing hot water temperature, you minimize the risk of a scald burn…but you don’t eliminate it!
Time needed to produce serious burn
Water
temperature ADULTS CHILDREN
120oF (49oC) > 5 minutes About 3 minutes
125oF (52oC) 1 ½ to 2 minutes About 45 to 60 seconds
130oF (54oC) About 30 seconds About 15 seconds
135oF (57oC) About 10 seconds About 5 seconds
140oF (60oC) < 5 seconds About 2 ½ seconds
CHILDREN’S SKIN IS MORE VULNERABLE
Unintentional childhood injuries
18/04/2339
ENVIRONMENTAL RISK FACTORS OF BURN INJURIES IN CHILDREN
LocationLocation Environment factors Environment factors
Home Home environmentenvironment
- use of candles, lanterns, fires, kerosene, gas use of candles, lanterns, fires, kerosene, gas heaters and portable stovesheaters and portable stoves
- location and lack of enclosures for open fires, location and lack of enclosures for open fires, flames, hot potsflames, hot pots
- hot water temperatureshot water temperatures
- lack of exits, functioning smoke alarmslack of exits, functioning smoke alarms
- poor quality, flammable construction and poor quality, flammable construction and furnishingsfurnishings
ProductsProducts - flammable, loose fitting clothingflammable, loose fitting clothing
- fireworksfireworks
- lighters that are not child resistantlighters that are not child resistant
- toxicity of materials used in furnishings toxicity of materials used in furnishings Barss et al, 1998www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/index1.html
Unintentional childhood injuries
18/04/2340
BURN PREVENTION
Raising or enclosing cooking areas Raising or enclosing cooking areas Electrification to reduce dependence on candles and kerosene Electrification to reduce dependence on candles and kerosene Safe stove design Safe stove design Improved house construction Improved house construction Installation and maintenance of smoke alarms and sprinkler Installation and maintenance of smoke alarms and sprinkler
systems systems Education about prevention and first-aid management of burns Education about prevention and first-aid management of burns Water temperature regulation Water temperature regulation Flame retardant fabrics Flame retardant fabrics
www.who.int/violence_injury_prevention/unintentional_injuries/burns/burns2/en/index1.htmlBarss et al, 1998
Unintentional childhood injuries
18/04/2341
Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity.
INJURIES - DROWNINGDEFINITION
Unintentional childhood injuries
18/04/2342
FACTS ABOUT DROWNING AND CHILDRENFACTS ABOUT DROWNING AND CHILDREN
Among the various age groups, children under five years of age have the highest drowning mortality rates worldwide (Exception: New Zealand and Canada).
Drowning is the leading cause of injury death to children aged 1-14 years in China
In Bangladesh, 20% of all deaths in children aged 1-4 years are due to drowning
Drowning was the second leading cause of unintentional injury death in children aged 1-14in the United States in 2000.
Drowning is the leading cause of unintentional injury death in children aged 1-3 in every Australian state.
Drowning in young children is often associated with a lapse of supervision.
Unintentional childhood injuries
18/04/2343
INJURIES - DROWNING
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
18/04/2344
CHILD DROWNING DEATHS IN CHINA, 2001CHILD DROWNING DEATHS IN CHINA, 2001
Age Urban rate* Percentageof all child
injury deaths
Rural rate* Percentageof all child
injury deaths1-4 4.25 42.74 19.34 60.665-9 1.85 44.47 16.82 59.39
10-14 1.38 44.47 13.98 54.63* All rates per 100,000 people
Source: Ministry of Health People's Republic of China
Unintentional childhood injuries
18/04/2345
Environmental risk factors
Floods Transportation (vessels) Water containers Bath tubs Recreation (pools, ponds, lakes)
These are also risk factors for electrocution!!!!
RISK FACTORSRISK FACTORS
Other risk factors
Gender Age Occupation Alcohol Epilepsy Socioeconomic status
Unintentional childhood injuries
18/04/2346
DROWNINGDROWNING PREVENTIONPREVENTION
Remove the hazard
Create barriers
Protect those at risk
Counter the damage
WHO
Unintentional childhood injuries
18/04/2347
INJURIES – POISONING
Epidemiology of child poisoning 0-4 years
Peak age for child poisoning is 0-4 years Child unintentional poisoning is a major cause of child death in
low and middle income countries Deaths are now uncommon in high income countries Hospital admission rates remain high in high income countries Poisoning agents vary between countries and over time Agents are generally ingested Girls are over-represented in poisoning deaths in some regions
Unintentional childhood injuries
18/04/2348
GLOBAL POISONING MORTALITY
WHO. World report on child injury prevention. 2008
Unintentional childhood injuries
18/04/2349
RISK FACTORS FOR CHILD POISONING
Small mass of child affects size of toxic dose Crawling infants access agents at, or near, floor level (eg
rodenticides) After 12 months, serious exposures most often involve
pharmaceuticals in high income countries Children ingest agents that are readily accessible Older siblings may administer medications to younger children Children are attracted by the appearance of many poisonous
agents and plants In high income countries most ingestions occur in the home
Unintentional childhood injuries
18/04/2351
COMMON CHILD POISONING AGENTSExamples by country and time
Agent Country Years
Rodenticides China 1990s
Paraffin South Africa 1990s
Paracetamol (acetaminophen)
Australia 1990s
Tobacco (< 2 years) Norway 1990-1993
Aspirin High income countries
Pre-1980s
Unintentional childhood injuries
18/04/2352
AVAILABLE COUNTERMEASURES
Child resistant packaging closures foil strips “mousers” other protective packaging (e.g. mothballs)
Child resistant storage
Regulatory control
Unintentional childhood injuries
18/04/2353
CHILD RESISTANT PACKAGING
Pharmaceuticals
Joan Ozanne-Smith
Unintentional childhood injuries
18/04/2354
Domestic chemicals
CHILD RESISTANT PACKAGING
Joan Ozanne-Smith
Unintentional childhood injuries
18/04/2356
POISONING MEDICAL MANAGEMENT
Toxicology databases available electronically
Poisons Information/Control Centres provide telephone advice and triage in many countries To the public Restricted to medical practitioners (U.K.)
Medical assessment using best practice protocols
Blood levels if indicated (e.g. paracetamol/ acetaminophen). Antidotes, chelating agents, activated charcoal, symptomatic treatment
Unintentional childhood injuries
18/04/2357
EXERCISE
PREVENTION Host Agent Environment
Pre-event
Event
Post-event
Haddon’s matrix
Unintentional childhood injuries
18/04/2358
ANSWER NOTESHaddon’s matrix
PREVENTION Host Agent Environment
Pre-event
Teach children not to help themselves to food or drink
Package small volumes Package low concentrations Child resistant closures Other child resistant designs Label clearly to avoid dosage errors
Parental, caregiver, professional education re: poisoning prevention Safe storage places Toxicology databases updated and readily available to relevant professionals Doctors, pharmacists, retailers warn of toxicity to children
Event
Supervision of children
Post-event
Seek advice from label, Poisons Information Centre, doctor or Emergency Department
Information from package and amount remaining identified
Details of poisoning events detailed in injury surveillance databases
Unintentional childhood injuries
18/04/2359
INJURIES - ANIMAL INVOLVEMENT
Attack/bite (dog, crocodile, shark, other wild animal) Envenomation (snakes, scorpions, spiders, sea
creatures) Fall from animal being ridden (most commonly horse) Transport related Crushed by animal (domestic) Allergic response to bee/wasp stings Disease carried by attacking animal (rabies, malaria,
etc) Consumption of poisonous creatures
Unintentional childhood injuries
18/04/2360
INJURIES - DOG ATTACKS
Death rate in United States: about 0.06/100,000
Rate in US is highest for infants
Hospital admission rate is 7.7/100,000 Australia, 2.6/100,000 Canada
Highest hospitalisation rate 0-4 years of age, then 5-9 years
Bites to face, scalp predominate for child; upper extremity for adults
Associated rabies occurs in 0.81/100,000 population Delhi, India (higher rate for 5-14 years of age)
Large number of rabies vaccine treatments is reported for Thailand
Unintentional childhood injuries
18/04/2361
DEVELOPING COUNTRY EXAMPLE
Child dog-bite in Vietnam
Proportion of all child animal bites 79.5%
Proportion of children hospitalised for animal bite injuries
61%
Proportion of severe child animal bite injuries
61%
Source: Report to UNICEF on the Vietnam Multi-Center Injury Survey. The Vietnam Public Health Research Network
Unintentional childhood injuries
18/04/2362
RISK FACTORS FOR DOG BITE Children, especially 0-5 yearsHouseholds with dogsCertain dog breeds and dog characteristicsChildren and the elderlyGender (males over-represented)Alcohol consumptionMale dogsVictim known to the dogHome location, especially
for children
WHO
Unintentional childhood injuries
18/04/2363
PREVENTION OF DOG ATTACKS
Prevention:
Reduce exposure to dogs by Avoid dog ownership in households with young children Avoid owning inappropriate breeds Dog regulations enforced (registration, leashes)
Public education: Never leave a young child alone with a dog All dogs should be socialized to accept children
Unintentional childhood injuries
18/04/2364
SNAKE BITE: GLOBAL ESTIMATES
Annually: More than 5 million cases
More than 50,000 deaths (registered)
400,000 amputations
Rates of bites as high as 600/100,000 for persons active in the rainforests of French Guiana
Envenomation reported in 17% of bites (Gabon)
Lethality varies between countries from 1% of bites to 15%
Unintentional childhood injuries
18/04/2365
SNAKEBITE
Prevention:
Reduce exposure to snakes by use of Protective clothing Culling/eradication in high risk areas
Improved access to early medical treatment and anti-venom
Unintentional childhood injuries
18/04/2366
SNAKEBITE:EXAMPLE OF PREVENTION IN SOUTH-EAST ASIA
Snakebite occurs more frequently in Sri Lanka than anywhere else in the world.
Public education campaigns were undertaken by the National Poisons Information Centre, Colombo, Sri Lanka
Stressing need to attend hospital without delay after a snake bite, Teaching people that pharmaceuticals are more effective than
traditional medicines for treating snake bites.
Public education campaigns from mid 1980s to mid 1990s, associated with a five-fold increase in hospital admissions due to snake bites, a reduction in mortality from 3.7% to less than 1%, and a reduction in morbidity.
Unintentional childhood injuries
18/04/2367
SCORPION STING
Widespread public health problem (e.g. Saudi Arabia, Israel, Algeria, Sub-Saharan Africa)
Of paediatric cases in Niger, 23% are fatal
Israel: 13% non-symptomatic; 72% mild; 15% moderate to severe
Anti-venom is available
Unintentional childhood injuries
18/04/2368
SCORPION STING: EXAMPLE OF PREVENTION IN NORTHERN AFRICA
Prevention programme undertaken by the Moroccan Centre Anti Poisons
Scorpion venom acts very quickly (within 24–48 hours), most stings occur in rural areas, a long way from health services.
At the time: no effective antivenom, physician’s undergraduate training did not include of effective treatment
for scorpion stings.
Centre organized training programmes addressed to health professionals.
It also produced and distributed a leaflet for the public describing how to prevent stings and what action should be taken in case of sting.
Prospective studies and retrospective studies of poisoning cases were undertaken in the main cities affected.
Unintentional childhood injuries
18/04/2369
JELLYFISH AND FISH STINGS
Fish stings (including stingray): small case series are reported from many countries, with few deaths
Hot water immersion relieves symptoms
Compression immobilization bandages may be counter-productive
Jellyfish stings: the response is generally hyper-sensitivity/anaphylaxis, with few deaths
Unintentional childhood injuries
18/04/2370
OTHER PREVENTIVE MEASURES
Jellyfish: warnings when prevalent, close beaches, netting-off “safe” swimming areas
Programs to prevent scorpion proliferation
Professional removal of bee hives and destruction of wasp nests in residential environs
Warning signage in wild animal habitats (crocodiles)
Wearing of protective gloves, footwear and clothing is recommended when handling fish
Unintentional childhood injuries
18/04/2371
VENOMOUS ANIMALS AND PLANTS
ICD-10 CODE
ICD-9 CODE
DESCRIPTION
X20 E905.0 Contact with venomous snakes and lizards
X21 E905.1 Contact with venomous spiders
X22 E905.2 Contact with scorpions
X23 E905.3 Contact with hornets, wasps and bees
X24 E905.4 Contact with centipedes and venomous millipedes (tropical)
X25 E905.5 Contact with other specified arthropods
X26 E905.6 Contact with venomous marine animals
X27 E905.7 Contact with other specified venomous animals
X28 Contact with other specified venomous plants
X29 Contact with other unspecified venomous animal or plant
E905.8 Other specified
E905.9 Other unspecified
Unintentional childhood injuries
18/04/2372
MEDICAL MANAGEMENT
Alerting mechanisms and access to medical careIdentification of animal involvedUse of anti-venom as indicatedControl bleeding and treat blood lossesAntidotes as availableManagement of allergic responsesSymptomatic management as requiredRabies vaccine in endemic regionsHot water immersion for stingray and jellyfish stings
Unintentional childhood injuries
18/04/2373
FUTURE DIRECTIONS FOR INJURY PREVENTION
Collection and dissemination of data Utilization of the full range of ICD injury codes Public health response Inter-sectoral collaboration Educate community and health workers on the
need for immediate and adequate post-exposure treatment
Research
Unintentional childhood injuries
18/04/2374
WHY SUCH LIMITED ACTION ON INJURIES?WHY SUCH LIMITED ACTION ON INJURIES?
Perception of injuries as ‘accidents’ - unpredictable and inevitable
Data hidden by place of occurrence, age, sex Lack of acknowledgement of what can be done Lack of ownership Multi-sectoral complexity Capacity to make the problem more visible Civil society organisations Loss of state regulations & enforcement after transition Donor priorities
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STRATEGIES OF INJURY INTERVENTION
Environmental, engineering designsEnforcement, legislative mandatesEducation, behaviourEconomic incentive, equityEmpowermentEvaluation
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CONSEQUENCES OF INJURIES
Large amount of disabilities
- Injuries to extremities- Traumatic brain injuries- Spinal cord injuries
Rehabilitation efforts
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STRATEGIES OF INJURY INTERVENTION
Cost benefit analyses have shown that injury prevention is value for money (European data):
• € 1 spent on smoke alarms saves € 69; • € 1 on child safety seats saves € 32; • € 1 spent on bicycle helmets saves € 29; • € 1 spent on prevention counselling by paediatrician
saves € 10
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MANY APPROACHES, ONE GOAL
• Collect and analyze data on injuries
• Evaluate risk factors
• Inform, educate, change behaviours
• Make environments safer
Prevention
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THE INTER-DISCIPLINARY NATURE OF INJURY STUDIES
Economics
Injury prevention
Law
Social sciences Healthsciences
Public health
Engineering
Education
Environment
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DIFFERENT ROLESDIFFERENT ROLES
Roles of:
Government
Industry
Donor organizations
Communities and individuals
Implementing proven interventions could save MORE THAN 1000 children's lives per day
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APPLYING KEY APPROACHES WILL SAVE CHILDREN'S LIVES
WHO. World report on child injury prevention. 2008
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POINTS FOR DISCUSSIONPOINTS FOR DISCUSSION
What data sources could you use to determine the injury burden in your country?
What sectors would you involve in setting up a injury prevention plan?
Is Haddon’s matrix useful in developing prevention programmes?
What role does civil society have to play and how could you help them get involved?
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First draft prepared by Leda E. Nemer, Kathrin von Hoff, Dinesh SethiSeveral slides were kindly provided by the WHO/VIP department, TEACH VIP user's
manual (and the WHO World Report on Child Injury Prevention, 2008)
With the advice of the Working Group on Training Package for the Health Sector: Cristina Alonzo MD (Uruguay); Yona Amitai MD MPH (Israel); Stephan Boese-O’Reilly MD MPH (Germany); Stephania Borgo MD (ISDE, Italy;) Irena Buka MD (Canada); Lilian Corra MD (Argentina) PhD (USA);; Amalia Laborde MD (Uruguay); Ligia Fruchtengarten MD (Brazil); Leda Nemer TO (WHO/EURO); R. Romizzi MD (ISDE, Italy); Katherine M. Shea MD MPH (USA).
Reviewers: Argo Soon, Ludwine Casteleyn, Joanne Vincenten, Francesca Racioppi (European Child Safety Alliance, Eurosafe)
WHO CEH Training Project Coordination: Jenny Pronczuk MDMedical Consultant: Ruth A. Etzel MD PhD Technical Assistance: Marie-Noel Bruné MSc
Last update – December 2009
ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
WHO is grateful to the US EPA Office of Children’s Health Protection for the WHO is grateful to the US EPA Office of Children’s Health Protection for the financial support that made this project possible and for some of the data, graphics financial support that made this project possible and for some of the data, graphics
and text used in preparing these materials.and text used in preparing these materials.
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The contents of this training module are based upon references available in the published literature as The contents of this training module are based upon references available in the published literature as of June 2004. Users are encouraged to search standard medical databases for updates in the science of June 2004. Users are encouraged to search standard medical databases for updates in the science for issues of particular interest or sensitivity in their regions and areas of specific concern.for issues of particular interest or sensitivity in their regions and areas of specific concern.
If users of this training module should find it necessary to make any modifications (abridgement, If users of this training module should find it necessary to make any modifications (abridgement, addition or deletion) to the presentation, the adaptor shall be responsible for all modifications made. addition or deletion) to the presentation, the adaptor shall be responsible for all modifications made. The World Health Organization disclaims all responsibility for adaptations made by others. All The World Health Organization disclaims all responsibility for adaptations made by others. All modifications shall be clearly distinguished from the original WHO material.modifications shall be clearly distinguished from the original WHO material.
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