Accident prevention and poverty

www.makingthelink.net

Accident prevention and poverty

Mike HayesChild Accident Prevention Trust

Unintentional Injury and Safeguarding Children

Monday 29th October 2012


About CAPT

CAPT is a national charity committed to reducing the number of children and young people who are killed, disabled or seriously injured as a result of accidents.

CAPT provides training, publications, consultancy and information services

CAPT runs Child Safety Week – community education campaign, raising awareness of serious childhood accidents & how to prevent them


CAPT’s philosophy

We aim to create a safer environment in which children and young people can live, learn and play

We understand that experimenting and risk-taking are part of growing up

We do not want to secure low injury rates at the expense of children’s health and quality of life



What are the consequences of injury?

Pain (from injury or subsequent treatment)Fear / anxietyPhysical disabilityEmotional effectsEducation – loss of schoolingDisruption to usual routine (social)Family stress and breakdownFinancial costs - to family, NHS and emergency services


Bradford data:source of information

Child and Maternal Health Observatory (ChiMat) accident prevention report – published last Friday

http://tinyurl.com/chimat-accidents

http://tinyurl.com/chimat-accidents


Hospital admissions for unintentional injuries: rate per 10,000 population (2010-11)

Bradford Yorkshire and The Humber

England0

20

40

60

80

100

120

140

160

180

Under 5s

5-17 years


Hospital admissions for falls: rate per 100,000 population (2008/9-2010/11)


England0

100

200

300

400

500

600

700

800

Under 5s5-16 years


Hospital admissions for burns and scalds: rate per 100,000 population (2006/7-2010/11)


England0

2

4

6

8

10

12

14

Under 5s5-16 years


Hospital admissions for burns and scalds - under 5s: rate per 100,000 population (2006/7-2010/11)

West Yorkshire councils

Bradford Calderdale Kirklees Leeds Wakefield Yorkshire and The Humber

England0

2

4

6

8

10

12

14


Deaths due to unintentional injuriesEngland and Wales, 1979 - 2010

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

0

200

400

600

800

1000

1200

Under 15

Under 5

No.

of d

eath

s


Downward trend

Why? Safety education, awareness-raising Increased child restraint and seat belt use and

improved vehicle design Increased smoke alarm ownership Safer (and new) consumer products Improvements in medical care Changes in child behaviour, reducing exposure

to hazards


Selected causes of death due to unintentional injuries by age, England and Wales, 2010

< 1 1–4 5–9 10–14 0-14 0-14 0-4 1-14

All accidents

M 15 33 19 43 110172 83 147

F 10 25 11 16 62

FallsM 2 1 - 1 4

6 4 4F - 1 - 1 2

Inanimate mechanical forces

M - 1 - 2 34 1 4

F - - 1 - 1

DrowningM 1 7 4 3 15

22 12 21F - 4 - 3 7

Other threats to breathing

M 7 13 3 11 3450 33 34

F 9 4 - 3 16


On average, one child in five is taken to hospital after an accident each year


Rates of death and injury due to accidents

For every death there are about 550 hospital admissions 10,500 A&E attendances.

10 admissions per 1,000 children 184 A&E attendances per 1,000 children 1 child in every 5.4 attends A&E annually About 5% of A&E attendances result in admission


Death rates per year per 100 000 children aged 0-15 years by eight class NS-SEC, 2001-3, England and Wales

Source: Edwards P, Green J, Roberts I, Lutchmun S, BMJ, 2006;333;119-123

Never worked/long term unemployed

Routine occupations

Semi-routine occupations

Lower supervisory/technical occupations

Small employers/own account workers

Intermediate occupations

Lower managerial/professional occupations

Higher managerial/professional occupations

0 5 10 15 20 25 30

25.4

5.0

4.0

2.7

2.9

2.9

1.6

1.9


Injury mortality rates by social class

Unskilled

Partly skilled

Manual skilled

Non-manual skilled

Managerial

Professional

0 10 20 30 40 50 60 70 80 90

83

38

34

19

16

17

European age standardised mortality rate per 100,000 population

Source: I Roberts and C Power (1996), BMJ Vol 31.3


Hospital admissions and inequalities

Hippisley-Cox J, Groom L, Kendrick D, Coupland C, Webber E, et al. (2002) Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992–7. British Medical Journal 324: 1132–1134.

http://www.bmj.com/content/324/7346/1132

http://www.bmj.com/content/324/7346/1132


Hospital admissions and inequalities

The total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation

These gradients were more marked for 0 4 year old children than 5 14 year olds

The steepest socioeconomic gradients were for pedestrian injuries (adjusted rate ratio 3.65) burns and scalds (adjusted rate ratio 3.49) poisoning (adjusted rate ratio 2.98)


Risk factors using GP records

Orton E, Kendrick D, West J, Tata LJ (2012) Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data. PLoS ONE 7(4): e35193.

http://tinyurl.com/orton-paper > 180,000 records from GP database Thermal injuries, fractures and poisoning

http://tinyurl.com/orton-paper


Thermal injuries risk factors

Male gender Increasing birth order n-shaped relationship with child age, with the highest

odds of injury occurring at age 1-2 years Decreased with increasing maternal age Children living in 2-adult households had a lower odds

of injury compared with those in single adult households.


Thermal injuries risk factors

Increased if the mother had a diagnosis of depression in the perinatal period

Adult hazardous or harmful alcohol consumption Increasing socioeconomic deprivation


Poisoning risk factors

Increasing birth order Younger maternal age An even steeper n-shaped relationship with child age,

with the highest odds of injury occurring at age 2–3 years

Diagnosis of perinatal depression Adult hazardous or harmful alcohol consumption Increasing socioeconomic deprivation


Accident prevention and poverty

The challenges Children! Our understanding of their development Our knowledge of what works


Accidents and child development - the changing child

Anatomical and physical characteristics

Physical abilities - gross and fine motor skills

Exploring behaviours Cognitive abilities Speech and language development Social and emotional development Risk behaviours


Fine motor skills

Holding and manipulating objects

Picking up objects Opening containers – child-

resistance Using “tools” – cutlery, crayon,

knife, scissors Chewing, swallowing and

breathing


Exploring behaviours

Mouthing behaviour – risk of choking, suffocation, poisoning

Colour, sound, shape, lights, texture, movement, characters and faces, shape, size, smell, resemblance to food child-appealing products natural hazards (fire, water, plants,

etc) burns, drowning, poisoning, choking,

electrocution



Exploring behaviours

Mouthing behaviour – risk of choking, suffocation, poisoning

Colour, sound, shape, lights, texture, movement, characters and faces, shape, size, smell, resemblance to food child-appealing products natural hazards (fire, water, plants,

etc) burns, drowning, poisoning, choking,

electrocution


What works?

What do we mean by “works”? How should we measure effectiveness?

If we don’t know that a programme is effective, it doesn’t mean that it isn’t


Approaches to prevention

Education and awareness-raising – who? Engineering and environmental change – modifying

products, settings, etc Legislation and enforcement – nationally, locally Empowering people – giving people the ability to act.

What people?


World report on child injury preventionWorld Health Organization and UNICEF

“There is no single blueprint for success but six basic principles underlie most of the successful child injury prevention around the world. These are: Legislation and regulations, and their enforcement Product modification Environmental modification Supportive home visits The promotion of safety devices Education and the teaching of skills”


Strategy 1 2 3 4 5

Setting (and enforcing ) laws on smoke alarms Developing a standard for child-resistant lighters Setting (and enforcing) laws on hot water tap temperature and educating the public Using thermostatic mixing valves to control hot water temperature Banning the manufacture and sale of fireworks Providing first aid for scalds – “cool the burn” Conducting home visits for at-risk families Distributing smoke alarms on their own (without accompanying laws) Conducting community-based campaigns and interventions Using traditional remedies on burns

Key strategies to prevent burns among children

1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful


Strategy 1 2 3 4 5

Implementing multifaceted community programmes such as “Children can’t fly” Redesigning nursery furniture and other products Establishing playground standards for impact absorbing surfacing, height of equipment and maintenance Legislating for window guards Using safety gates and guard rails Conducting supportive home visits and education for at-risk families Raising awareness through educational campaigns Implementing housing and building codes

Key strategies to prevent falls among children

1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful


Home safety education and provision of safety equipment for injury prevention

Kendrick D et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012.http://tinyurl.com/kendrick-cochrane

http://tinyurl.com/kendrick-cochrane



Overall families who received home safety education were more likely to: have a safe hot tap water temperature have a working smoke alarm and a fire escape plan have fitted stair gates have socket covers on unused sockets store medicines and cleaning products out of reach of

children



Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment, is effective in increasing a range of safety practices.

Home safety interventions provided in the home may reduce injury rates, but more research is needed to confirm this finding.

Home safety education was equally effective in the families whose children were at greater risk of injury.


Safe at HomeNational Home Safety Equipment Scheme

http://www.safeathome.rospa.com/evaluation.htm

Evaluation report: If continued in the long term, the national programme

showed potential to reduce injuries, through the combination of effective safety equipment, free installation and targeted education

Has the potential to improve safety behaviours in vulnerable families and to reduce unintentional injuries

http://www.safeathome.rospa.com/evaluation.htm


Community-based injury prevention programmes

Towner et al. What works in preventing unintentional injuries in children and young adolescents? An updated systematic review.http://tinyurl.com/towner-review Key elements:

Long-term strategy Effective focused leadership Multi-agency collaboration Involvement of the local community Appropriate targeting Time to develop

Use of local surveillance systems to motivate participants and to evaluate interventions

http://tinyurl.com/towner-review


Partnerships

Statutory sector Local government, including public health and

children’s services Health sector Emergency services, especially fire and rescue

services Voluntary and community sector

Support for the families in greatest need


You are not alone!

www.capt.org.ukwww.makingthelink.net

http://www.capt.org.uk/

http://www.makingthelink.net/

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Accident prevention and poverty