The 4th to 10th of April 2011 was the National Public Health Week (NPHW) and this year’s theme “Safety is no accident: Live injury free”, was apt considering the global burden of injuries and the scant attention they previously received. A recent article in ‘The Nations Health’ (2011) asserts that Injuries are amongst the immediate public health concerns identified by the Institute of Medicine (IOM). What is an injury? How was it defined previously and how is it defined today and why the difference.
Injuries were traditionally thought of as unavoidable and random “accidents” making them seem like a part of the myriad inevitabilities of life over which we have no control. This of course made injuries little thought of as public health issues and therefore not in the purview of public health policy and prevention programs. However public health officials and researchers have agreed that injuries are preventable and constitute a huge global burden on all age groups. The World Health Organization (WHO) in its factsheet, “Facts about injuries”, estimates that about 5 million people die from injuries annually (WHO, 2001) more than the death toll from malaria and HIV/AIDS combined and in the same document defines an injury as physical damage to the body which results from acute exposure to chemical, electrical, thermal, mechanical or radiant energy in amounts that exceed the physiologic tolerance of the body.
Injuries are categorized into intentional and unintentional. Intentional injuries include deliberate acts of violence directed at self or others, while unintentional injuries include traffic collisions, burns, poisoning, drowning and falls. I have decided to write on keeping children safe for a lot of reasons, most cogent of being their vulnerability. The first pertinent question would be who is a child? There are many correct answers one of which is that for most parents they will always refer correctly to their children as “my children” irrespective of age, another consideration is that childhood defer by socioeconomic situations and cultural norms. For the purposes of this submission a child is any one 0-18 years drawing on the United Nations definition in its convention, on the rights of a child article 1. We will however not be too rigid on this definition as some data include 19 year old people.
Childhood injuries are a major public health concern, they deserve more attention than they get and they bring pain and far reaching consequences to families and communities; cutting dreams short and many times leaving behind huge burdens of guilt and depression on families and communities.
To further buttress the enormity of childhood injuries there is a lot of relevant data from the World report on childhood injury prevention (WHO,2008) and the CDC- Childhood Injury report 2008 which brings the problem closer home by giving detailed figures about the situation in the United States.
The world health organization attributes a whopping 950, 000 deaths annually from injuries worldwide to children 0- 18 years old. About 90% of these injuries are unintentional. In addition tens of millions are hospitalized for non- fatal injuries, which may end up with life- long disabilities. Further break down of this data shows that road traffic collisions are the leading cause of death amongst 15- 19 year olds and the second leading cause amongst 10- 19 year olds. Like a lot of public health concerns the burden of injuries fall heavily on the poor both amongst countries and within countries. About 95% of injuries fall on children in low and middle income countries. Though more in developing nations, injuries still cause a huge death toll on children in developed countries, accounting for 40% of all deaths in children. The fact that injuries can be prevented cannot be overemphasized, the rate of childhood injuries in children less that 15 years dropped by half between 1970 and 1995 in Organization for Economic cooperation and development countries (OECD). Until recently not much had been done in low and middle income countries, this may be due to competing priorities for available resources. This is changing slowly as research continues to support the effectiveness of injury prevention policies and programs. There is need for more to be done for the most vulnerable population on earth, “our children”, irrespective of their continent, country or family.
The Centers for Disease Control and Prevention (CDC) in its Childhood Injury report 2008 focuses on unintentional injury in children 0-19 years in the United States between the years 2000 and 2006. The leading cause of morbidity and mortality amongst these children is unintentional injuries with an estimated 20 deaths daily from preventable injury, and 12,175 children deaths annually from mostly traffic collisions. Unintentional injuries are more amongst male children than female, highest amongst American Indians and Native Alaskans and lowest amongst Asian and pacific Islanders. The fatal injuries varied by type amongst different age groups for children less that 1 year cause of death was mostly suffocation, those between 1- 4 years mostly by drowning and for those 5- 19years being an occupant in a vehicle involved in a road traffic crash. There were also differences by states and regions. In the case where injuries were non-fatal it is estimated that about 9.2 million initial hospital emergency room visits of children were for unintentional injuries. About 20 million children and adolescents are afflicted by injuries which restrict their movements and account for 17 billion dollars in medical costs. The point has been made injuries to children abound and the data has shown that such injuries can be in the house or during play; drowning, suffocation, falls, electrocution, burns and mostly on the road; collisions. What can we do as parents, teachers, policy makers and children too? As detailed above injuries are preventable that is why the theme is “SAFETY IS NO ACCIDENT”.
Safety measures at home; this list is by no means exhaustive and inculcates suggestions from sources such as the NPHW website, Safe kids USA and others
Ensure that the rooms are adequately lit; hallways, staircases, closets
Electrical cords should be kept out of the way and outlets should be child inaccessible and properly covered
Chemicals including cleaning fluids and drugs should be kept in locked cabinets or at least away from children
Children should not be where hot food is being cooked or served and the stove should always be attended to by an adult. Do not carry a baby and hot food
Water heater should be regularly checked for temperature and always set it at 120F or lower and always test water with the back of your hands before putting your children into the bath and never leave them unattended
Ensure the smoke alarm is installed and works and Practice safety drills such that the family knows how to exit in case of fire or other emergency
Home pools should be barricaded with 4 sided 5 feet high fences and self latching and self closing gates
Childproofing the whole house; stair gates, crib rail, cabinet locks
Remember infants must sleep “back to bed” with nothing in the crib; no pillows, no loose sheets, no soft toys
There should be barriers around fireplaces, ovens and furnaces
Window guards should be installed to prevent falls
At Play; this is so easy to overlook especially since the children sometimes see this as too stressful
Wear helmets when riding bikes or other sports that require this as a minimum
Shin pads are also necessary
Monitor children to ensure they comply; this is so important
Make sure children have their annual physical and an okay from their doctors to engage in sports and they should warm up before any sports activity
Children should drink enough water during sports and play to prevent dehydration
Signs showing that kids are playing are also a good way to keep children safe
Protective surfaces rather than asphalt or cement should be installed beneath playground equipment to prevent play related injuries
Educate coaches on youth athletic injury prevention
On the move; this falls mostly on parents and adults, sometimes on the teens as they begin their journey on the road. Adults still have a part to play even in the case of teens on the road. Remember most children die on the road, do not increase the statistics.
Always ensure you and all the passengers in the car have their belts on. According to their age, children should be properly belted in car seats and boosters.
Infant car seats should face the rear for as long as possible as facing rear is safer for infants. Though they may face front from 20 pounds that’s the minimum and children shouldn’t be rushed to forward facing positions as soon as they hit 22 pounds. In fact the new recommendation is that kids less that 1 should definitely face rear and should stay till 2 years as long as they fit the height and weight recommendations of the manufacturer. This is corroborated in the March/April, 2011 edition of Pediatrics and is in the new National highway Traffic Safety Administration (NHTSA) recommendations.
Avoid jaywalking, be aware of your environment and face traffic when walking. Wear visible clothing in the night so you will be seen.
Do not send texts, take calls, groom yourself or eat and drink while driving
Be a designated driver, do not drink and drive
Wear helmet and reflective clothing while on a scooter, bike or other vehicles
Let your teens pledge not to text, drink, speed, make calls or carry too many passengers
The issue of injury prevention is one that everyone can be a part of, by doing a little daily and teaching children safety tips, one can change the course of the future and reduce the death and toll of injury.
References
CDC Childhood Injury Report, 2008, Patterns of Unintentional injuries amongst children 0-19 years old in the United States 2000- 2006 http://www.cdc.gov/SafeChild/ChildhoodInjuryReport/index.html
National Public Health Week (NPHW) website 2011, http://www.nphw.org/nphw11/first1.htm#
Safe kids USA website http://www.safekids.org/our-work/research/fact-sheets/home-safety-fact-sheet.html
The National Highway Traffic Safety Administration (NHTSA) website http://www.nhtsa.gov/Safety/CPS
The Nation’s Health, May/ June 2011, The official newspaper of the American Public Health Association
Pediatrics March 2011, Official Journal of the American College of Pediatrics, Online edition PEDIATRICS (doi:10.1542/peds.2011-0213) http://pediatrics.aappublications.org/cgi/content/abstract/peds.2011-0213v1
World Health Organization 2001, Facts about Injuries, Preventing Global injuries, http://www.who.int/violence_injury_prevention/resources/publications/en/injury_factsheet.pdf
World Health Organization, 2008, World Report on Child Injury prevention, http://whqlibdoc.who.int/publications/2008/9789241563574_eng.pdf
