Child mortality in the Netherlands in the past decades: an overview of external causes and the role of public health policy

The Spatial Scale and Spread of Child Victimization

Previous research shows that large, densely populated urban areas have higher rates of child victimization that have persisted over time. However, few investigations have inquired about the processes that produce and sustain hot and cold spots of child victimization. As a result, the mechanisms that produce the observed spatial clustering of child victimization, and hence "why" harms against children tend to cluster in space, remains unknown. Does the likelihood of being a victim of violence in one location depend on a similar event happening in a nearby location within a specified timeframe? Rather, are child victims of violence more likely to reside in suboptimal neighborhood conditions? This paper aims to present an analytical and theoretical framework for distinguishing between these locational (point) processes to determine whether the empirical spatial patterns undergirding child victimization are more reflective of the "spread" via contagion (i.e., dependency) or whether they are produced by neighborhood structural inequality resulting from spatial heterogeneity. To detect spatial dependence, we applied the inhomogeneous K-function to Los Angeles Medical Examiner data on child homicide victim locations while controlling for regional differences in victimization events (i.e., heterogeneity). Our analysis found strong evidence of spatial clustering in child victimization at small spatial scales but inhibition at larger scales. We further found limited support for the spatiotemporal clustering of child victimization indicative of a contagion effect. Overall, our results support the role of neighborhood structural vulnerability in the underlying mechanisms producing patterns of child victimization across Los Angeles County. We conclude by discussing the policy implications for understanding this spatial patterning in geographical context and for developing effective and targeted preventive interventions.

Trends in mortality from non-natural causes in children and adolescents (0-19 years) in Europe from 2000 to 2018

BACKGROUND

Non-natural mortality in children and adolescents is a global public health problem that varies widely from country to country. Data on child and adolescent maltreatment are not readily available, and mortality due to violent causes is also underestimated.

METHODS

Injury-related mortality rates (overall and by specific causes) from 2000 to 2018 in selected European countries were analysed to observe mortality patterns in children and adolescents using data from the Eurostat database. Age-standardized mortality rates per 100,000 person-years were calculated for each country. Joinpoint regression analysis with a significance level of 0.05 and 95% confidence intervals was performed for mortality trends.

RESULTS

Children and adolescent mortality from non-natural causes decreased significantly in Europe from 10.48 around 2005 to 5.91 around 2015. The Eastern countries (Romania, Bulgaria, Poland, Slovakia, Czech Republic) had higher rates; while Spain, Denmark, Italy, and the United Kingdom had the lowest. Rates for European Country declined by 5.10% per year over the entire period. Larger downward trends were observed in Ireland, Spain and Portugal; smaller downward trends were observed for Eastern countries (Bulgaria, Czech Republic, Poland, Slovakia) and Finland. Among specific causes of death, the largest decreases were observed for accidental causes (-5.9%) and traffic accidents (-6.8%).

CONCLUSIONS

Mortality among children and adolescents due to non-natural causes has decreased significantly over the past two decades. Accidental events and transport accidents recorded the greatest decline in mortality rates, although there are still some European countries where the number of deaths among children and adolescents from non-natural causes is high. Social, cultural, and health-related reasons may explain the observed differences between countries.

Determinants of neonatal, infant and under-five mortalities: evidence from a developing country, Bangladesh

We investigated the macroeconomic determinants of neonatal, infant, and under-five mortalities in Bangladesh for the period 1991-2018 and discuss implications of the United Nations' Sustainable Development Goal 3 (SDG 3) and Millennium Development Goal 4 (MDG 4) for developing countries. We used annual time series data and the econometric techniques of Fully Modified Ordinary Least Squares (FMOLS) and Dynamic Ordinary Least Squares (DOLS) regressions for analysis. Determinants most effective in combating neonatal, infant, and under-five mortalities include variables such as 'protecting newborns against tetanus', 'increasing healthcare expenditure', and 'making sure births are attended by skilled healthcare staff'. Employing more healthcare workers and assuring more and improved healthcare provisions can further reduce the neonatal, infant, and under-five mortalities. Developing countries with similar macroeconomic profiles can achieve similar SDG 3 and MDG 4 outcomes by emulating the policies and strategies Bangladesh applied to reducing child mortalities over the last three decades.

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated

AIM

Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden.

METHODS

We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years.

RESULTS

Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%).

CONCLUSION

Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths.

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial

BACKGROUND

Since 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously.

METHODS

We will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes.

DISCUSSION

If the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale.

TRIAL REGISTRATION

The study is registered in the Dutch Trial Register ( NTR6622 ).

Procedures in child deaths in The Netherlands: a comparison with child death review

Aim

Child Death Review (CDR) is a method in which every child death is systematically and multidisciplinary examined to (1) improve death statistics, (2) identify factors that give direction for prevention, (3) translate the results into possible interventions, and (4) support families. The aim of this study was to determine to what extent procedures of organizations involved in the (health) care for children in The Netherlands cover these four objectives of CDR.

Subject and methods

Organizations in the Eastern part of The Netherlands and Dutch umbrella organizations involved in child (health) care were asked to provide their protocols, guidelines or other working agreements that describe their activities and responsibilities in case of a child’s death. Eighteen documents and nine interview reports were made available. For the analyses we used scorecards for each CDR objective.

Results

The procedures of Perined, the National Cot Death Study Group, Dutch Cot Death Foundation and Child Protection Service cover the largest part of the objectives of CDR. Organizations pay most attention to the translation of results into possible interventions. Family support gets the least attention in protocols, guidelines and other working agreements.

Conclusion

Dutch organizations separately cover parts of CDR. When the procedures of organizations are combined, all CDR objectives are covered in the response to only specific groups of child deaths, i.e., perinatal deaths, Sudden Unexpected Deaths in Infants and fatal child abuse cases. Further research into the conditions that are needed for an optimal implementation of CDR in The Netherlands is necessary. This research should also evaluate the recently implemented NODOK procedure (Further Examination of the Causes of death in Children), directed to investigate unexplained deaths in minors 0–18 years old.

Road traffic injuries among children and adolescents in Singapore - Who is at greatest risk?

INTRODUCTION

Pediatric road traffic injuries remain a significant cause of death and disability in many countries in Asia, despite the implementation of road traffic safety laws. We aim to describe the injuries, the use of restraints among road users, and risk factors associated with severe injuries for children in Singapore.

METHODS

We performed a retrospective chart review of road traffic injuries presenting to the only two pediatric tertiary care hospitals in Singapore, from January 2012 to April 2016. We included children <16years old presenting to the emergency departments within 24h after injury (pedestrian, bicycle, motorcycle, motor vehicle). We calculated the frequencies for specific injury mechanisms, injury severity scores (ISS), and in-hospital outcomes of severe injuries (death, urgent resuscitation and emergent surgery). We performed a multivariate logistic regression to determine risk factors associated with severe injury.

RESULTS

There were 2468 patients during the study period. The mean age was 7.9 years (SD 4.7); 60.1% of road injuries involved motor vehicle occupants (1483/2468). Most bicyclist/motorcyclists were not wearing helmets (70.0%, 245/350) and 51.1% of motor vehicle passengers (758/1483) were not restrained. Compared to motor vehicle passengers, pedestrians (adjusted OR 2.38, 95% CI 1.41-3.99), bicyclists (adjusted OR 2.12, 95% CI 1.04-4.32) and motorcyclists (adjusted OR 6.09, 95% CI 2.04-18.24) were more likely to sustain severe injuries.

CONCLUSION

Child pedestrians, bicyclists and motorcyclists are especially vulnerable for severe injures. Further injury prevention efforts must focus on the enforcement of legislation to protect these high-risk groups.

Evaluation of a school-based depression prevention program among adolescents with elevated depressive symptoms: study protocol of a randomized controlled trial

BACKGROUND

Adolescents are at risk of developing depressive symptoms. Given the prevalence, recurrence and negative consequences of adolescent depression, it is crucial to implement prevention programs for high-risk adolescents. Prevention programs at an indicated level have shown to be successful in reducing depressive symptoms in adolescents. This study will evaluate the (cost)effectiveness of the prevention program 'Op Volle Kracht (OVK 2.0)' for adolescents with elevated depressive symptoms.

METHODS

We will perform a Randomized Controlled Trial (RCT) with an intervention and control condition to test the effectiveness of an indicated prevention program aimed at depression in adolescents. Adolescents in their second year of secondary education (11-15 year) will be screened for depressive symptoms. Those with heightened levels of depressive symptoms (CDI-2 ≥ 14) will be randomly assigned to the intervention (N = 80) or control group (N = 80). The participants in the intervention condition will receive a prevention program comprising eight meetings of 60 min each. The participants in the control condition will receive psycho-educational information. All participants and their parents will complete assessment at baseline, post-intervention, and 6-, 12- and 24- month follow-up. Primary outcome will be depressive symptoms. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of OVK 2.0 on secondary outcomes.

DISCUSSION

This paper describes a study designed to screen adolescents for depressive symptoms and offer them a prevention program to prevent the onset of depressive symptomatology. Adolescents in the intervention condition are expected to show lower levels of depressive symptoms at 12 month follow-up compared to adolescents in the control condition. If OVK 2.0 proves to be effective, the screening and intervention program could be implemented in schools on a large scale.

TRIAL REGISTRATION

Dutch Trial Register NTR5725 . Date registered: 11^th of March 2016.

Trends in external causes of child and adolescent mortality in Poland, 1999-2012

OBJECTIVES

To examine the pattern and trend of deaths due to external causes among Polish children and adolescents in 1999-2012, and to compare trends in Poland's neighboring countries.

METHODS

Death records were obtained from the Central Statistical Office of Poland. External causes mortality rates (MR) with 95 % confidence interval were calculated. The annual percentage change of MR was examined using linear regression. To compare MR with Belarus, Ukraine, Czech Republic and Germany, data from the European Mortality Database were used.

RESULTS

MR were the highest in the age 15-19 years (33.7/100,000) and among boys (22.7/100,000). Unintentional injuries including transport accidents, drowning, and suicides (especially in children over 10 years old), were the main cause of death in the analyzed groups. Between 1999 and 2012 annual MR for unintentional injuries declined substantially. MR due to injuries and poisoning in Poland were higher compared with Czech Republic and Germany and lower in comparison with Belarus and Ukraine.

CONCLUSIONS

Deaths due to unintentional injuries are still the leading cause of death among Polish children and adolescents. There are differences in death rates between Poland and neighboring countries.

Implementation of Child Death Review in the Netherlands: results of a pilot study

BACKGROUND

Child mortality in the Netherlands declined gradually in the past decades. In total 1130 children and youth aged 0 to 19 years died in 2014 (i.e. 29.4 per 100,000 live births). A better understanding of the background and the circumstances surrounding the death of children as well as the manner and cause of death may lead to preventive measures. Child Death Review (CDR) is a method to systematically analyze child deaths by a multidisciplinary team to identify avoidable factors that may have contributed to the death and to give directions for prevention. CDR could be an addition to further reduce avoidable child deaths in the Netherlands. The purpose of this study is to explore the strengths, weaknesses, opportunities and threats (SWOT) of the pilot-implementation of CDR in a Dutch region. The results are translated in recommendations for future implementation of the CDR method in the Netherlands.

METHODS

Children who lived in the pilot region and died aged 29 days after birth until 2 years were, after parental consent, included for reviewing by a regional CDR team. Eighteen logs and seven transcribed records of CDR meetings concerning 6 deceased children were analyzed using Atlas ti. The SWOT framework was used to identify important themes.

RESULTS

The most important strengths identified were the expertise of and cooperation within the CDR team and the available materials. An important weakness was the poor cooperation of some professional groups. The fact that parents and professionals endorse the objective of CDR was an important opportunity. The lack of statutory basis was a threat.

CONCLUSIONS

Many obstacles need to be taken away before large-scale implementation of CDR in the Netherlands becomes possible. The most important precondition for implementation is the acceptance among professionals and the statutory basis of the CDR method.

The effect of VoorZorg, the Dutch nurse-family partnership, on child maltreatment and development: a randomized controlled trial

BACKGROUND

Child maltreatment is a great public health concern that has long-term mental and physical health consequences and can result in death. We studied the effect of a nurse home visiting program on child maltreatment among young disadvantaged families in The Netherlands. This study is the first to investigate the effects of this program outside of the United States.

METHODS

We conducted a single blind, parallel-group, randomized controlled trial that compared usual care with the nurse home visitation program, which began during pregnancy and continued until the children's second birthdays, in 460 disadvantaged women who were pregnant for the first time and <26 years of age. The primary outcome was the existence of a report about the child from a child protecting services agency (CPS reports). Secondary outcome measures included home environment and child behavior.

RESULTS

Two hundred twenty-three participants were assigned to the control group, and 237 were assigned to the intervention group. Three years after birth, 19% of the children in the control group had a CPS report. The 11 percent of children in the intervention group with CPS files was significantly lower (relative risk 0.91, p-value 0.04). At 24 months, the intervention group scored significantly better on the IT-HOME. At 24 months after birth, the children in the intervention group exhibited a significant improvement in internalizing behavior (relative risk 0.56, p-value 0.04) but no evidence of a difference from the control group in externalizing behavior (relative risk 0.71, p-value 0.12).

CONCLUSION

The number of CPS reports for the intervention group was significantly lower than that of the control group. Additionally, the long-term home environments were improved and internalizing behaviors of the children were lower in the intervention group.

TRIAL REGISTRATION

Dutch Trial Register NTR854.