A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP)

Analysis of clinical characteristics and health resource costs in children hospitalised for injuries in southern Sichuan, China

Aim

To investigate the clinical characteristics and health resource costs among children hospitalised for injuries in southern Sichuan, China, and to provide guidance for prevention and treatment.

Methods

We collected clinical data concerning children aged from 29 days to 18 years hospitalised for injuries from January 1, 2017, to December 31, 2021, retrospectively analysing the basic characteristics, evolution of injury characteristics over time, risk factors for events with adverse outcomes, and health resource costs.

Results

Among 5,826 hospitalised children with injuries, males (63.6%), those in rural areas (40.3%), and adolescents (33.5%) were most commonly injured. Most injuries occurred at home (52.6%), and during summer. The most common injury types were falls, burns, road traffic injuries, poisoning, and foreign body injuries (32.0%, 17.9%, 13.6%, 8.8%, and 7.9%, respectively). After 2019, the proportion of intentional injuries among adolescent girls was significantly higher. Road traffic injuries most commonly led to poor clinical outcomes (95%CI: 5.39-31.51), followed by falls (95%CI: 2.20-10.67). Adolescents were at higher risk of poor prognosis. Injuries occurring in rural areas, adolescents, road traffic injuries, and falls cost high health resource.

Conclusion

Injuries among children remain serious, with males and adolescents from villages predominantly affected. Attention should be paid to intentional injuries among adolescent females also. Targeted prevention and control measures for road traffic injuries and falls should be strengthened.

The prevention of - and first response to - injuries in Nepal: a review of policies and legislation

BACKGROUND

Injuries, the cause of an estimated 4.5 million deaths annually and many more disabilities worldwide each year, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and legislation in Nepal that had the potential to prevent injuries.

METHODS

We identified legislation and policy that met inclusion criteria through a stakeholder meeting, networks and contacts, and websites and electronic resources. Each included document was critically reviewed to identify areas of strength and opportunities for improvement. We compared the included documents against WHO's recommendations of known effective interventions.

RESULTS

Sixty-two documents met the inclusion criteria for this review. Of these, 24 (38.7%) were exclusively related to road injuries, 11 (17.7%) to occupational injuries, 6 (9.7%) to injuries in the home and 5 (8.1%) to injuries at school; 30 (48.4%) documents included text related to the first response to injuries. Of 127 strategic recommendations by WHO that provided an area for policy or legislative focus, 21 (16.5%) were considered adequately met by Nepali policy and legislation, 43 (33.9%) were considered partially met and 63 (49.6%) were not met.

CONCLUSION

We drew five conclusions from this critical policy review, which we have related to recommendations as follows: widening the scope of legislation and policy for injury prevention to emphasize injuries occurring at home or school; addressing the causes of injuries and promoting proven preventive measures; greater clarity on both individual and institutional roles and responsibilities; trustworthy data and quality evidence to inform decision-making; and financial investment and capacity-strengthening for injury prevention and first response. The current system of federal governance in Nepal has potential for strengthening injury prevention and first response at the central, provincial and local levels.

Keeping afloat: a case study tracing the emergence of drowning prevention as a health issue in Bangladesh 1999-2017

BACKGROUND

Drowning is a leading cause of child death in Bangladesh. The present study investigated the emergence of drowning reduction as a priority within Bangladesh and the position it currently holds on the national policy agenda.

METHODS

This case study documents the evolution of policy responses to drowning, reporting on data from semistructured interviews and a document analysis. To identify key factors that have facilitated the prioritisation of drowning prevention, data were synthesised using Shiffman and Smith's 2007 Policy Prioritisation Framework. Furthermore, an inductive approach was used to identify key themes unique to drowning prevention that were not embedded in the framework.

RESULTS

Four key phases of policy development for drowning prevention were distinguishable: (1) identification of issue and the emergence of actor support; (2) enhanced leadership and the accumulation of issue characteristics; (3) the formation of an internal frame and its impact on global support; and (4) enhanced national recognition and supportive global normative factors. Four additional themes unique to the case of drowning were also identified: competing health priorities, limited issue awareness, shift of disease burden to non-communicable diseases and the multisectoral nature of drowning.

CONCLUSION

This study demonstrates that the level of political prioritisation given to drowning prevention has evolved over the last decade and a half. A comprehensive understanding of factors that have elevated the issue onto the policy agenda will ensure future stakeholder engagement activities can be designed to foster deeper and more sustained commitment by key actors and organisations.

Self-reported injury in Australian young adults: demographic and lifestyle predictors

OBJECTIVES

Injury is the major cause of mortality and morbidity among adolescents and young adults. This study examined the use of injury self-reports and various causes of injury among adolescents.

METHODS

A cohort recruited in 2002 as a representative sample of students from the State of Victoria in south-east Australia was followed and resurveyed in young adulthood in 2010 (mean age 21.0) and 2012 (mean age 23.1) with 75% of the target sample retained (N=2,154, 55.8% female).

RESULTS

Prior injuries were reported by 55.5% in 2010 and 54.6% in 2012, leaving 18% with continuing disability. Reported causes of injury in 2012 were sports (55.1%) and alcohol use (9.7%). Logistic regression revealed that injury in 2012 was predicted by rural school attendance in 2002 (Adjusted Odds Ratio [OR] 1.4 CI 1.1-1.7) and in 2010 by male gender (OR 2.2, CI 1.8-2.6), reported self-harm (OR 1.6 CI 1.1-2.2), and unemployment (OR 0.7, CI 0.5-1.0).

CONCLUSIONS

Self-reported injury among young adults is reliably reported, and suggests the need to further examine gender, rural communities and self-harm, and indicates modifiable contributors to injury. Implications for public health: Modifiable contributors to injury prevention are revealed as work environment, sports participation and alcohol use.