Evaluation of a child safety program based on the WHO safe community model

Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.

Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study

BACKGROUND

Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries.

OBJECTIVE

This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong.

METHODS

This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong.

RESULTS

We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries.

CONCLUSIONS

This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.

Differences in child injury hospitalizations in Sweden: The use of time-trend analysis to compare various community injury-prevention approaches

Aim: Sweden's child injury fatality rates are among the lowest in the world. The country has engaged in a number of community injury-prevention programmes. The purpose of this study was to compare child injury hospitalization rates from the Skaraborg District with the rest of Sweden. Our study hypothesis was that municipalities that offered comprehensive child injury-prevention programmes would see significant decreases in their child injury hospitalization rates, compared with other areas. Methods: The study areas comprised three groups, consisting of municipalities in Skaraborg that had adapted the Safe Communities approach to injury prevention programmes, other municipalities in the District, and the rest of Sweden. The aim of the analysis was twofold: (1) to fit time trends for children's injuries in various areas in an integrated manner; and (2) to compare time trends across locations between community safety-promotion programmes as well as with the control areas. Panel data models and parametric splines were used. Results: There were differences between incidence rates in the study areas and with regard to gender. There was a steep decrease in injury rates in one of the Safe Communities study areas for both genders. Conclusions: The methods applied in this analysis reveal more detailed and sophisticated time trends than the usual simple linear regression approach. The model provided a clearer view of the interactions of gender, area, and time as they impacted on children's injuries, and allowed for better insight into the impact of safety programmes.

Assessment of home hazards for childhood injuries in an urban population in New Delhi

BACKGROUND

Childhood injuries, especially the unintentional category of injuries, occur most commonly in the environment inside a child's home. The primary objective of the present study was to assess the presence of home hazards for childhood injuries in households in an urban resettlement colony in New Delhi.

METHODS

A community-based cross-sectional study was carried out in an urban resettlement colony in Delhi. A hazards assessment tool was used to check the presence of hazards in the houses.

RESULTS

A total of 225 households were included. It was seen that121 (53.7%) had a cooking stove within the reach of the child, and 190 (84.3%) had the gas pipe within reach. Fire hazard was seen in 84% of houses. About 78% of households did not have locked storage for chemicals.

CONCLUSION

The study revealed a significant burden of hazards for childhood injuries within their own homes, thus emphasizing the need for injury prevention interventions to reduce the number of hazards.

Home safety education and provision of safety equipment for injury prevention (Review)

BACKGROUND

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals.

MAIN RESULTS

Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD. There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92). Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96). Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.

Implementation and results of a survey on safe community programs in Gangbuk-gu, Korea: focusing on participants at a local public health center

OBJECTIVES

The purpose of this study was to investigate the current status of and problems with the Safe Community Programs in Gangbuk-gu, one of the 25 districts of the capital city of Korea.

METHODS

The study subjects were 396 individuals who were involved in Safe Community Programs between 2009 and 2011. We examined the effectiveness and willingness of respondents to participate as a safety leader of the Safe Community Program with a questionnaire. We examined the injury death rates of Gangbuk-gu by using of the death certificate data of Korea's National Statistical Office. Descriptive statistics and chi-squared tests were used.

RESULTS

The effectiveness of programs did not differ but active participation differed significantly among subjects (p<0.05). The injury death rate of Gangbuk-gu as a whole increased during the implementation period. However, senior safety, in particular, may be a helpful program for reducing injuries in Gangbuk-gu.

CONCLUSIONS

This study suggests that the lack of active participation may be a major problem of Safe Community Programs in Gangbuk-gu. Therefore, Safe Community Programs should be expanded to the entire district of Gangbuk-gu and more active participation programs should be developed.

Home safety education and provision of safety equipment for injury prevention

BACKGROUND

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals.

MAIN RESULTS

Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.

Severe injury mechanisms in two paediatric trauma centres: Determination of prevention priorities

BACKGROUND

To meet community needs, injury prevention programs for children should be targeted to trends in objective data on mechanisms of injury. The aim of the present study was to identify the most important severe injury mechanisms.

METHODS

The present study retrospectively reviewed severe paediatric trauma patients in two regional trauma centres. Injury prevention priority scores were computed using different severity measures - injury severity score (ISS), revised trauma score, trauma-related injury severity score, Glasgow Coma Scale (GCS) and mortality - to identify prevention priorities.

RESULTS

A total of 3732 children with severe injury were identified; mean age (+/-SD) was 9.0+/-5.2 years and 2469 (66.2%) were boys. The GCS was 7 or lower in 209 patients (5.6%) and the median ISS was 9. Overall, there were 77 deaths (2.1%). 'Fall from height' was the most frequent mechanism of injury, and 'motor vehicle traffic injury' resulted in the most severe injury. The most significant mechanisms of injury, using ISS, were 'fall from height', 'motor vehicle traffic injury', 'pedestrian struck by motor vehicle', 'bicycle injuries' and 'child abuse'. Different priorities were identified depending on the severity measures used - 'fall from height' would be the priority with ISS, revised trauma score and trauma-related injury severity score; 'motor vehicle traffic injury' with mortality and 'drowning/submersion' with GCS. 'Fall from height' was the highest ranked mechanism of injury in one centre compared with 'motor vehicle traffic injury' in the other. Younger children tended to have injuries as a result of falls, while adolescents had more motor vehicle occupant injuries. Failure to use safety devices, such as helmets and seat belts, was a common finding among severely injured children.

CONCLUSION

The present study shows that the severe injury prevention priorities identified vary depending on the severity measures used. The variations seen across age groups and between the two centres are also important factors that must be taken into account when developing prevention programs or considering research initiatives.

The impact of child safety promotion on different social strata in a WHO Safe Community

Background:

The objective of the current study was to evaluate outcomes of a program to prevent severe and less severe unintentional child injuries among the different social strata under WHO Safe Community program. Specifically, the aim was to study effectiveness of Safe Community program for reducing child injury.

Methods:

A quasi-experimental design was used, with pre- and post-implementation registrations covering the children (0 -15 years) in the program implementation area (population 41,000) and in a neighboring control municipality (population 26,000) in Östergötland County, Sweden.

Results:

Boys from not vocationally active households displayed the highest pre-intervention injury rate in both the control and intervention areas. Also in households in which the vocationally significant member was employed, boys showed higher injury rates than girls. Households in which the vocationally significant member was self-employed, girls exhibited higher injury rates than boys in the intervention area. After 6 years of program activity, the injury rates for boys and girls in employed category and injury rates for girls in self-employed category displayed a decreasing trend in the intervention area. However, in the control area injury rate decreased only for boys of employed families.

Conclusions:

The study indicated that almost no changes in injury rates in the control area suggested that the reduction of child injuries in the intervention area between 1983 and 1989 was likely to be attributable to the safety promotion program. Therefore, the current study indicates that Safe Community program seems to be successful for reducing child injuries.

The 'WHO Safe Communities' model for the prevention of injury in whole populations

BACKGROUND

The World Health Organization (WHO) 'safe communities' approach to injury prevention has been embraced around the world as a model for co-ordinating community efforts to enhance safety and reduce injury. Approximately 150 communities throughout the world have formal 'Safe Communities' designation. It is of public health interest to determine to what degree the model is successful, and whether it reduces injury rates. This Cochrane Review is an update of a previous published version.

OBJECTIVES

To determine the effectiveness of the WHO Safe Communities model to prevent injury in whole populations.

SEARCH STRATEGY

Our search included CENTRAL, MEDLINE and EMBASE, PsycINFO, ISI Web of Science: Social Sciences Citation Index (SSCI) and ZETOC. We handsearched selected journals and contacted key people from each WHO Safe Community. The last search was December 2008.

SELECTION CRITERIA

Two authors independently screened studies for inclusion. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

MAIN RESULTS

We included evaluations for 21 communities from five countries in two geographical regions in the world: Austria, Sweden and Norway, and Australia and New Zealand. Although positive results were reported for some communities, there was no consistent relationship between being a WHO designated Safe Community and subsequent changes in observed injury rates.

AUTHORS' CONCLUSIONS

There is marked inconsistency in the results of the studies included in this systematic review. While the frequency of injury in some study communities did reduce following their designation as a WHO Safe Community, there remains insufficient evidence from which to draw definitive conclusions regarding the effectiveness of the model.The lack of consistency in results may be due to the heterogeneity of the approaches to implementing the model, varying efficacy of activities and strategies, varying intensity of implementation and methodological limitations in evaluations. While all communities included in the review fulfilled the WHO Safe Community criteria, these criteria were too general to prescribe a standardised programme of activity or evaluation methodology.Adequate documentation describing how various Safe Communities implemented the model was limited, making it unclear which factors affected success. Where a reduction in injury rates was not reported, lack of information makes it difficult to distinguish whether this was due to problems with the model or with the way in which it was implemented.

Injury mortality in local communities in Sweden and in the three Baltic States: implications for prevention

This study provides a comparative time-trend evaluation of injury mortality in local communities in Sweden and the three Baltic States, considering their national socio-political and economic situations and with analysis of local injury prevention structures and activities. Data for the period from 1990 to 2002 were gathered from national statistical offices for the cities of Borås, Tartu, Jelgava and Kaunas and from WHO databases for national level analyses. The death rates for Borås remained relatively stable over the time period, while the Baltic communities had increasing rates until 1994 and seemed to stabilize after 1997. The differences in injury mortality in the studied communities were highest for the 0 - 19 year age group and especially in the 20 - 64 year age group, but not for the 65+ year age group. Local communities in the Baltic States should consider coordinated safety promotion and injury prevention programmes as a complement to national safety promotion framework.

Home safety education and provision of safety equipment for injury prevention

BACKGROUND

In industrialised countries injuries are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home, but there is little meta-analytic evidence that child home safety interventions improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.

OBJECTIVES

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.

SEARCH STRATEGY

We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies. We contacted authors of included studies and surveyed a range of organisations.

SELECTION CRITERIA

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneoulsy combined in meta-regressions by social and demographic variables.

MAIN RESULTS

Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.

AUTHORS' CONCLUSIONS

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. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.

Long-term effects of community-based injury prevention on the island of Vaerøy in Norway: a 20-year follow up

AIM

A multifactorial injury prevention programme started in 1981 and ran for about 10 years in an island community in Norway with a population of about 1,000. A study was undertaken to evaluate effects of the programme over a period of 20 years.

METHODS

Injuries were recorded by the one medical doctor on the island for several years during the period 1970-2001. The programme was carried out very intensively from 1981 to 1987. The intensity gradually decreased to a medium level that lasted until about 1994, when it was further reduced to a low level.

RESULTS

The injury incidence rate was reduced from 17.7% in 1980 (n = 188) to 9.7% in 1987 (n = 97) with relative risk reduced to 0.55 (95% CI 0.44-0.70, p < 0.0001). In 2001, an incidence rate of 9.6% was observed (n = 91). An even higher reduction was observed for serious injuries. The age groups 15-24 and 65+ showed the most distinct reductions from 1980 to 2001 while minor reduction was observed in children (0-14 years). The incidence rate of traffic injuries was reduced by 77% in spite of an increase in the number of motor vehicles. Occupational, home, and other injuries were reduced by 38%, 35%, and 49% respectively. The incidence rates were 2.6-3.0 times higher for men than for women through the 20-year observation period.

CONCLUSION

This study indicates that a long-lasting multifactorial community-based intervention in a small community with defined aims may lead to a considerable and long-lasting reduction in injuries.

Hospitalized Swedish children with hand and forearm injuries: a retrospective review

AIM

To analyse incidences and find risk groups in children hospitalized with hand injuries in a national retrospective study.

METHODS

All children with a primary hand or forearm injury admitted to Swedish hospitals during 1987-2001 were retrieved from the Swedish Hospital Discharge Register and analysed as to incidence and characteristics.

RESULTS

Among 9855 children included, the median age was 7.0 y and two-thirds were boys. The incidence increased in both younger (0-6 y) and older (7-14 y) children. Wounds and fractures almost doubled, while muscle/tendon injuries decreased. In younger children, wounds and burns were the most frequent diagnoses. In older children, fractures and muscle/tendon injuries were common. Sharp objects caused most of the injuries. University hospitals treated almost half of the children.

CONCLUSION

The number of children with hand injuries admitted to hospitals in Sweden increased annually. Analyses of causes behind the increase are important to counter this trend.

Community-based programmes to prevent falls in children: a systematic review

OBJECTIVE

We systematically reviewed the literature to examine the evidence for the effectiveness of community-based interventions to reduce fall-related injury in children aged 0-16 years.

METHODS

We performed a comprehensive search of the literature using the following study selection criteria: community-based intervention study; target population was children aged 0-16 years; outcome measure was fall-related injury rates; and either a community control or historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors.

RESULTS

Only six studies fitting the inclusion criteria were identified in our search and only two of these used a trial design with a contemporary community control. Neither of the high quality evaluation studies showed an effect from the intervention and while authors of the remaining studies reported effective falls prevention programmes, the pre- and post-intervention design, uncontrolled for background secular trends, makes causal inferences from these studies difficult.

CONCLUSION

There is a paucity of research studies from which evidence regarding the effectiveness of community-based intervention programmes for the prevention of fall-related injury in children could be based.

Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study

OBJECTIVE

The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors.

METHODS

The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively.

RESULTS

During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92-2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft + distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In small-area analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics.

CONCLUSIONS

Femur fractures and associated injuries remain a major cause of morbidity in children. Predictors of femur fractures change with age; however, the risk is generally higher among children who live in the areas with lower socioeconomic indicators.

The 'WHO Safe Communities' model for the prevention of injury in whole populations

BACKGROUND

The safe communities approach has been embraced around the world as a model for coordinating community efforts to enhance safety and reduce injury. Over 80 communities throughout the world have been formally designated as 'Safe Communities' by the World Health Organization. It is of public health interest to determine to what degree the model is successful, and whether its application does indeed reduce injury rates in communities to which it is introduced.

OBJECTIVES

To determine the effectiveness of the Safe Communities model to prevent injury in whole populations, or targeted sub-groups of populations.

SEARCH STRATEGY

The search strategy was based on electronic searches, handsearches of selected journals, snowballing from reference lists of selected publications and contacting a key person from each WHO-designated Safe Community.

SELECTION CRITERIA

Studies were independently screened for inclusion by two reviewers. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies.

MAIN RESULTS

Only seven WHO Safe Communities, of more than 80 worldwide, have undertaken controlled evaluations using objective sources of injury data. These communities represent only four countries from two geographical regions in the world: the Scandinavian countries of Sweden and Norway and the Pacific nations of Australia and New Zealand. Safe Communities in Sweden and Norway have resulted in significant reductions in injury rates. The Australian and New Zealand communities have been unable to replicate the same level of success.

AUTHORS' CONCLUSIONS

Evidence suggests the WHO Safe Communities model is effective in reducing injuries in whole populations. However, important methodological limitations exist in all studies from which evidence can be obtained. A lack of reported detail makes it unclear which factors facilitate or hinder a programme's success, and makes uncertain, whether the success of any particular application of the model is necessarily replicable in other communities. In evaluated programmes that did not report significant decreases in injury rates, this lack of information makes it difficult to distinguish between evidence of no effect of the model, or no evidence of effect. The four countries that have evaluated their Safe Communities with a sufficiently rigorous study design have higher economic wealth and health standards and lower injury rates than much of the world. No evaluations were available from other parts of the world, despite the designation of WHO Safe Communities in countries such as South Africa, Bangladesh, China, Vietnam, Canada, UK and USA. Generalisation of results of studies conducted in just four countries, to the international population needs to be done with caution. There is a need for more high-quality, methodologically strong evaluations of the model in a range of diverse communities and detailed reporting of implementation processes.

All-terrain vehicle injury in children: strategies for prevention

OBJECTIVE

A variety of educational efforts, policies, and regulations have been adopted to reduce all-terrain vehicle (ATV) injury in children. Despite this, ATV use by children continues and serious injuries are common. The purpose of this study was to investigate the knowledge, practices, and beliefs of ATV users to help develop effective educational strategies to promote safer ATV use.

DESIGN

Focus groups were conducted to characterize participant ATV use and safety awareness as well as to explore avenues for prevention. Feedback on draft ATV safety public service announcements was elicited. Themes of transcribed focus group data were summarized.

SETTING

Rural state with high ATV use and injury rates.

SUBJECTS

Adult and adolescent ATV users.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Summaries of focus group discussions.

RESULTS

ATV riders frankly discussed current use and safety behaviors and were aware of some ATV risks. Youths felt that age specific regulation was unlikely to be a helpful strategy. Participants endorsed messages demonstrating graphic consequences as likely to get the attention of young riders regarding risks. Educational settings were suggested, including hunter and driver safety classes.

CONCLUSIONS

Efforts to improve ATV safety awareness should clearly show pediatric ATV injury risk and safety practices. Campaigns must also show realistic understanding of current use practices to be credible for users. Messages emphasizing the consequences of ATV use were endorsed as most likely to have impact. Approaches based on age based restrictions were considered unrealistic and alternative strategies were suggested.

Community based prevention programs targeting all injuries for children

OBJECTIVE

Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing all-cause injury in children 0-14 years of age.

METHODS

A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; children under 14 years; outcome measure was injury rates; and either a community control or an historical control was used in the design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.

RESULTS

Thorough electronic and library search techniques yielded only nine formally evaluated community based all-cause child injury prevention programs that have reported actual injury outcomes. Of these nine studies, seven provided high level evidence where contemporary control communities were used for comparison; the remaining two used a pre and post-design or time trend analysis where historical data from the community were used as the comparison. Only three of the seven studies with contemporary control communities found significant effect of the intervention; the two studies without controls noted significant reductions in injury rates after the intervention period.

CONCLUSION

There is a paucity of research from which evidence regarding the effectiveness of community based childhood injury prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Community based programs to prevent poisoning in children 0-15 years

OBJECTIVE

Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0-15 years of age.

METHODS

A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.

RESULTS

The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children.

CONCLUSION

There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

The process and impact of implementing injury prevention projects in smaller communities in New Zealand

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.

Association between childhood community safety interventions and hospital injury records: a multilevel study

STUDY OBJECTIVE

To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome.

DESIGN

A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression.

SETTING

Twenty five municipalities in Stockholm County in Sweden were studied.

PARTICIPANTS

Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years.

MAIN RESULTS

Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children.

CONCLUSIONS

This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.