Child injuries in Lebanon: assessing mothers' injury prevention knowledge attitude and practices

BACKGROUND

Childhood injury is a neglected public health problem with a sizeable burden on children's well-being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers' Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers' supervision.

METHODS

This cross-sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers' KAP toward childhood injuries using self-administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes.

RESULTS

A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5-10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospitalized children were more likely to be males and older than 5 years (p < 0.001). More than one-third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non-working mothers, accounting for possible confounders (p = 0.001).

CONCLUSION

Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers' KAP toward child injury prevention. Further studies are recommended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.

Comparing primary caregivers' reported injury data with routinely recorded injury data to assess predictors of childhood injury

BACKGROUND

Linking self-reported data collected from longitudinal studies with administrative health records is timely and cost-effective, provides the opportunity to augment information contained in each and can offset some of the limitations of both data sources. The aim of this study was to compare maternal-reported child injury data with administrative injury records and assess the level of agreement.

METHODS

A deterministic linkage was undertaken to link injury-related data from the Growing up in New Zealand (GUiNZ) study to routinely collected injury records from New Zealand's Accident Compensation Corporation (ACC) for preschool children. The analyses compared: (i) the characteristics of mothers with linked data vs. those without, (ii) injury incidences from maternal recall with those recorded in ACC injury claims, and (iii) the demographic characteristics of concordant and discordant injury reports, including the validity and reliability of injury records from both data sources.

RESULTS

Of all mothers who responded to the injury questions in the GUiNZ study (n = 5836), more than 95% (n = 5637) agreed to have their child's record linked to routine administrative health records. The overall discordance in injury reports showed an increasing trend as children grew older (9% at 9 M to 29% at 54 M). The mothers of children with discordance between maternal injury reports and ACC records were more likely to be younger, of Pacific ethnicity, with lower educational attainment, and live in areas of high deprivation (p < 0.001). The level of agreement between maternal injury recall and ACC injury record decreased (κ = 0.83 to κ = 0.42) as the cohort moved through their preschool years.

CONCLUSIONS

In general, the findings of this study identified that there was underreporting and discordance of the maternal injury recall, which varied by the demographic characteristics of mothers and their child's age. Therefore, linking the routinely gathered injury data with maternal self-report child injury data has the potential to augment longitudinal birth cohort study data to investigate risk or protective factors associated with childhood injury.

Unintentional injury deaths in children and youth, 2010-2019

BACKGROUND

Unintentional injuries are the leading cause of death for children and youth aged 1-19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0-19 years have changed during 2010-2019.

METHOD

CDC analyzed 2010-2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0-19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state.

RESULTS

From 2010-2011 to 2018-2019, unintentional injury death rates decreased 11% overall-representing over 1,100 fewer annual deaths. However, rates increased among some groups-including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018-2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15-19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010-2011 to 2018-2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)-driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.

A rare case of anterior shoulder dislocation in 1-year- and 10-month-old toddler: case report and literature review

We report our clinical experience of a 1 year and 10 month child with traumatic anterior shoulder dislocation who underwent non-operative reduction and Desault's bandage immobilization for 10 days. No associated fractures were found and after bandage removal, full ROM of the shoulder was immediately assessed. Further research is needed to unified guideline of treatment and the time of immobilization for this type of injury in pediatric population.

Severe tracheobronchial harm due to lithium button battery aspiration: An in vitro study of the pathomechanism and injury pattern

BACKGROUND

Button battery incidents have become a rising medical issue in recent years, especially for infants. The increasing number of these cases can be explained by the expanding use of objects of everyday life and toys. As a result, button batteries in many households are ubiquitous in different states of charge. The extremely long shelf-life and the increasing energy densities of lithium button batteries boost the potential medical complications of accidental swallowing.

OBJECTIVE

The study aimed to analyze the pathophysiology of damage to tracheobronchial structures by button batteries aspiration over time.

METHODS

CR2032 and CR927 lithium button batteries (3.2/3.0 V) were exposed to porcine trachea preparations intraluminal at 37 °C in intervals up to 36 h. Measurements were made of the voltage curve, the discharge current, and the resulting pH values around the electrodes. The effects on tissue were examined using macroscopic time-lapse images and microscopic pictures of sections of the fixed specimens over time.

FINDINGS

The examinations showed a tissue electrolysis reaction directly after the beginning of battery exposure, which led to an immediate coagulation impairment of the respiratory epithelium. Over time, a strongly alkaline environment was established around the batteries. The resulting tissue colliquation caused profound tissue damage beyond the basal membrane of the mucosa, affecting the tracheobronchial cartilage after only 4 h of exposure time. After 12 h, there was significant necrosis of the annular ligaments of the trachea and the peribronchial pulmonary tissue. After completion of the experimental exposure time of 36 h, there was still a sufficient residual voltage on all button batteries of the experiments.

CONCLUSIONS

Besides accidental ingestion, the aspiration of button batteries is a life-threatening situation. The partial or complete acute airway obstruction in the trachea or the bronchi initially is the leading symptom, as with any foreign body aspiration. However, the results of the investigations show that even after a short exposure time, relevant tissue damage can be caused by the electrolysis reaction of the battery. After 12 h, a profound destruction of cartilage, connective tissue, and smooth muscles was observed in vitro, which may cause significant consequential damage in vivo. These findings reveal the need for rapid diagnosis and immediate foreign body removal after any battery ingestion. Moreover, the results show how relevant prevention of these accidents is, and that future safety modifications of these types of battery by the manufacturers would be appropriate.

[Trends of injury mortality among children in different stages of the China Children's Development Outlines]

Objective: To describe the trends and potential reasons responsible for injury mortality among children under 18 years old in different stages of the China Children's Development Outlines (CCDO) for children from 1990 to 2017, in China. Methods: Data derived from the Global Burden of Disease 2017 (GBD2017) were used to analyze the change of injury mortality, among children under 18 years old, by sex and provinces. Results: Since 1990, the Chinese government had formulated and implemented three CCDOs on Children. Each CCDO proposed corresponding main targets and strategic measures based on the development of children under current situation, in each area, accordingly. The first two CCDOs failed to set clear targets for child injury prevention and control, but the third one did propose a quantifiable target. The injury mortality rate of children under 18 years old showed a declining trend in all periods of the three CCDOs, by 26.07%, 40.68% and 26.48%, respectively. Both boys and girls showed significant downward trend in these three stages. Mortality rate on child injury differed in these three stages in all the 31 provinces. Conclusion: Thanks to the contribution of CCDO in different stages that providing important policies and impetus for the prevention and control of child injury, the number of deaths caused by child injury kept reducing, from 1990 to 2017, in China.

[Road traffic injury happened on the way to school, among primary and secondary school students in Mengzi city, Honghe prefecture, Yunnan province in 2018]

Objective: To understand the current situation of road traffic injuries among primary and secondary school students in Mengzi city. Methods: Using the cluster random sampling method, more than 9 000 primary and secondary school students from 20 primary and secondary schools in Mengzi city, were randomly sampled. A questionnaire survey was conducted on the occurrence of road traffic injuries in school students. Results: A total of 9 197 students were surveyed, including 150 from road traffic injuries. The incidence rates of road traffic injuries was 1.63% among students in Mengzi city and 2.85% among junior high school students, with the high incidence in May. The leading places of injuries were village roads (38.00%), city roads (33.33%) and district roads (12.67%), respectively. 26.67% of the traffic injuries occurred on the way to or from schools, with riding on electric bicycle (52.00%) as the major cause and contusion/abrasion (75.33%) appeared as the major signs. Both lower and upper limbs plus multiple parts were accounting for 45.51%, 22.16% and 16.17%, respectively of all the injuries. 70.67% of all the cases with road traffic injuries in children, recovered after treatment. Children with road traffic injuries would stay in the hospital for up to 90 days but spent less than 30 000 Yuan. Conclusion: The incidence of road traffic injuries among students in Mengzi city seemed relatively high, with junior high school students reached the highest. Riding electric bicycle appeared as the leading cause for traffic injuries in children in Mengzi city of Yunnan province.

[Occurrence of injuries among left-behind children from 27 poor rural areas in 12 provinces of China, 2016]

Objective: To understand the injuries among 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, 2016. Methods: Data were collected from the survey of 'Health Service Needs Assessment' (HSNA) program on left-behind children, from poor rural areas in the middle and western parts of China. Factors including causes, types, locations, related activities, ways of treatment and outcomes among left-behind children with injuries in 2016, were described and analyzed by gender and age groups. Results: In 2016, per-person and person-time incidence rates of injuries were 8.88% and 11.21%, among the 16 459 left-behind children from 27 poor rural areas in 12 provinces of China, both higher in boys, than in girls. Most injuries were unintentional with its proportion higher in older children. The main types of injuries were seen as falls, blunt and sharp injuries, with burns and animal injuries more common in younger children. Injuries among left-behind children mainly took place at home, kindergarten/school, and on the highways/streets/roads, during playing. Most common ways of treatment would include at the emergency settings, self-treated, with older children more likely to treat by themselves. Most injuries were cured. Conclusions: In programs on prevention and control of injuries targeting the left-behind children in poor rural areas, special attention should be given to older boys, on falls and blunt/sharp injuries, at home or kindergarten/school. Education programs should pinpoint on self-rescue skills and guidance on kids by the parents, with behavioral norms and social support included. Related comprehensive prevention and control mechanism should be developed in families, schools and communities, with medical resources and insurance mechanism explored to serve these population and districts, including those left-behind children.

[Further promotion on children injury prevention and control in China]

Injury is an important public health problem that threatening children's health. Researches have been carried out to prevent child injuries in China. Disease burden on injury for children have been moderated, but remained as the first cause of death in Chinese children, so injury prevention among children should still be treated as priority to promote children's health. It is necessary to establish and improve strategies in injury prevention which should be led by the government and correlated institutes, as to carry out a systematic, comprehensive and scientific system for children injury prevention and control. In order to reduce children's injuries and promote children's health, relevant policies and regulations should base on "Healthy China 2030" to formulate and implement action plans, to carry out practice and scientific research on children injury prevention, and to strengthen the team construction and talent training on this issue.

[Disease burden on falls among 0-19 years old population in China, in 1990 and 2017]

Objective: To analyze and compare the disease burden of falls in Chinese population aged 0-19, in 1990 and 2017. Methods: Indicators including number of deaths, mortality rates, years of life lost due to premature mortality (YLL), years lived with disability (YLD) and disability-adjusted of life years (DALY), on falls, were gathered from the Global Burden of Disease (GBD) 2017 and used to describe the disease burden and corresponding parameters on falls, between 1990 and 2017, in China. Results: In 2017, number of death, YLLs, YLDs, DALYs caused by falls were 5 321, 0.43 million person years, 0.14 million person years and 0.57 million person years respectively, among aged 0-19 group. Rates on standardized mortality, YLLs, YLDs and DALYs on falls were 1.76/100 000, 141.49/100 000, 46.99/100 000, and 188.48/100 000, respectively. The burden of falls decreased with the increase of age. Compared with 1990, disease burden of falls decreased in all age groups, both in male and female, with more seen in the lower age groups. Compared with 1990, the number of deaths, rates on YLLs, YLDs and DALYs caused by falls decreased by 65.08%, 46.63%, 47.38% and 36.33% respectively, in 2017. However, the YLDs rate increased by 73.31% between 1990 and 2017. The ratio of YLLs to DALYs decreased from 90.84% in 1990 to 75.07% in 2017, with a proportion as 17.36%. Conclusion: Compared with 1990, although the disease burden of falls among aged 0-19 group showed a decreasing trend, falls still caused serious disease burden for the aged 0-19 group. Research that targeting prevention on falls, should be continued.

Predicting pool safety habits and intentions of Australian parents and carers for their young children

INTRODUCTION

Children under five years are most at risk of experiencing fatal and nonfatal drowning. The highest proportion of drowning incidents occur in private swimming pools. Lapses in adult supervision and failures in pool barriers are leading contributory factors for pool drowning in this age group.

METHODS

We investigated the role of the theory of planned behavior social cognitions (attitude, subjective norm, and perceived behavioral control) as well as perceived barriers, planning, role construction, and anticipated regret on parents' and carers' intentions and habits toward two pool safety behaviors: restricting access and supervising children around private swimming pools. The study adopted a cross-sectional correlational design. Participants (N = 509) comprised Australian parents or caregivers with children aged under five years and access to a swimming pool at their residence. Participants completed a battery of self-report measures of social cognitive variables with respect to the swimming pool safety behaviors for their children.

RESULTS

Path analytic models controlling for past behavior indicated that subjective norm, planning, anticipated regret, and role construction were important predictors of habit, and subjective norm was a consistent predictor of intentions, for both behaviors. Planning predicted intentions in the restricting access sample, while attitudes, barriers, and role construction also predicted intentions in the supervising sample. Both models controlled for past behavior.

CONCLUSION

Current findings indicate the importance of psychological factors for restricting access and supervising behaviors, with normative factors prominent for both reasoned (intentions) and non-conscious (habits) behavioral antecedents. It seems factors guiding restricting access, which likely require regular enactment of routine behaviors (e.g., ensuring gate is not propped open, pool fence meets standards), may be governed by more habitual than intentional processes.

Changes in parents' perceived injury risk after a medically-attended injury to their child

Unintentional injuries are a major cause of hospitalization and death for children worldwide. Since children who sustain a medically-attended injury are at higher risk of recurrence, it is crucial to generate knowledge that informs interventions to prevent re-incidence. This study examines when, in the year following a medically-attended injury, parents perceive the greatest risk of injury recurrence. Since perception of injury risk is associated with parental preventive behavior, this can inform decisions on the timing of parent-targeted interventions to prevent re-injury. Study participants were 186 English-fluent parents of children 0 to 16 years, presenting at the British Columbia Children's Hospital for an unintentional pediatric injury. Parents were excluded if their child had a disability or chronic health condition. Perceived risk of the same and of any injury recurring were elicited from parents, when they sought treatment at the hospital, as well as one, four, and twelve months later. The study ran between February 2011 and December 2013. Mixed-effects models were used to analyze changes in parents' responses. Analysis indicates that perceived risk of the same injury recurring did not change. However, perceived risk of any injury recurring increased from baseline to first follow-up, then decreased during the rest of the year. Overall, perceived risk of any injury was higher for parents whose child had a history of injuries. Visits to the Emergency Department for a pediatric injury may not be optimal timing to deploy injury prevention interventions for parents. Follow-up visits (when parents' perceived risk is highest) may be better.

A parent-led intervention to promote recovery following pediatric injury: study protocol for a randomized controlled trial

BACKGROUND

Injury is one of the most prevalent potentially emotionally traumatic events that children experience and can lead to persistent impaired physical and emotional health. There is a need for interventions that promote full physical and emotional recovery and that can be easily accessed by all injured children. Based on research evidence regarding post-injury recovery, we created the Cellie Coping Kit for Children with Injury intervention to target key mechanisms of action and refined the intervention based on feedback from children, families, and experts in the field. The Cellie Coping Kit intervention is parent-guided and includes a toy (for engagement), coping cards for children, and a book for parents with evidence-based strategies to promote injury recovery. This pilot research trial aims to provide an initial evaluation of the impact of the Cellie Coping Kit for Children with Injury on proximal targets (coping, appraisals) and later child health outcomes (physical recovery, emotional health, health-related quality of life).

METHOD / DESIGN

Eighty children (aged 8-12 years) and their parents will complete a baseline assessment (T1) and then will be randomly assigned to an immediate intervention group or waitlist group. The Cellie Coping Kit for Injury Intervention will be introduced to the immediate intervention group after the T1 assessment and to the waitlist group following the T3 assessment. Follow-up assessments of physical and emotional health will be completed at 6 weeks (T2), 12 weeks (T3), and 18 weeks (T4).

DISCUSSION

This will be one of the first randomized controlled trials to examine an intervention tool intended to promote full recovery after pediatric injury and be primarily implemented by children and parents. Results will provide data on the feasibility of the implementation of the Cellie Coping Intervention for Injury as well as estimations of efficacy. Potential strengths and limitations of this design are discussed.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT03153696 . Registered on 15 May 2017.

Impact of the United States federal child tax credit on childhood injuries and behavior problems

Children who grow up in poverty are at risk for various poor outcomes. Socioeconomic policies can shape the conditions in which families are raising children and may be effective at reducing financial strain and helping families obtain economic sufficiency, thereby reducing risk for poor health outcomes. This study used data from two surveys conducted in the US, the National Longitudinal Survey of Youth 1979 (NLSY79) and the NLSY79 Young Adult survey to determine whether the U.S. Federal Child Tax Credit (CTC), a socioeconomic policy that provides tax relief to low- and middle-income families to offset the costs of raising children, is associated with child well-being, as indicated by whether the child had injuries requiring medical attention and behavioral problems. Fixed-effects models, accounting for year and state of residence, detected a lower likelihood of injuries requiring medical attention (OR = 0.58, 95% CI [0.40, 0.86]) and significantly fewer behavior problems (b = -2.07, 95% CI [-4.06, -0.08]) among children with mothers eligible to receive a CTC, but only when it was partially refundable (i.e., mothers could receive a tax refund for a portion of the CTC that exceeds their tax liability) for families making as little as $3000 a year. Tax credits like the CTC have the potential to alleviate financial strain among families, and consequently, may have impacts on injury and behavior problems.

[Disease burden of injuries in children aged 0-14-year-old in 1990 and 2013, in China]

Objective: To analyze the disease burden of injuries in Chinese children aged between 0-14-year-old, in 1990 and 2013. Methods: Data derived from the Global Burden of Disease 2013 was used to analyze the disease burden of injuries among children aged between 0-14-year-old in each province of China, using relevant indicators including mortality and the rate on disability-adjusted life years (DALY). Results: In 2013, the number of deaths, rates on mortality and DALY caused by injuries in children aged between 0-14-year-old were 73 766, 29.46 per 100 000 and 2 449.36 per 100 000, respectively. Each indicator of injury burden appeared higher in boys than that in girls. With the increase of age, burden caused by injuries in each age group showed a decreasing trend. Provinces and autonomous regions as Xinjiang, Tibet, Gansu, Qinghai and Ningxia ranked the top 5 regions on both mortality rate and DALY rate among children aged between 0-14-year-old. The top 3 injury-related mortality rates and rate on DALY were drowning, road traffic injury and exposure to mechanic forces, among children. Compared to the disease burden of injuries in the 1990s, all indicators showed decreasing trends in children aged between 0-14-year-old, with girls more than boys, and variations in different age groups. In all areas of China, improvements were seen on intervention programs related to the injury-caused burden among children aged between 0-14-year-old, except for Ningxia, Yunnan and Chongqing. Conclusions: During the last two decades, there had been significant improvements in reducing the injury-caused burden among the Chinese children aged between 0-14-year-old. However, injury is still the most important risk on health of children under 4-year-old, with boys in particular. Drowning and road traffic injury were the two leading causes of death in children aged between 1 and 14-year-old.

Child pedestrian safety knowledge, behaviour and road injury in Cape Town, South Africa

Pedestrian injuries are a leading cause of death among South African children, and young children residing in low-income communities are more at risk, due to various factors such as inadequate road infrastructure, exposure to traffic due to reliance on walking as a means of transport, and lack of supervision. This study used a cross-sectional, non-randomized self-report survey to assess pedestrian safety knowledge, road-crossing behaviour and pedestrian injuries of primary school children in selected low-income settings in Cape Town. The survey focused on three primary schools that had joined the Safe Kids Worldwide Model School Zone Project and was administered to 536 children aged 6-15 years, in their home language of isiXhosa. Descriptive and bivariate analyses as well as multivariate regression analyses were conducted to investigate potential predictor variables for pedestrian collision severity and unsafe road-crossing behaviour. Walking was the sole form of travel for 81% of the children, with a large proportion regularly walking unsupervised. Children who walk to or from school alone were younger and reported riskier road-crossing behaviour, although children who walk accompanied tended to have higher pedestrian collision severity. "Negligent Behaviour" related to road-crossing was significantly associated with higher pedestrian collision severity, with predictors of "Negligent Behaviour" including the lack of pedestrian safety knowledge and greater exposure to traffic in terms of time spent walking. More than half of the reported pedestrian collisions involved a bicycle, and older boys (10-15 years) were most at risk of experiencing a severe pedestrian injury. The findings substantiate emerging evidence that children in low-income settings are at greater risk for child pedestrian injury, and emphasise the need for evidence-based safety promotion and injury prevention interventions in these settings.

Baby walker injury, disability, and death in a high-income middle eastern country, as reported by siblings

Background

Baby walkers (BWs) are frequent causes of infant injuries. Little research is reported from the Middle East and few population-based studies anywhere.

Methods

Using multistage random sampling in a city of the United Arab Emirates, 4 of 8 female Arab government high schools and 3 final-year classes each from science and arts tracks were selected. Structured self-administered questionnaires assessed prevalence, frequency, severity, and external causes of BW incidents and injuries, and residential hazards.

Results

Response was 100 %, 696 students, 55 % (n = 385) Emirati citizens. 87 % (n = 605) of families used/had used BWs. Among 646 injuries were 118 ER (emergency) visits, 42 hospitalizations, 11 disabilities, and 3 deaths. Average risk was 1 incident/user, 1 injury/4 users, 1 ER visit/20, 1 hospitalization/55, 1 disability/200, 1 death/1000. Odds ratios for >1:1 floor levels were 2.3 (95 % confidence interval: 1.2, 4.3) for hospitalization, 16.8 (95 % CI: 2.1, 132.5) disability. Incidents included hitting objects 48 % (n = 1322), overturning 23 % (n = 632), accessing hazardous objects 17 % (n = 473), and falling down stairs 11 % (n = 300); 1 % (n = 32) fell into swimming pools. In 49 % (n = 297/605) of user families, ≥1 child had been injured.

Conclusions

Despite causing many injuries including disabilities and fatalities, BWs were used by nearly all families. Governments should consider Canada’s lead in prohibiting importation, sales, and advertising of BWs.

The role of NGOs in child injury prevention: an organizational assessment of one network of NGOs

Unintentional injuries are estimated to claim the lives of more than 875,000 children each year; millions more live with long-term consequences and permanent disabilities. The epidemiology of injuries has become clearer in the past decade. NGOs need to work in concert with each other to address the global burden of injuries by sharing information. Several NGOs have heeded this call, and the field has seen the emergence of global organizations aimed at highlighting the burden of injuries and streamlining injury prevention activities worldwide. Safe Kids Worldwide Inc. (SKWW) is a global network in 16 countries whose mission is to address the burden of injuries in children under 15 by harnessing the potential of local NGOs. An organizational assessment was conducted of SKWW which included structured organizational assessment, functional organizational mapping and contextual analysis that allowed for an in-depth examination of the strengths and challenges of SKWW's injury prevention approach. Over one year, primary and secondary data were collected and analyzed from headquarters and individual country offices. SKWW appears to be an effective model and has experienced a strong momentum and growth over the last two decades. Global NGOs that address the burden of injuries should start by defining a clear and universal strategic goal, build on local successes, maximize their strengths, and create avenues for stronger country engagement.

Factors associated with mothers' beliefs and practices concerning injury prevention in under five-year children, based on health belief model

BACKGROUND

Injuries are the first leading but predictable, avoidable and preventable cause of death among under five-year children worldwide. The present study aimed to identify the factors associated with mothers' beliefs and practices concerning injury prevention in under five-year children.

METHODS

This cross-sectional study was conducted from August to October 2011 in Hamadan County, the west of Iran, enrolling 580 mothers with at least one under five-year child. The data collection instrument was a questionnaire including 85 questions regarding demographic characteristics; knowledge; practices; Health Belief Model (HBM) constructs; and history of injury occurrence among the children. The reliability of the questionnaire was evaluated by a pilot study using Cronbach's alpha coefficient. Data had been collected through interview with mothers, by trained interviewers.

RESULTS

Almost 22.59% of mothers reported at least one injury in their under five-year children. Of 131 injuries occurred, 85 cases were mild, 23 cases were moderate, and 23 cases were severe. About 52.67% of injuries occurred in boys, 37.41% in less than one-year children, 73.28% at home, and 61.07% when the children were playing game. Fall (24.28%), burn (20.61%) and poisoning (14.50%) were the common causes of injuries. There was a positive correlation between mothers' practices and knowledge, perceived benefits, cues to action and self-efficacy and a negative correlation between mothers' practices and perceived susceptibility, severity, and barriers.

CONCLUSION

Knowledge, perceived severity, perceived barriers, cues to action, and self-efficacy of mothers toward the injuries in children were among the most important predictive constructs, which may be used for planning educating programs.