Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the National Health Survey of Pakistan

National estimates of injuries for children under 5 years based on population representative surveys are not readily available globally and have not been reported for developing countries. This study estimated the annual incidence, pattern and distribution of unintentional injuries according to age, gender, socio‐economic status, urban/rural residence and disability caused among children aged under 5 years in Pakistan. The National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of households to assess the health profile of the country. A two‐stage stratified design was used to select 3223 children under 5 years of age for interview and examination. Data were used for boys and girls in urban and rural areas over the preceding year. A community development index was developed to assess the relationship between socio‐economic status and injuries. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. Post hoc power calculations were made for each variable keeping the design effect at 3.0. The overall annual incidence of unintentional injuries was 47.8 [95% CI 36.6, 59.0] per 1000 per year; 50.2 [95% CI 37.0, 63.4] and 45.2 [95% CI 29.4, 61.0] per 1000 per year among boys and girls under 5 years of age respectively. An estimated 1.1 million unintentional injuries occur in Pakistan annually among these children. Injury rates increase with age among the under‐5s. Urban and rural injuries were 56.1 [95% CI 33.5, 78.7] and 44.1 [95% CI 31.1, 57.1] per 1000 per year respectively. The children living in least developed communities had almost 3 times higher risks of injuries than most developed communities. The annual incidence of types of injuries were: falls 28.7 [95% CI 19.5, 37.9], cuts/bruises 9.7 [95% CI 5.3, 14.1] and burns 6.6 [95% CI 3.0, 10.2] per 1000 per year. Falls were the most common type of injury (60%) followed by cuts/bruises (21%) and burns (14%). The majority of injuries occur at home (85%), with just 10% due to road traffic. Road traffic injuries and injuries to the female child were more likely to result in disability. There is a high burden of unintentional injuries and disability among children under 5 in Pakistan. These results are useful for planning further research and for prioritising prevention programmes nationally and in other developing countries with similar situation.     

1349例意外损伤住院儿童分析

目的:分析儿童意外损伤的类别及相关因素。方法:对1349例儿童意外损伤住院病例按国际损伤分类标准,对损伤类别、构成、年龄、性别、住院费用及天数进行分析。结果:儿童意外损伤占同期住院患儿及全部意外损伤住院人数的8%,是导致同期1月以上年龄住院患儿死亡的第1位原因。儿童意外损伤的前4位原因是交通事故、意外跌落、烧烫伤和意外中毒。男女比为1.79∶1。交通事故和意外跌落高峰年龄段在4～9岁,烧烫伤和意外中毒主要发生在3岁前。其中交通事故的平均住院费用最高,平均住院时间最长。坠落物致伤及机器致伤也占一定比例,分别为3.92%和1.33%。结论:应当大力开展儿童意外损伤危险因素的识别和干预,以减少儿童意外损伤的发生。     

Home Unintentional Non-fatal Injury Among Children Under 5 Years of Age in a Rural Area, El Minia Governorate, Egypt

Injury is the leading cause of morbidity and mortality in children aged 1–14 years, with home injuries a particular problem in the preschool-age group. The focus of this study was to determine the frequency, and the outcome of unintentional non-fatal injuries among children under 5 years of age in the household, and to describe the related risk factors through a community-based survey. A cross-sectional community based study was conducted on a random sample of 1,255 rural Egyptian children under 5 years of age. Data were collected by a questionnaire which included; socio-demographic data, history, type, and the outcome of unintentional home injuries in the previous year. Of 1,255 children, 55.9 % were males and 44.1 % were females, and their mean age was 28.6 ± 11.8 months. The frequency of unintentional non-fatal home-related injuries was 20.6 %. Injury rates were the highest among children during the third year of life, those of less educated parents, those whom mothers are of young age, and those with low household socioeconomic standard. Homes of injured children were not significantly different from the homes of non-injured children. Burns were the most common injuries among all the study groups (38 %) followed by falls (35.3 %). ‘Handicaps’ were more strongly associated with falls and burns (6.6 and 4.1 % respectively). Unintentional injuries are common among children under 5 years of age in rural Egypt. Therefore, measures should be taken to prevent children from the most frequently recorded home injuries such as burns and falls.     

盘县地区儿童车祸伤及防范

目的探讨儿童车祸伤的发生及防范。方法对某院2005年1月～2009年12月就诊的717例儿童意外伤害病例资料进行了回顾性分析。结果 6～12岁学龄儿童为意外伤害事故发生的高峰年龄段。0～14岁儿童意外伤害类型及排位主要为交通事故、意外中毒、跌落伤、烧烫伤。结论儿童意外伤害应以预防为主,采取家庭、学校、社会结合的预防方法。     

2007-2008年北京市0~6岁儿童伤害社区监测结果分析

【目的】 通过社区监测了解儿童伤害特点,制定有针对性的干预措施。 【方法】 采用分层整群抽样方法抽取北京市城市2个街道和农村3个乡镇,通过社区卫生服务中心和幼儿园监测0~6岁儿童伤害发生情况。 【结果】 2007-2008年平均每年监测0~6岁儿童8 085人,2年中,0~6岁儿童伤害发生率从2.09%下降至1.75%。儿童主要伤害原因为跌伤(49.51%)、钝器伤(12.30%)、动物伤害(10.36%)、烧烫伤(10.03%)和道路交通伤害(8.09%);城市儿童以跌伤、钝器伤为主,农村儿童以跌伤、动物伤害和道路交通伤害为主。儿童伤害主要发生地点为家中(32.04%)、幼儿园(22.98%)、院子/楼梯/楼道(14.24%)、道路(13.59%)和休闲活动场所(11.33%);主要伤害部位为头部(50.81%)、上肢(28.80%)和下肢(14.24%);以无意伤害、轻度伤害为主。 【结论】 社区伤害监测为儿童伤害预防提供了一个切实可行的数据收集途径。跌伤、钝器伤是城市儿童防范的重点,犬咬伤和自行车辐条伤是农村儿童防范重点。     

菏泽市东明县农村儿童意外伤害特征及其影响因素研究

目的 了解14岁以下农村儿童非致死性意外伤害的流行特征及其影响因素, 为当地儿童意外伤害的预防干预提供理论依据。方法 采用整群分层抽样方法抽取菏泽市东明县乡镇4所中小学及2所幼儿园的儿童475名为调查对象进行自拟问卷调查, 数据经SPSS 13.0软件进行统计分析。结果 调查的475名农村儿童意外伤害发生率为40%。碰撞(20.53%)、跌落(18.95%)、中毒(13.68%)为农村儿童意外伤害类型的前三位。农村儿童意外伤害的发生地点主要在家中(25.3%)和休闲活动场所(23.7%), 发生部位以上肢和头面部为主, 农村儿童意外伤害发生的严重程度中致残占3.1%。性别、(父)母亲文化程度、儿童性格以及是否留守儿童是农村儿童发生意外伤害的危险因素。伤害组家长的意外伤害认知低于非伤害组, 差异有统计学意义(t=-9.952, P<0.05)。结论 菏泽市农村儿童意外伤害发生率较高, 伤害类型以跌落、碰撞为主;影响儿童意外伤害的因素以家长的文化程度及对伤害的认知最为明显。     

意外损伤住院的6岁以下儿童相关因素分析

目的：研究6岁以下儿童意外损伤的危险因素，为制定有效的预防措施提供依据。方法：分析我院1994年1月1日-2004年12月31日收治的儿童意外损伤中6岁以下儿童病例的损伤类别、年龄、性别、住院时间及费用等特点。结果：741例6岁以下儿童意外损伤占同期儿童意外损伤总住院人数的55％。意外损伤的前4位原因是烧、烫伤、意外跌落、交通事故和意外中毒。男女比为1．65：1。烧、烫伤随年龄增长明显减少，而交通事故伤随年龄增长逐渐增多。住院费用最高及住院时间最长的是交通事故伤。结论：6岁以下儿童是意外损伤的高危人群，在年龄、性别及意外损伤类别上有其特点。社会、学校及家庭应密切配合，研究儿童意外损伤的各种危险因素，制定有效的预防措施。     

4～14岁儿童意外损伤相关因素分析

目的 研究学龄期儿童意外损伤的危险因素,为制定有效的预防措施提供依据.方法 分析1994年1月1日～2004年12月31日收治的儿童意外损伤中4～14岁学龄期儿童病例的损伤类别、发生地点及时间、年份趋势及年龄、性别特点.结果 803例4～14岁学龄期儿童意外损伤占同期全部儿童意外损伤住院人数的59.52%.意外损伤的前四位原因是交通事故、意外跌落、烧烫伤和意外中毒.男女之比为1.95：1.全部统计的损伤中在学校发生的9.33%.交通事故损伤发生的地点以放学及上学路上最多,占全部交通事故损伤的33.30%,其他前三位发生地点以家内及家周围为多.意外损伤随年龄增长逐渐减少,女孩随年龄增长减少更为明显.交通事故及意外跌落伤在近5年有明显增多趋势.结论 学龄期儿童是意外损伤的高危人数,在年龄、性别及发生地点上有其特点.社会、学校及家庭应密切配合,制定有效的预防措施.     

北京市2011-2016年托幼园所儿童伤害发生情况

分析北京市2011-2016年托幼园所儿童伤害发生趋势,为托幼园所儿童伤害预防工作提供依据.方法 对2011-2016年北京市托幼园所上报的儿童伤害年报表进行数据分析.结果 2011-2016年北京市发生儿童伤害的园所构成比从31.91%下降至19.65%,托幼园所儿童伤害检出率从5.92‰下降至2.01‰(x2值分别为88.25,1 343.85,P值均<0.01).2011-2016年间城区儿童伤害检出率从8.10‰下降至2.54‰,郊区儿童伤害检出率从2.33‰下降至1.28‰(x2值分别为1 275.08,50.64,P值均<0.01);每年城区儿童伤害检出率均高于郊区,差异均有统计学意义(x2值分别为426.50,275.51,123.34,75.09,45.62,72.91,P值均<0.01).儿童伤害发生较多的为跌伤(1.49‰~4.40‰)、钝器伤(0.21‰~0.52‰)、他伤\攻击伤(0.11‰~0.44‰).结论 托幼园所儿童伤害应得到重视,采取综合措施预防伤害发生.     

Incidence of Physical Injuries in a Rural Community in Sri Lanka: Results of the First Community Survey in Sri Lanka

Background:

Injuries account for approximately 11% of all hospital admissions in Sri Lanka. However, no published data are available with regard to the community incidence of injuries in Sri Lanka.

Objectives:

To determine the community incidence of major intentional and unintentional physical injuries in a rural community in Sri Lanka.

Materials and Methods:

A rural community consisting of 225 families with 1029 inhabitants was studied. Data on major injuries for a period of one year were collected retrospectively.

Results:

There were 85 major injuries in the community during the year of study. This gives a major injury incidence of 82.6 per 1000 person years. This is three times the incidence based on hospital-derived data. Animal bites being the most common cause of injury was noted in 2.3% of the population followed by falls in 1.6%, contact with objects in 1.5%, cut injuries in 1% and road trauma in 1%.

Conclusions:

This study shows a higher incidence of major physical injuries (both intentional and unintentional) in the community than figures derived from hospital data. The prevention of injuries in a community such as the one studied here should be aimed at animal bites, falls, contacts with objects, cut injuries and road trauma.     

The incidence of injuries among 87,000 Massachusetts children and adolescents: results of the 1980-81 Statewide Childhood Injury Prevention Program Surveillance System

This study describes the incidence of fatal and nonfatal injuries occurring in 87,022 Massachusetts children and adolescents during a one-year period. A surveillance system for injuries at 23 hospitals captured 93 per cent of all discharges for ages 0-19 in the 14 communities under study. Sample data were collected on emergency room visits, hospital admissions, and deaths for all but a few causes of unintentional injuries. The overall incidence was 2,239 per 10,000. The true incidence rates are probably higher than those reported. The ratio of emergency room visits to admissions to deaths was 1,300 to 45 to 1. Injury rates varied considerably by age, sex, cause, and level of severity. Age-specific injury rates were lowest for infants and elementary school age children and highest for toddlers and adolescents. The overall ratio of male to female injury rates was 1.66 to 1. Injuries from falls, sports, and cutting and piercing instruments had a high incidence and low severity. Injuries from motor vehicles, burns, and drownings had lower incidence, but greater severity. Results provide evidence that both morbidity and mortality must be considered when determining priorities for injury prevention. Current prevention efforts must be expanded to target injuries of higher incidence and within the adolescent population.     

遵义市农村学龄儿童烧烫伤特征及影响因素分析

目的探讨遵义市农村学龄儿童烧烫伤特征及影响因素,为制定预防儿童烧烫伤策略提供理论依据。方法采用多阶段整群随机抽样法抽取遵义市凤冈县2所小学和1所中学共465名儿童为调查对象,采用自制问卷调查近一年烧烫伤情况,运用单、多因素非条件Logistic回归分析其烧烫伤影响因素。结果烧烫伤发生率为8.82%,36.6%是热水和热油导致,发生部位主要是手掌/手臂(53.7%),主要发生地是家中(75.6%),发生季节主要是夏季(46.3%)。多因素分析显示,男童发生烧烫伤的危险性较女童高(OR=5.38)、独生子女(OR=11.05)、留守儿童(OR=8.61)等是儿童发生烧烫伤的危险因素。学习成绩好(OR=0.45)、懂得烧烫伤正确处理方法(OR=0.83)等是烧烫伤发生的保护因素。结论遵义市农村儿童烧烫伤发生率较高,应加强烧烫伤知识普及,关爱留守儿童,以降低其烧烫伤发生率。     

1990～2003年浙江省城乡居民伤害死亡流行特征分析

目的　了解浙江省伤害死亡特征,为伤害预防和研究提供信息。方法　利用浙江省疾病监测点1990～2 0 0 3年死亡登记系统资料,采用ICD 10进行伤害死因分类,分别比较各种伤害类别和外部原因的死亡率。结果　1990～2 0 0 3年浙江省农村、城市伤害死亡率分别为72 77/ 10万～84 4 7/ 10万、2 5 5 2 / 10万～5 0 4 9/ 10万,其中2 0 0 3年分别为84 4 7/ 10万、4 6 30 / 10万,农村高于城市;交通伤、坠落、自杀和溺水为伤害死亡的主要类别;14年间溺水、自杀死亡率出现不同程度下降,坠落、交通伤死亡率出现上升趋势。非故意伤害死亡前三位原因,农村为交通伤、坠落、溺水,城市为坠落、交通伤、溺水;自杀的主要方式农村、城市分别为中毒、机械性窒息。农村男、女伤害死亡率分别为93 19/ 10万、5 4 2 5 / 10万,第一位死因分别为交通伤、中毒;城市男、女伤害死亡率分别为38 4 5 /10万、30 0 8/ 10万,第一位死因分别为交通伤、坠落;均男性高于女性。伤害死亡率以老年人群为高。10岁以下无论城乡、男女死亡率最高均为溺水;10～5 5岁人群,城市男女性死亡率最高均是交通伤,农村男性为交通伤,女性为中毒;5 5岁以上人群,无论城乡、男女死亡率最高均为坠落。结论　1990～2 0 0 3年浙江省城乡居民伤害死亡率仍然维持较高     

石家庄市居民伤害现况研究

目的：了解石家庄市居民伤害现状,为伤害的预防提供依据。方法：采用多阶段分层整群抽样方法,对城市２个居委会和农村６个自然村居民２１５４４人的伤害情况进行回顾性调查。结果：伤害标准化发生率为４．２１％,农村高于城市,男性高于女性。位居伤害前３位的依次是：交通伤、跌伤、中毒,城市以交通伤居首位,农村以中毒居首位。１４岁以下和６０岁以上年龄组以跌伤为主,１５￣３４岁组煤气中毒,交通伤较多,３５￣５９岁组交     

宁夏银川市儿童伤害流行病学特征分析

目的了解宁夏银川市儿童伤害非致死性和致死性病例流行特征,为制定伤害防控策略提供科学依据。方法收集银川市3家伤害哨点监测医院2006-2012年儿童伤害病例,使用全国伤害管理软件及Excel 2010进行分析。结果收集0~17岁儿童伤害病例16 730例,包括非致死性16 632例和致死性98例。全部病例男女比为1.97∶1,其中学龄前儿童占48.20%,学龄儿童占51.80%;总病例伤害发生原因前3位为跌倒/坠落、道路交通伤害和烧烫伤,历年病例伤害发生原因顺位无明显差异,与总病例大体一致;伤害发生地点主要为家中、公路/街道和学校。致死性病例以男性为主;发生原因主要为交通伤害,其次为跌倒/坠落和溺水,第三为烧烫伤和中毒;发生地点前3位依次为公路/街道、家中和公共居住场所。结论银川市儿童伤害主要以非致死性伤害为主,其中学龄前儿童与学龄儿童各约占一半,发生原因主要为跌倒/坠落,发生地点主要为家中;致死性伤害发生原因主要为交通伤害,发生地点主要为公路/街道,为制定有针对性的儿童伤害防控策略及干预措施提供科学依据。     

Unintentional injury mortality in India, 2005: Nationally representative mortality survey of 1.1 million homes

ABSTRACT: BACKGROUND: Unintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional injury deaths in a nationally representative mortality survey. METHODS: Trained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates. RESULTS: In 2005, unintentional injury caused 648 000 deaths (7% of all deaths; 58/100 000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185 000 deaths; 29% of all unintentional injury deaths), falls (160 000 deaths, 25%) and drowning (73 000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70 years or older (410/100 000). CONCLUSIONS: These direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.     

深圳市社区儿童伤害监测干预模式的研究

目的建立并实施＂社区儿童伤害监测干预模式＂,降低儿童伤害发生率,改善儿童生存质量。方法选择伤害发生率比较高的深圳市龙岗区横岗镇作为社区儿童伤害监测干预点,干预前后分别进行伤害发生情况的问卷调查。结果建立了＂社区儿童伤害监测干预模式＂,伤害发生率由8.36%下降至6.40%,差异有统计学意义。与干预前比较,机械伤、中毒、意外跌落差异均有统计学意义。结论 ＂社区儿童伤害监测干预模式＂能有效地控制儿童伤害发生,为深圳市社区儿童伤害预防提供了新的方法。     

2006-2014年江苏省两地区医院伤害监测病例分布特征分析

目的 掌握江苏省两地区医院伤害监测哨点医院伤害病例的分布特征,从而为制订城市和农村的伤害防治策略提供依据。方法 对2006-2014年因伤害首次在江苏省两地区6家全国伤害监测哨点医院就诊的伤害病例进行描述性分析。结果 2006-2014年江苏省6家监测医院共报告伤害病例508 728例。城市点病例伤害发生年龄组构成比前三位分别为40~岁（11.9%）、20~岁（11.1%）和45~岁（10.1%）;农村点病例年龄组构成比前三位分别为20~岁（11.7%）、40~岁（10.5%）和25~岁（9.8%）。城市点病例职业构成以商业、服务业人员最高,占14.7%,农村点病例职业构成以生产运输设备人员及有关人员最高,占45.2%。城市点病例发生首要原因为跌倒/坠落伤（32.2%）;农村点病例发生首要原因为道路交通伤（25.0%）。城市点病例和农村点病例伤害经常发生的地点是公路/街道,伤害发生时活动主要为休闲活动,伤害意图以非故意为主。结论 无论是城市点还是农村点,伤害发生的原因均以跌倒/坠落伤和道路交通伤为主,因此应实施有针对性的干预措施,降低伤害的发生率。     

Are we closing the Aboriginal child injury gap? A cohort study

Objective: To assess if rates of hospitalised injury in Australian Aboriginal children, and differences in these rates between Aboriginal and non‐Aboriginal children, have changed over time. Methods: We used linked hospital data for New South Wales (NSW), Australia, to construct cohorts of children born in NSW hospitals between 2003–2007 and 2008–2012. We calculated rates of hospitalised injuries per 10,000 person years for Aboriginal and non‐Aboriginal children for both cohorts, and compared these using rate differences and rate ratios. Results: Rates of unintentional injury hospitalisation were similar in Aboriginal children in both cohorts and Aboriginal children had 1.7 times higher rates of unintentional injury hospitalisation compared with non‐Aboriginal children. Rate ratios between Aboriginal and non‐Aboriginal children for leading injury mechanisms, burns, poisonings and transport were similar in both cohorts, with 2.5, 3.0 and 2.4 times higher rates in Aboriginal children in the 2008–2012 cohort, respectively. Conclusions and Implications for public health: Our findings suggest that current injury prevention measures have not been successful in reducing either rates of unintentional injury in Aboriginal children, or injury inequalities between Aboriginal and non‐Aboriginal children. We recommend the implementation of targeted Aboriginal led injury prevention measures.     

Unintentional injuries in the home in the United States Part I: mortality

BACKGROUND: Unintentional injuries are a leading cause of death in the United States. It is unclear, however, what proportion of these injuries occur in the home. The purpose of this paper is to quantify and describe fatal unintentional injuries that take place in the home environment. METHODS: Data from the National Vital Statistics System (NVSS) were used to calculate average annual rates for unintentional home injury deaths, with 95% confidence intervals from 1992 to 1999 for the United States overall, and by mechanism of injury, gender, and age group. RESULTS: From 1992 to 1999, an average of 18,048 unintentional home injury deaths occurred annually in the United States (6.83 deaths per 100,000). Home injury deaths varied by age and gender, with males having higher rates of home injury death than females (8.78 vs 4.97 per 100,000), and older adults (>/=70 years) having higher rates than all other age groups. Falls (2.25 per 100,000), poisoning (1.83 per 100,000), and fire/burn injuries (1.29 per 100,000) were the leading causes of home injury death. Rates of fall death were highest for older adults, poisoning deaths were highest among middle-aged adults, and fire/burn death rates were highest among children. Inhalation/suffocation and drowning deaths were important injury issues for young children. CONCLUSIONS: Unintentional injury in the home is a significant problem. Specific home injury issues include falls among older adults, poisonings among middle-aged adults, fire/burn injuries among older adults and children, and inhalation/suffocation and drowning among young children. In addition, recommendations are presented for improvements to the NVSS.