Academic journal article Bulletin of the World Health Organization

Injury Prevention Counselling to Improve Safety Practices by Parents in Mexico

Academic journal article Bulletin of the World Health Organization

Injury Prevention Counselling to Improve Safety Practices by Parents in Mexico

Article excerpt

Voir page 596 le resume en francais. En la pagina 596 figura un resumen en espanol.


Most developing countries are experiencing increases in injury-related mortality and morbidity. This is especially true in Latin America. Injury has become a leading killer of Latin American children (1-3).

Despite the significance of the problem, little formal research has been directed towards injury prevention. In developed countries a variety of injury prevention efforts have proved effective. They involve the three main strategies of enforcement, engineering and education (4-7). The latter includes education for parents on childhood safety, the approaches to which include the use of mass media campaigns and group or one-to-one counselling. Many studies have demonstrated the effectiveness of office based or clinic-based counselling by primary care providers. Such counselling has increased safety practices by parents and decreased childhood injuries (8-14). The American Academy of Pediatrics reviewed 20 articles on injury prevention counselling in primary care, 18 of which demonstrated its effectiveness (15). Such counselling has been shown to be cost-effective (16).

There is reason to believe that counselling of this kind might be particularly effective in Latin America, where there have been few such activities and where the baseline safety-related knowledge of parents may be low. We undertook a pilot project to assess whether low-cost educational programmes for parents could improve their practice of childhood safety.



The study was conducted in Monterrey, Mexico's third largest city, having a population of 1 500 000. In recent years various educational programmes have been conducted with a view to increasing parents' practice of childhood safety. In 2000-01, efforts were made to increase such programmes and tailor them to the safety needs and educational backgrounds of parents in different socioeconomic strata in the city. We report an evaluation of the programme developed by the Tec de Monterrey School of Medicine in collaboration with the City of Monterrey. The study was approved by Monterrey's Health Department. The programme was individualized for groups in the upper, middle and lower socioeconomic strata. Before the programme began, baseline information on safety practices was obtained from parents attending clinics or living in neighbourhoods where it was going to be introduced as well as from similar control groups

For the upper socioeconomic stratum group the sites were two private clinics. For the middle socioeconomic stratum group the sites were two clinics that charged low fees and served a middle-class clientele. For the lower socioeconomic stratum group the sites were publicly subsidized clinics and the neighbourhoods they served.

Counselling on injury prevention

In all the clinics some elements of injury prevention counselling were already being used as part of overall health promotion. This counselling was upgraded in the project under discussion.

For the upper and middle socioeconomic strata the upgrading involved lectures and demonstrations lasting six hours and utilizing audio-visual materials from several sources, including The Injury Prevention Program (TIPP) of the American Academy of Pediatrics (17) and a locally developed programme entitled Pal Ki (Healthy Child) in the Mayan language. The topics included motor car and pedestrian safety, burn prevention, home safety and recreational safety. Several such courses were organized in 2000-01.

In addition, parts of the middle socioeconomic stratum group received clinic-based counselling, consisting of talks given in waiting rooms which lasted 15-20 minutes. Some of the above-mentioned audio-visual materials were used. TIPP information sheets in Spanish were given to the participants. Some parents received one-to-one counselling from a doctor. …

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