Academic journal article Bulletin of the World Health Organization

Injury Prevention and the Attainment of Child and Adolescent health/Prevention Des Traumatismes et Progres Vers la Sante De L'enfant et De l'adolescent/La Prevencion De Las Lesiones Y la Consecucion De la Salud del Nino Y del Adolescente

Academic journal article Bulletin of the World Health Organization

Injury Prevention and the Attainment of Child and Adolescent health/Prevention Des Traumatismes et Progres Vers la Sante De L'enfant et De l'adolescent/La Prevencion De Las Lesiones Y la Consecucion De la Salud del Nino Y del Adolescente

Article excerpt

Introduction

Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The international focus of child health interventions has been on reducing mortality of children aged less than 5 to achieve the Millennium Development Goals. This has meant that the 5-18-year age group, in which injuries constitute a great burden, has received less attention. Indeed across the whole age spectrum of childhood and adolescence, the issue of child and adolescent injuries is often absent from discussions and is largely invisible in policies.

In December 2008, WHO and the United Nations Children's Fund published the first Worm report on child injury prevention) calling attention to the problem internationally. The report focused on the five leading causes of child injury deaths--road traffic injuries, drowning, poisoning, burns and falls--and set out what can be done to prevent these injuries. This article expands on the report's arguments that child injuries must be integrated into child health initiatives and proposes some initial steps for achieving this integration.

The importance of child injury

Injury is a significant cause of death and morbidity among children from the age of one, (1) and increases to become the leading cause of death among children aged 10 to 19 years (Fig. 1). Each year approximately 950 000 children aged less than 18 years die as a result of an injury or violence. Nearly 90% of these--about 830 000--are due to unintentional injuries--about the same number that die from measles, diphtheria, polio, whooping cough and tetanus combined. Most of these unintentional injuries are the result of road traffic crashes, drowning, burns, falls and poisoning, with the highest rates occurring in low-income and middle-income countries (Table 1). In addition to these deaths, tens of millions more children sustain injuries that do not kill them but are serious enough to require hospital treatment and sometimes result in disability.

The importance of child injury can be obscured by a focus on the major causes of mortality of children aged less than 5, which in most of the world's countries do not include injury. Even in regions where injury deaths are known to be underreported and child survival is determined mainly by perinatal causes, lower respiratory infections, diarrhoeal disease, malaria and measles, child injury has an impact on mortality rates of children aged less than 5 and comprises a substantial proportion of child deaths after the age of 5 years. In countries that have made substantial progress in eliminating or reducing childhood deaths from other causes, however, child injury clearly emerges as a major problem. For example in high-income countries, unintentional injuries account for nearly 40% of all child deaths, even though these countries generally have substantially lower child injury fatality rates than low- and middle-income countries. (1)

An example from Bangladesh illustrates the point of the relative position of injuries compared with other causes of death. Long-term trend data from the Matlab community laboratory are available for the period 1974 to 2000. Drowning has always been a significant cause of death and in the pre-immunization era, it killed as many children aged less than five as measles. When vaccine-preventable causes were virtually eliminated, drowning rates remained much the same. The relative proportion of drowning mortality has thus increased, rising from 9% of deaths in l-4 year-olds in 1983 to 53% in 2000. (2,3)

Why must we act now?

Data show clearly that child injuries take an unacceptably high toll on children's health and development and on society (Box 1). …

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