Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala,Uganda

ABSTRACT

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22–15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01–1.96). Older children (12–18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26–4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03–12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21–3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11–0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.     

Risk factors for injury in community-level football: a cohort study

We investigated the independent effect of commonly postulated risk factors on injury incidence in amateur football (soccer), using a prospective cohort design with follow-up over two seasons. A total of 1702 male and female players aged 13 years or older contributed information on 21,797 player-matches. Confirmed, were the effect of male vs. female sex (injury rate ratios (IRR) = 0.81, 95% confidence interval (CI): 0.67–0.97), older age (increasing IRR gradient), New Zealand European ethnicity (IRR = 0.87, 95% CI: 0.74–1.01), being taller (180–189 cm: IRR = 1.32, 95% CI: 1.06–1.63), previous injury (IRR = 1.32, 95% CI: 1.12–1.57), playing against medical advice (IRR = 1.24, 95% CI: 1.03–1.49), playing while recovering from injury (IRR = 1.40, 95% CI: 1.20–1.49), history of cigarette smoking (IRR = 1.27, 95% CI: 1.00–1.61) and time of season (IRR = 0.97, 95% CI: 0.96–0.98). Female, adult, non-European and taller players could be paid particular attention in injury prevention programmes. The need for effective injury management is reinforced. Adding physical conditioning to pre-season training may be required.     

Injuries among preschool children in the federal state of Brandenburg in relation to social factors – 1997–1999

The aim was to determine the epidemiology and risk factors of childhood and young adult injuries among long-term Afghan refugees in Pakistan. A stratified cluster study was undertaken on a random sample of refugee households from June to July 2002. The Afghan Refugee Injury Survey was administered to the head of the household and recorded all injuries among household members within the last 3 months. Crude injury incidence was 12.3 per 1000 population among those aged 0?–?29 years (age groups 0?–?4, 5?–?14 and 15?–?29 years). Those aged 15?–?29 years had the highest injury rate (18.3 per 1000) closely followed by those aged 5?–?14 (12.3 per 1000) and much higher than the 0?–?4 years category (2.3 per 1000). Falls accounted for most injuries (48%) with both road traffic injuries and assaults accounting for 15%. The 15?–?29 year age group (odds ratio?=?9.1) and those educated informally or for less than 6 years (odds ratio?=?2.10), were associated with injury (p?相似文献   

Fatal violence among children under 15 years in four cities of South Africa, 2001–2005

Homicide rates for South African children were estimated at double the global average in 2000. This article presents a secondary data analysis of the National Injury Mortality Surveillance System (NIMSS), with full coverage in four major metropolitan cities. Child homicide rates for 2001–2005 were calculated within the 0–4, 5–9 and 10–14 year age groups. The homicide rates were similar to the global pattern, with higher rates for boys, and among children aged 0–4 years than for older children. Poisson regression, accounting for city level clustering, was used to investigate age, sex and period effects in the homicide rate. The model indicated that the gender difference was more marked in the 10–14 year age groups (RR = 2.17; 95% CI 1.97–2.38) than in the 5–9 year (RR = 1.43; 95% CI 1.27–1.62) with the 0–4 year age group in-between (RR = 1.80; 95% CI 1.55–2.10). These data confirm previous observations that fatal violence among children is a public health concern, but, given the high rates of homicide among South African adults and other competing public health problems, it is difficult to motivate for action to address the issue of violence against children. Nonetheless, there are sufficient indications that efforts to reduce childhood violence are urgently needed.     

How socioeconomic status influences road traffic injuries and home injuries in Rome

Road traffic injuries (RTI) and home injuries (HI) are a relevant public health problem, especially among people living in deprived areas. The objective of this study was to explore the relationship between morbidity, hospitalisation, mortality from RTI and HI, and socioeconomic status (SES) of the area of residence. RTI and HI surveillance based on the Emergency Information System, the Hospital Information System and the Mortality Registry of Lazio region are the three sources of this study to create a unique surveillance system. For each subject, the SES index (5 levels) of its census tract of residence was obtained. The study population included emergency department admissions (year 2005) of residents in Rome, Italy. Incidence Rate Ratios (IRRs) have been estimated using Poisson Regression. The rates of RTI and HI emergency department visits were higher among the most deprived level of SES (IRR = 1.27, 95% CI: 1.24–1.30; IRR = 1.33, 95% CI: 1.29–1.37, respectively) compared to the most privileged ones; a similar result was found for hospitalisation (IRR = 1.19, 95% CI: 1.08–1.32; IRR = 1.11, 95% CI: 1.01–1.22). A strong relation was found between RTI mortality rates and poor level of SES. The study concluded that RTI and HI incidence were associated to sociodemographic factors.     

The impact of pedestrian countdown signals on single and two vehicle motor vehicle collisions: a quasi-experimental study

The objective of this study was to examine the impact of pedestrian countdown signals (PCS) on the rate of motor vehicle collisions (MVCs) in Toronto, Canada. A quasi-experimental design was used to compare rates of single and two vehicle MVCs before and after installation of PCS in Toronto, Canada between January 2005 and December 2009. Collision incidence rates were compared using Poisson regression analyses with adjustment for relevant cofounders and reported as incidence rate ratios (IRR) with 95% confidence intervals (CI). Secondary analyses were performed on subsets of collisions by collision type and injury severity. A total of 94,175 MVCs occurred at or near 1965 intersections at which PCS were installed over the five-year study period. Overall, the MVC incidence rate increased 7.5% (IRR = 1.075; 95% CI: 1.042–1.109; p < 0.0001) after installation of PCS. The installation of PCS led to an increase in MVCs. PCS may have an unintended consequence of increasing the rate of MVCs.     

Environmental risk factors contributing to traffic accidents in children: a case-control study

The aim of this study is to identify environmental risk factors related to road accidents in children of Tehran. This case-control study was performed in 2013. The cases were injured pedestrians aged 5–15 who were admitted to major hospitals supervised by Tehran University of Medical Sciences. The sample size for the cases was 273 and for the control group was 546. For the completeness of the clusters, 7 extra persons in case (total = 280) and 14 persons (total = 560) in control group were included. The interference of confounding variables assessed through forward conditional logistic regression. Result shows occurrence of traffic accidents was significantly associate with the width of the alleys or (<5 m: OR = 8.4, 95% CI: 3.3–21.5; 5–8 m: OR = 4.7, 95% CI: 1.8–12.2), distance from home to school((<100 m: OR = 1.7, 95% CI: 1.0–2.8), existence of parking lot (OR = 1.5, 95% CI: 1.0–2.3), traffic congestion (OR = 4.1, 95% CI: 2.6–6.4), traffic speed (OR = 2.1, 95% CI: 1.3–3.2) and existence of pedestrian bridges(OR = 4.2, 95% CI: 2.6–6.8). In the light of the important role of environmental factors in the occurrence of child traffic accidents, alleviating structural risk factors in addition to education and enforcement need more systematic efforts and planning by policymakers and urban planners to attain pedestrian safety goals.     

Latino families report lower child injury rates than white families

Latino children have lower visit rates to emergency departments and primary care physicians than white children in the USA. Using a nationally representative household survey, this study asked whether parental report of injury was also lower for Latino children, after adjusting for demographic, socioeconomic, health status and health care access factors. Data were obtained on injuries for which medical advice or treatment was received from the National Health Interview Survey (NHIS) from 1997 to 2003. Using the multistage probability design of NHIS, annual rates and adjusted odds of childhood injury report by race and ethnicity were calculated. Respondents reported lower rates of injury for Latino children (6.0 (95% CI 5.3-6.8)/100 person-years) than white children (13.4 (12.7-14.2)/100 person-years). Lower injury rates were mainly due to lower rates of sports injuries and accidental falls. Latino children had lower odds of reported injury than white children, even after adjusting for multiple factors (odds ratio 0.7; 95% CI 0.6-0.8). Lower odds of injury report among Latino children are independent of direct measures of demographic, socioeconomic, health status and health care access factors and indirect measures of acculturation including respondent language and country of origin. Potential explanations include lower exposure to risk, greater child supervision, reporting bias, differences in cultural attitudes toward seeking of health care and reduced health care access that cannot be explored in NHIS due to the form of the current questions. Further research is needed to investigate cultural differences in risk exposure, child supervision and seeking of injury care.     

Respondents’ recall of injury events: an investigation of recall bias in cross-sectional injury data from the Sudan Household Health Survey 2010

Recall bias is a well-documented limitation of population-based cross-sectional injury surveys. To fill some gaps in this area, we investigated the extent and nature of recall bias in Sudan Household Health Survey (SHHS 2010) injury data. The extent of incomplete recall was measured by comparing the total reported injuries over 12 months with the annualised number of injuries in the four weeks preceding the survey. Multivariable logistic regression was used to investigate the association of socio-demographic variables, injury attributes and interviewee characteristics with differential recall. Relevant interactions were tested. Overall, reported injuries were 33% of the expected. Injuries among children 1–4 years had lower odds of being reported to have occurred earlier than the four weeks preceding the survey than people aged 65 years and over (OR = 0.24, 95% CI 0.12–0.47). Injuries that received inpatient care in the first week were more likely to be recalled than those that did not receive care (OR = 2.07, 95% CI 1.14–3.75). Respondent's age was associated with differential recall. Differential injury recall should be considered when using SHHS 2010 to compare injury occurrence between children under five and older groups or at the level of health care received.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

Child and young adult injuries among long-term Afghan refugees

The aim was to determine the epidemiology and risk factors of childhood and young adult injuries among long-term Afghan refugees in Pakistan. A stratified cluster study was undertaken on a random sample of refugee households from June to July 2002. The Afghan Refugee Injury Survey was administered to the head of the household and recorded all injuries among household members within the last 3 months. Crude injury incidence was 12.3 per 1000 population among those aged 0-29 years (age groups 0-4, 5-14 and 15-29 years). Those aged 15-29 years had the highest injury rate (18.3 per 1000) closely followed by those aged 5-14 (12.3 per 1000) and much higher than the 0-4 years category (2.3 per 1000). Falls accounted for most injuries (48%) with both road traffic injuries and assaults accounting for 15%. The 15-29 year age group (odds ratio = 9.1) and those educated informally or for less than 6 years (odds ratio = 2.10), were associated with injury (p < 0.05) after adjustment for age, gender, occupation and education. Occupation was not associated with injury at a statistically significant level. Afghan refugee children and young adults are disproportionately affected by injuries, especially falls, than children in developed countries. Appropriate injury prevention strategies must be implemented among refugee camps with long-term refugees as part of their health programmes.     

Fatal violence among children under 15 years in four cities of South Africa, 2001-2005

Homicide rates for South African children were estimated at double the global average in 2000. This article presents a secondary data analysis of the National Injury Mortality Surveillance System (NIMSS), with full coverage in four major metropolitan cities. Child homicide rates for 2001-2005 were calculated within the 0-4, 5-9 and 10-14 year age groups. The homicide rates were similar to the global pattern, with higher rates for boys, and among children aged 0-4 years than for older children. Poisson regression, accounting for city level clustering, was used to investigate age, sex and period effects in the homicide rate. The model indicated that the gender difference was more marked in the 10-14 year age groups (RR?=?2.17; 95% CI 1.97-2.38) than in the 5-9 year (RR?=?1.43; 95% CI 1.27-1.62) with the 0-4 year age group in-between (RR?=?1.80; 95% CI 1.55-2.10). These data confirm previous observations that fatal violence among children is a public health concern, but, given the high rates of homicide among South African adults and other competing public health problems, it is difficult to motivate for action to address the issue of violence against children. Nonetheless, there are sufficient indications that efforts to reduce childhood violence are urgently needed.     

Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries

This study was intended to estimate the magnitude and explore the determinants of childhood drowning in rural Bangladesh. A cross-sectional survey as well as a population-based case - control study was conducted. By multistage cluster sampling 51 147 children aged 1 - 4 years were identified from 108 827 rural households. All drownings in children aged 1 - 4 years in the preceding 5 years were identified and recruited as cases and two living children of the same age group were selected from the same localities as controls. Socio-economic, demographic, environmental and other related information was collected from mothers of both cases and controls by face-to-face interview with the help of structured questionnaires. The incidence of drowning among children aged 1 - 4 years old was 156.4 per 100 000 children-year. The highest rate (328.1 per 100 000; 95% CI 254.8 - 421.7) was observed in 1 year old male children. The proportional mortality due to drowning in the children was 27.9%. Mothers' age and literacy and family income were identified as risk factors. Drowning is one of the major causes of 1 - 4 years childhood mortality in Bangladesh. One-year-old male children from poor families were at great risk of drowning in rural Bangladesh.     

Pattern of childhood falls in a low-income setting: a cross-sectional study in Dar es Salaam

The objective was to determine patterns and circumstances of childhood falls in a low-income setting in Dar es Salaam, Tanzania. This cross sectional study is based on a household survey conducted in July 2009.

A total of 3927 children up to age 18 from 1928 households in 15 sampled wards were surveyed through a structured questionnaire. The current study includes information regarding fall occurrence, socio-demographic and economic factors. Data were analysed using chi-square, t-test and logistic regression. Male children had 42% higher odds of falls compared to females, and rural residents had more than two times higher odds compared to urban residents. Falls occurred three times more among age group 1–4 and two times more among age group 5–9 compared to those between 15 and 18 years. Most falls occurred outdoors (62%) while playing (51%) with boys being over-represented. Females and children aged 1–4 years fell more from stairs whereas most infants fell from furniture. Male gender, younger age groups and rural residence were significant factors for fall injuries. The circumstances in which these falls occur also differ significantly. Intervention efforts should emphasise these patterns.     

The association of psychological symptoms with unintentional injuries among retired employees of a university in China

To investigate the association of psychological symptoms with injury risk, psychological symptoms were measured using symptom checklist-90 revised (SCL-90-R) and the unintentional injury information was followed up for 1 year among retired employees at a university in China. The injury rate had a significant difference between groups of raw mean score > or =2.0 and <2.0 for SCL-90-R global factor and subscale factors of obsessive compulsiveness, interpersonal sensitivity, depression and anxiety. After accounting for the factors of daily housework, physical activities, living alone and demographic factors, SCL-90-R global factor (odds ratio (OR) = 1.87, 95% CI: 1.20-2.91) and subscales factors of obsessive compulsiveness (OR = 1.93, 95% CI: 1.31-2.85), interpersonal sensitivity (OR = 2.05, 95% CI: 1.09-3.02), depression (OR = 2.09, 95% CI: 1.40-3.12) and anxiety (OR = 1.58, 95% CI: 1.03-2.44) were still significantly associated with an elevated risk of unintentional injury among the retired employees. In order to reduce the risk of unintentional injuries among the elderly, a psychological health service should be provided in the community.     

Hospitalized fall-related injury trends in Sweden between 2001 and 2010

Previous studies have indicated increasing trends of hospitalized fall-related injuries amongst elderly. Whether this is true also in Sweden is unknown though it is important to study considering the potential societal impact. Data were obtained regarding hospitalized injuries with falls as external cause among those aged 65 years and above with information on injury type, gender and age, on a yearly basis, from 2001 to 2010. Age- and sex-specific incidence rates were calculated (per 100,000 population) for all fall-related injuries, and for each injury type and trend lines were drawn. Linear regression analyses and percentage change were calculated for the types of fall-related injuries. A decreasing incidence was observed in the younger age groups (65–79 years) with greater decreases amongst women (women: ?14.6%, men 65–79 years: ?10.5%). However, increasing rates were observed in the older age group (80 years and above), with greater increases amongst men (women: 4.3%, men: 11.4%). Superficial injuries showed greater increases than fractures amongst those aged 80 years and above. This study indicates that older elderly in Sweden are increasingly being hospitalized for less serious injuries. This changing injury panorama is important to include in the future planning of both health care and fall-related prevention.     

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994-2005

The purpose of child restraint seats (CRS) is to reduce the number of individuals killed or injured in motor vehicle (MV) crashes. Japanese Road Traffic Law 17-3-4 (April 2000) specifies a requirement that CRS be used for all children aged 0-5 years. The objective of this evaluation was to determine the legislative impact on fatalities in Japan for the period 1994-2005. Data were obtained from the Institute for Traffic Accident Research and Data Analysis. A time-series Poisson regression model was used to analyse the change (6 years pre/post) in incidence rate ratios of fatality and injury in MV crashes among children ages 0-5 years. Despite increases in CRS use, fatalities failed to decrease significantly after enactment of the law (incidence rate ratio: 0.80; 95% CI: 0.49-1.31). In 2005, 67% of children aged 0-5 years, who were killed as MV occupants were not seated in CRS. Between 2000 and 2005, the lack of CRS led to 43% of front seat passenger deaths, 54% of rear seat deaths, 143 children died in total and 500 + children were seriously injured. It was found that the compulsory CRS law enacted in April 2000 did not result in a statistically significant reduction in child MV occupant fatalities and injuries in Japan.     

Feasibility of routine collection of injured worker occupational information in hospital emergency departments

The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35–0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21–0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.     

Road traffic injury among child motorcyclists in Vientiane Capital,Laos: a cross-sectional study using a hospital-based injury surveillance database

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2–0.5, for children 10–14 years; adjusted OR: 0.1, 95% CI, 0.05–0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.     

Childhood and adolescent injuries in elementary schools in north-western Uganda: extent,risk and associated factors

Childhood injuries remain understudied in Uganda. The objective of this study was to determine the extent, nature and determinants of school-related childhood injury risk in north-western Uganda. A cohort of 1000 grade fives from 13 elementary schools was followed-up for one term. Survival and multi-level modelling techniques compared the risk rates across gender, schools and locations. Childhood injuries are common in north-western Uganda. Most of them occur during travel, breaks, practical classes and gardening, while walking, playing, learning and digging. Most injuries result from collisions with objects, sports and falls. Two-thirds of children receive first aid and hospital care. Times to injury were 72.1 and 192.9 person days (p = 0.0000). Gender differences in time to event were significant (p = 0.0091). Girls had better survival rates: cumulative prevalence of childhood injury was 36.1%; with significant gender differences (p = 0.007). Injury rate was 12.3/1000 person days, with a hazard ratio of 1.4. Compared to girls, boys had a 37% higher injury rate (p = 0.004). Rates varied among schools. Associated factors include sex and school. Rural–urban location and school differences do influence childhood injury risk. Childhood injuries are common: the risk is high, gender- and school-specific. Determinants include gender and school. Location and school contexts influence injury risk.