11149771336 8989855028 3401139837 ROAD TRAFFIC DROWNING BURNS 2228814731 1984415785 1623814720 8573 6309 FALLS POISONING VIOLENCE SELF-INFLICTED ■B0YS ■GIRLS INJURY DEATHS IN CHILDREN AND ADOLESCENTS UNDER THE AGE OF 15 YEARS,BY CAUSE AND SEX.2002 Source:WHO Global Burden of Disease project for 2002,version 5. In most regions and countries,the gender gap in injury deaths increases with age.At the global level, injury death rates among children under the age of 1 year,as well as those aged 1-4 years,are about the same for males and females.However,in children aged 5-9 years male death rates are a third higher than female rates,a discrepancy that increases to 60%among those aged 10-14 years.Adolescents aged 15 to 17 years show an adult profile,with males accounting for more than 86%of all injury deaths(1). The male:female difference in injury death rates persists across country income status but tends to be more pronounced in the higher income nations.In the low-and middle-income countries,for those under 15 years the male injury death rate is about 20%higher than that for females,while in high-income countries,the male injury death rate is 50%higher than the female(1). Risk factors While injury is a significant risk for children and adolescents throughout the world,its incidence and effects are highly unequal.Globally,the vast majority of child and adolescent injury deaths(95%)occur in low- and middle-income countries,where the injury death rate for children under 15 years of age is about five times that in high-income countries (1). Inequalities in injury risk are apparent at a number of levels,between regions,and between and within countries.In addition to regional and country differences,there are also clear social and economic 7
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inequalities between population groups or particular subgroups.Poverty is an important Poverty is an risk factor and is strongly associated with most types of injury and violence among important social children.In low-and middle-income countries,for instance,poorer children are more likely factor associated to be pedestrians,to live in homes where open flames are needed for cooking,heat and with most types of light,and to play in spaces that are also workplaces and where machinery and dangerous infury and violence chemicals may be present.In high-income countries,studies have shown that the children among children. of unskilled workers are three to four times more likely to die from injury than are the children of skilled workers(10).Injury death rates among children of indigenous people, such as those from Australia,also show a steep gradient(11).Moreover,in countries where child injury death rates have fallen overall,the greatest improvements are generally observed among the more affluent,as opposed to those living in lower socioeconomic households(10). In addition to the biological(e.g.age,development stage)and gender factors noted previously,experience across the world has shown that a number of other risk factors,including the absence of protective factors and the nature of the local environment,are also important determinants of the risk of both fatal and non- fatal injuries in children and adolescents.Environmental factors,for example,the presence of basic infrastructure such as footpaths and safe crossing zones (which effect the separation of pedestrian and vehicle traffic)and the nature and type of housing,play a particularly significant role in shaping the exposure to risk and injury causation and thus the incidence and pattern of child injury.In the case of road transport,the number,type and quality(i.e.construction standards)of vehicles,the presence of footpaths and road crossings,the quality of roads and road traffic infrastructure,and the legal requirements for driving and for the use of restraints(and the degree to which they are enforced and followed)all have an impact on the environment for children,the degree of risk they face in their daily lives and,in turn,on the level and pattem of road traffic injury.In the case of housing,regulations governing the construction of homes and the use of safety measures such as smoke alamms,safety glass and balustrades,all measures widely adopted in high-income countries,have done much to reduce the risk of house fires and falls and have lead to concomitant reductions in injury deaths from these causes. The availability and access to medical care is another important factor that can influence not only the likelihood of surviving an injury but also its severity in the longer term.The speed and quality of emergency services,the level,effectiveness and affordability of trauma care,and the availability and quality of health care services for rehabilitation all impact survivability and the degree and duration of any impairment associated with injury.Although these factors are significant for all injured individuals,differentials in access to care adds further to the extra burden of injury experienced by disadvantaged population groups. Economic and social costs Although there is a dearth of literature on the costs of child and adolescent "The true scale of the injury,particularly from the low-and middle-income countries,it is clear that childhood injuries tragedy the economic and social burden associated with such injures is substantial. should be gauged by its depth Isolated studies from high-income countries have shown injury to be a major as wellits breadth-by asking contributor to hospital and health-care costs.For instance,in the United not only how many families States of America,it is estimated that unintentional injury among children are affected but also how and adolescents aged 1-19 years accounts for 11%of all hospital severely.And in this case the admissions,39%of emergency department attendances and 13%of medical multiplier-the depth of griel costs(12). and anguish involved in the death ofa child-is beyond all Aside from the direct medical costs,injury and injury deaths incur huge measure"(2.λ indirect costs,both economic and social.Death,injury and disability can have major impacts on individuals and their families,and in many cases these impacts are lifelong.This wider burden of child and adolescent injury can be described in a number of ways.The most compelling is as "..anguish beyond measure"(2).The sudden and unexpected death of a child has a profound emotional impact on families.Beyond this,child 8
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