accident prevention and poverty
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Unintentional Injury and Safeguarding Children Monday 29 th October 2012. Accident prevention and poverty. Mike Hayes Child Accident Prevention Trust. About CAPT. - PowerPoint PPT PresentationTRANSCRIPT
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Accident prevention and poverty
Mike HayesChild Accident Prevention Trust
Unintentional Injury and Safeguarding Children
Monday 29th October 2012
www.makingthelink.net
About CAPT
CAPT is a national charity committed to reducing the number of children and young people who are killed, disabled or seriously injured as a result of accidents.
CAPT provides training, publications, consultancy and information services
CAPT runs Child Safety Week – community education campaign, raising awareness of serious childhood accidents & how to prevent them
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CAPT’s philosophy
We aim to create a safer environment in which children and young people can live, learn and play
We understand that experimenting and risk-taking are part of growing up
We do not want to secure low injury rates at the expense of children’s health and quality of life
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What are the consequences of injury?
Pain (from injury or subsequent treatment)Fear / anxietyPhysical disabilityEmotional effectsEducation – loss of schoolingDisruption to usual routine (social)Family stress and breakdownFinancial costs - to family, NHS and emergency services
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Bradford data:source of information
Child and Maternal Health Observatory (ChiMat) accident prevention report – published last Friday
http://tinyurl.com/chimat-accidents
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Hospital admissions for unintentional injuries: rate per 10,000 population (2010-11)
Bradford Yorkshire and The Humber
England0
20
40
60
80
100
120
140
160
180
Under 5s
5-17 years
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Hospital admissions for falls: rate per 100,000 population (2008/9-2010/11)
Bradford Yorkshire and The Humber
England0
100
200
300
400
500
600
700
800
Under 5s5-16 years
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Hospital admissions for burns and scalds: rate per 100,000 population (2006/7-2010/11)
Bradford Yorkshire and The Humber
England0
2
4
6
8
10
12
14
Under 5s5-16 years
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Hospital admissions for burns and scalds - under 5s: rate per 100,000 population (2006/7-2010/11)
West Yorkshire councils
Bradford Calderdale Kirklees Leeds Wakefield Yorkshire and The Humber
England0
2
4
6
8
10
12
14
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Deaths due to unintentional injuriesEngland and Wales, 1979 - 2010
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
0
200
400
600
800
1000
1200
Under 15
Under 5
No.
of d
eath
s
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Downward trend
Why? Safety education, awareness-raising Increased child restraint and seat belt use and
improved vehicle design Increased smoke alarm ownership Safer (and new) consumer products Improvements in medical care Changes in child behaviour, reducing exposure
to hazards
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Selected causes of death due to unintentional injuries by age, England and Wales, 2010
< 1 1–4 5–9 10–14 0-14 0-14 0-4 1-14
All accidents
M 15 33 19 43 110172 83 147
F 10 25 11 16 62
FallsM 2 1 - 1 4
6 4 4F - 1 - 1 2
Inanimate mechanical forces
M - 1 - 2 34 1 4
F - - 1 - 1
DrowningM 1 7 4 3 15
22 12 21F - 4 - 3 7
Other threats to breathing
M 7 13 3 11 3450 33 34
F 9 4 - 3 16
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On average, one child in five is taken to hospital after an accident each year
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Rates of death and injury due to accidents
For every death there are about 550 hospital admissions 10,500 A&E attendances.
10 admissions per 1,000 children 184 A&E attendances per 1,000 children 1 child in every 5.4 attends A&E annually About 5% of A&E attendances result in admission
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Death rates per year per 100 000 children aged 0-15 years by eight class NS-SEC, 2001-3, England and Wales
Source: Edwards P, Green J, Roberts I, Lutchmun S, BMJ, 2006;333;119-123
Never worked/long term unemployed
Routine occupations
Semi-routine occupations
Lower supervisory/technical occupations
Small employers/own account workers
Intermediate occupations
Lower managerial/professional occupations
Higher managerial/professional occupations
0 5 10 15 20 25 30
25.4
5.0
4.0
2.7
2.9
2.9
1.6
1.9
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Injury mortality rates by social class
Unskilled
Partly skilled
Manual skilled
Non-manual skilled
Managerial
Professional
0 10 20 30 40 50 60 70 80 90
83
38
34
19
16
17
European age standardised mortality rate per 100,000 population
Source: I Roberts and C Power (1996), BMJ Vol 31.3
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Hospital admissions and inequalities
Hippisley-Cox J, Groom L, Kendrick D, Coupland C, Webber E, et al. (2002) Cross sectional survey of socioeconomic variations in severity and mechanism of childhood injuries in Trent 1992–7. British Medical Journal 324: 1132–1134.
http://www.bmj.com/content/324/7346/1132
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Hospital admissions and inequalities
The total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation
These gradients were more marked for 0 4 year old children than 5 14 year olds
The steepest socioeconomic gradients were for pedestrian injuries (adjusted rate ratio 3.65) burns and scalds (adjusted rate ratio 3.49) poisoning (adjusted rate ratio 2.98)
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Risk factors using GP records
Orton E, Kendrick D, West J, Tata LJ (2012) Independent Risk Factors for Injury in Pre-School Children: Three Population-Based Nested Case-Control Studies Using Routine Primary Care Data. PLoS ONE 7(4): e35193.
http://tinyurl.com/orton-paper > 180,000 records from GP database Thermal injuries, fractures and poisoning
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Thermal injuries risk factors
Male gender Increasing birth order n-shaped relationship with child age, with the highest
odds of injury occurring at age 1-2 years Decreased with increasing maternal age Children living in 2-adult households had a lower odds
of injury compared with those in single adult households.
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Thermal injuries risk factors
Increased if the mother had a diagnosis of depression in the perinatal period
Adult hazardous or harmful alcohol consumption Increasing socioeconomic deprivation
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Poisoning risk factors
Increasing birth order Younger maternal age An even steeper n-shaped relationship with child age,
with the highest odds of injury occurring at age 2–3 years
Diagnosis of perinatal depression Adult hazardous or harmful alcohol consumption Increasing socioeconomic deprivation
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Accident prevention and poverty
The challenges Children! Our understanding of their development Our knowledge of what works
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Accidents and child development - the changing child
Anatomical and physical characteristics
Physical abilities - gross and fine motor skills
Exploring behaviours Cognitive abilities Speech and language development Social and emotional development Risk behaviours
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Fine motor skills
Holding and manipulating objects
Picking up objects Opening containers – child-
resistance Using “tools” – cutlery, crayon,
knife, scissors Chewing, swallowing and
breathing
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Exploring behaviours
Mouthing behaviour – risk of choking, suffocation, poisoning
Colour, sound, shape, lights, texture, movement, characters and faces, shape, size, smell, resemblance to food child-appealing products natural hazards (fire, water, plants,
etc) burns, drowning, poisoning, choking,
electrocution
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Exploring behaviours
Mouthing behaviour – risk of choking, suffocation, poisoning
Colour, sound, shape, lights, texture, movement, characters and faces, shape, size, smell, resemblance to food child-appealing products natural hazards (fire, water, plants,
etc) burns, drowning, poisoning, choking,
electrocution
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What works?
What do we mean by “works”? How should we measure effectiveness?
If we don’t know that a programme is effective, it doesn’t mean that it isn’t
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Approaches to prevention
Education and awareness-raising – who? Engineering and environmental change – modifying
products, settings, etc Legislation and enforcement – nationally, locally Empowering people – giving people the ability to act.
What people?
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World report on child injury preventionWorld Health Organization and UNICEF
“There is no single blueprint for success but six basic principles underlie most of the successful child injury prevention around the world. These are: Legislation and regulations, and their enforcement Product modification Environmental modification Supportive home visits The promotion of safety devices Education and the teaching of skills”
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Strategy 1 2 3 4 5
Setting (and enforcing ) laws on smoke alarms Developing a standard for child-resistant lighters Setting (and enforcing) laws on hot water tap temperature and educating the public Using thermostatic mixing valves to control hot water temperature Banning the manufacture and sale of fireworks Providing first aid for scalds – “cool the burn” Conducting home visits for at-risk families Distributing smoke alarms on their own (without accompanying laws) Conducting community-based campaigns and interventions Using traditional remedies on burns
Key strategies to prevent burns among children
1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful
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Strategy 1 2 3 4 5
Implementing multifaceted community programmes such as “Children can’t fly” Redesigning nursery furniture and other products Establishing playground standards for impact absorbing surfacing, height of equipment and maintenance Legislating for window guards Using safety gates and guard rails Conducting supportive home visits and education for at-risk families Raising awareness through educational campaigns Implementing housing and building codes
Key strategies to prevent falls among children
1 = effective 2 = promising 3 = insufficient evidence 4 = ineffective 5 = harmful
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Home safety education and provision of safety equipment for injury prevention
Kendrick D et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012.http://tinyurl.com/kendrick-cochrane
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Home safety education and provision of safety equipment for injury prevention
Overall families who received home safety education were more likely to: have a safe hot tap water temperature have a working smoke alarm and a fire escape plan have fitted stair gates have socket covers on unused sockets store medicines and cleaning products out of reach of
children
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Home safety education and provision of safety equipment for injury prevention
Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment, is effective in increasing a range of safety practices.
Home safety interventions provided in the home may reduce injury rates, but more research is needed to confirm this finding.
Home safety education was equally effective in the families whose children were at greater risk of injury.
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Safe at HomeNational Home Safety Equipment Scheme
http://www.safeathome.rospa.com/evaluation.htm
Evaluation report: If continued in the long term, the national programme
showed potential to reduce injuries, through the combination of effective safety equipment, free installation and targeted education
Has the potential to improve safety behaviours in vulnerable families and to reduce unintentional injuries
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Community-based injury prevention programmes
Towner et al. What works in preventing unintentional injuries in children and young adolescents? An updated systematic review.http://tinyurl.com/towner-review Key elements:
Long-term strategy Effective focused leadership Multi-agency collaboration Involvement of the local community Appropriate targeting Time to develop
Use of local surveillance systems to motivate participants and to evaluate interventions
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Partnerships
Statutory sector Local government, including public health and
children’s services Health sector Emergency services, especially fire and rescue
services Voluntary and community sector
Support for the families in greatest need
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You are not alone!
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