Unsafe environments for children are associated with increased risks of drowning, burns, falls and poisoning. Factors that may make an environment unsafe include home and school building design, furnishing, products such as baby walkers, storage and packaging of toxic products, and a lack of childproof containers for drugs, cleaning products and other chemicals.
The Health Behaviour in School-aged Children (HBSC) study (7), a cross-national survey conducted in collaboration with the Regional Office in 35 countries, showed that in 2002, 45% of young peo-ple aged 11–15 years reported at least one medically treated injury during the previous 12 months; of these, 50% reported the occurrence of two or more injuries and 5% reported four or more injuries.
In each country, more boys than girls had had one or more medically treated injuries (7).
The relative contribution of drowning, poisoning, falls and burns to all deaths from these causes in 0–24-year-olds is shown in Fig. 12. Drowning is the most frequent cause of death, but falls are the dominant cause in the majority of the industrialized countries, in particular in Austria, Italy and Switzerland. In the countries of eastern Europe, the Caucasus and central Asia, a large proportion of the deaths are due to poisoning – as many as 70% in Estonia.
Fig. 11. Mortality in the group of young people aged 0–24 years from non-traffic unintentional injuries and GDP per capita, WHO European Region
Notes. TFYR Macedonia = The former Yugoslav Republic of Macedonia.
Data for 2002 or latest available. Unintentional injuries include drowning (ICD 9 BTL: E521; ICD 10: W65 –W74), falls (ICD 9 BTL:
E50; ICD 10: W00 – W19), burns (ICD 9 BTL: E51; ICD 10: X00 – X09), and poisoning (ICD 9 BTL: E48; ICD 10: X40 – X49).
Source: UNECE (14), WHO mortality database (15).
DROWNING
In many countries, drowning is the leading cause of mortality in children aged 1–4 years. Rates are highest in the former Soviet Union and Baltic countries (Fig. 12). The proximity of water is an important risk factor in different settings, particularly when children have unsupervised access to it, including unfenced pools or uncovered wells, and living near rivers, canals, ditches, dams and lakes (16).
GDP per capita, PPP US$
Georgia
Boys are at greater risk of drowning than girls, probably because they swim more often and engage in riskier behaviour (17–19). Children from lower socioeconomic groups tend to be less good at swimming than those from higher groups, resulting in an increased risk in the less well-off (16).
Fig. 12. Proportion of deaths the group aged 0–24 years from selected external causes, excluding traffic, by country in 2002
Note. TFYR Macedonia = The former Yugoslav Republic of Macedonia.
* Data for 2001
** Data for 2000
Source: WHO mortality database (15).
Measures to prevent drowning include the fencing of pools and other water areas, covering wells, better supervision of children in baths and swimming areas, and the provision of lifeguards and water flotation devices at swimming areas. Other useful measures include the prompt draining of bathtubs and training in swimming and water safety (20,21).
0% 20% 40% 60% 80% 100%
POISONING
Children who have access to harmful substances due to storage in childproof containers in non-secured cupboards and within easy reach are at greater risk of being poisoned. Effective preventive measures include the use of child-resistant closures, packaging systems for drugs, safer storage and restricted availability of dangerous substances (22,23) (Box 6).
Box 6. Programme to reduce accidental poisoning in the Netherlands
Reducing the incidence of accidental poisoning by using child-resistant packaging for chemicals and drugs was the main objective of a programme initiated in the Netherlands in 1981 (24). The programme targets the one million chil-dren under five years of age in the Netherlands and is still running. It involves a partnership between the Ministry of Health, the Ministry of Welfare and Sport, the Consumer Safety Institute, the National Poison Information Centre and manufacturers.
Surveillance data on poisoning collected by the Consumer Safety Institute are used to advocate legislation. With the support of the Ministry of Health, the requirements for child-resistant packaging of certain hazardous substances have been included in a Commodities Act, following consultations with manufacturers and other stakeholders.
Products are tested for the need for child-resistant closures by laboratory facilities established by the Inspectorate for Commodities. The range of substances included has been extended in response to the changing pattern of poi-soning and the introduction of new chemicals.
This programme has been successful: a 1991 evaluation showed that it had led to a 50% decrease in the hospital-ization of children for poisoning over a 10-year period. At the same time, educational campaigns in the 1990s result-ed in further decreases. The Netherlands now has the lowest poisoning rate in the Region.
In older children, particularly adolescents, acute alcohol poisoning through binge drinking is an emerg-ing problem in Europe. Moreover, alcohol is a risk factor for the death of children and adolescents from interpersonal violence, suicide, RTIs and other injuries (25,26).
FALLS
Among children most fatal falls are in urban areas, usually from buildings or other structures, and unsafe building design represents a risk factor. Socioeconomic deprivation, poor supervision and unsafe playgrounds, as well as the use of babywalkers are associated with injuries in falls. Effective interventions include the use of appropriate ground surfaces and lower climbing areas in play-grounds (9,27). As most fall injuries occur in or around the home (28), the use of balcony protec-tors, stair-gates, safety catches, restrictors and safety glass in windows are effective preventive measures (9,27).
BURNS
Burns are an important cause of injury and death in children and adolescents (Fig. 12) (29).
Burns and scalds can arise from fires and contact with hot surfaces and liquids, radiation, elec-tricity and chemicals. House fires are associated with the highest mortality, while scalds arising from contact with hot liquids, usually in the kitchen, cause serious injuries and often disability.
Smoking and alcohol are important risk factors for house fires, for example when an intoxicat-ed person falls asleep while smoking. Other risk factors are, however, not well understood, and more information is needed on the circumstances, agents and location of burns accidents (16).
The use of smoke detectors, fire-resistant clothing and raised cooking surfaces have been shown to be effective (27,30), with an 80% decrease in injury and death from fires in the total popula-tion as a consequence of the correct use of smoke alarms (31). Other preventive measures include the use of safer cooking stoves, enclosing open flames or using fire guards, avoiding smoking in bed, encouraging the use of child-safe lighters, using safe building designs, and encouraging safe-ty inspections to enforce regulations. Scalding can be prevented by lowering the temperature of water heater thermostats, by using safer cooking utensils, and by equipping the stove with a safe-ty device (Box 7).
Box 7. Home safety check scheme, Gloucestershire, United Kingdom
In 1984, the county of Gloucestershire, United Kingdom, adopted a Home Safety Check Scheme (32) which aimed to reduce the number of injuries in the home. It targeted vulnerable groups: very young children (under 5 years old), the elderly (over 60 years) and people suffering from an illness or disability. Services offered by the scheme include home safety visits with a safety inspection of all electrical appliances (including electric blankets), a free smoke detector fitting service and provision of a wide range of children’s safety equipment. The smoke detector installa-tion service operates in partnership with the Gloucestershire Fire and Rescue Service and provides regular servic-ing (includservic-ing free replacement alarm batteries). The scheme is operated with other agencies to enable safety equip-ment to be made available to disadvantaged families free of charge.
Full evaluation is under way, but the results of a self-reported behaviour study show that over 80% of participants found the visits useful and reported increased knowledge and safer behaviour.