In Scotland, unintentional injury is a common cause of emergency admission to hospital for children. It accounts for about 1 in 8 hospital admissions and 1 in 13 deaths. Approximately 41% of unintentionalinjuries in children occur in those under 5. 1
training, the development of standard operating procedures, sharing and reading the first four transcripts between researchers coding the data and regular teleconferences, face-to-face meetings and e-mail contact. Our review was limited, as all reviews are, by the quality of the included studies and the quality of their reporting. Our review focused on barriers and facilitators identified by authors of included studies. As these were not the primary outcome measures for most included studies, it is possible that some outcome reporting bias occurred in authors ’ reports of these. Details about how authors became aware of barriers to and facilitators of the delivery of the interventions within their studies were sparse, and explicit attempts by authors to study barriers and facilitators were rare. Most studies reported on barriers and facilitators from the perspective of those delivering interventions, not from the perspective of those receiving interventions. Our interviews with children ’ s centre managers and staff took place during a time of reorganisation for many children ’ s centres, making it difficult at times to find staff who were willing and able to participate, and a small number of interviews were curtailed because of other work pressures. Managers nominated staff members to participate in interviews, hence a selection bias may have occurred whereby particular views are under- or over-represented. The wide range of responses provided by participants would suggest that this may not have occurred to an important extent. Nominated staff tended to be more hesitant and unsure about their children ’ s centre ’ s role in injury prevention than managers, but they were able to provide information about the practical experience of delivering interventions, which was very valuable. It is possible that the parents and children ’ s centre staff who agreed to take part in the interviews had a particular interest in or were motivated by the aims of the study or child safety in general and that their views may reflect this. As for other qualitative research, given its context-specific nature, it is not appropriate to generalise our findings to the wider population of parents or children ’ s centres. However, the maximum variation sampling, the large number of interviews conducted and the multicentre nature of both of our interview studies will have helped to obtain a wide representation of views and experiences, which should be broadly transferable to parents of young children and children ’ s centre staff in other disadvantaged areas of the country.
All reviews are dependent on the quality of reporting in the in- cluded studies and the availability and willingness of study au- thors to respond to requests for information. Unsurprisingly, the more recently published studies, especially RCTs, tended to be re- ported more comprehensively. The majority of studies described the content of the intervention in sufficient detail and described and reported injury outcomes enabling data to be extracted for meta-analysis. Three cluster allocated studies reported findings ad- justed for clustering (Emond 2002; Minkovitz 2003 (b); Johnston 2004). Most studies used parental reports of injuries, which may be subject to biased reporting, particularly as blinding partici- pants to treatment arm allocation is not possible with interven- tions such as these. However, there did not appear to be a con- sistent relationship between self-reported injury or that verified by medical records and effect size. Safety outcomes were reported less consistently, with a minority of studies reporting whether a statistically significant difference was found, but not reporting ef- fect sizes for some safety outcomes (Olds 1986; Feldman 1992; Emond 2002; Culp 2007). Some studies reported overall Home Observation of the Environment scores but not the subscale most relevant to child safety (Larson 1980; Olds 1986; Kitzman 1997; St Pierre 1999; Armstrong 2000; Koniak-Griffin 2003; Barlow 2007; Caldera 2007), or an overall score for the Massachusetts HomeSafety Questionnaire but subscale scores for safety practices and use of safety equipment (Culp 2007) or scores for all child care skills combined but not separate sleep safety scores (Feldman 1992). It is possible that improvements in the safety subscales were not reflected in improvements in overall scores (Armstrong 2000). The quality of studies was variable, with either half or more of the RCTs included in the meta-analysis being susceptible to bias in terms of allocation concealment and/or outcome assessment. However, despite this, sensitivity analyses demonstrated little im- pact of excluding studies without blinded outcome assessment on the results. Excluding studies without adequate allocation conceal- ment resulted in a similar effect size but the effect was no longer statistically significant, possibly due to a lack of power. Only two studies included in the meta analysis reported high attrition rates.
3.25 With the exception of window restrictors, all age groups would benefit from homesafety equipment (smoke and carbon monoxide alarms and thermostatic mixing valves). Window restrictors should benefit children aged over 2 as they are capable of climbing and falling from an unguarded window. The age at which window restrictors become ineffective is not clear. However, it is likely that most children can overcome child-resistant mechanisms by the time they reach the age of 5. Key-operated locks (where the key is inaccessible to a child) tend to be effective for longer. It is important to note the need to open windows in a fire emergency.
Analyses of longitudinal studies have shown the in ﬂ uence of parents on child outcomes that are related to injury risk. Research from the ALSPAC cohort has shown that positive parenting behaviour, parent – child interaction and a stimulating home environment were associated with enhanced development by the age of three (21) and improved cognitive and behavioural outcomes in children by age 5 (22). The ‘ better ’ the parenting, the more likely children are to be well adjusted and developmentally competent (23). Other studies, for mothers with learning dif ﬁ culties, have shown that supportive parent training can improve childcare practices (24). Evidence suggests that enhanced carer supervision can help reduce injury risk to children (25,26). Parenting interventions have the potential to reduce poor maternal mental health and increase maternal self ef ﬁ cacy (27,28), to improve maternal – child interactions (29), and to change child behaviour, especially behaviour that is challenging or could place the child at risk of injury (27,30,31). Parenting interventions can reduce injury risk either through these mechanisms or through increased parental knowledge of safety practices (32), improvement in the quality of the home environment (33), or through the use of homesafety practices such as having a ﬁ tted and functioning smoke alarm, using stair gates or keeping sharp objects safely (34,35). Parenting programmes have shown reductions in injury risk taking behaviour in primary school aged children (36). Health visitor interventions to support parents can reduce injury rates in both prospective studies (37) and meta-analysis of randomised controlled trials (38). Meta-analysis of parenting interventions, primarily conducted in high-risk or disadvantaged families, have demonstrated signi ﬁ cantly lower risks of injury, as measured by parental self-report of either medically or non-medically attended injuries (39,40). Parents value programmes that enable the acquisition of knowledge, skills and understanding, and facilitate acceptance and support from other parents. Such outcomes reduce feelings of guilt and social isolation, increase empathy with children, and give con ﬁ dence to cope with challenging child behaviour (41). A child ’ s medically attended injury represents a ‘ teachable moment ’ when parents are receptive to information regarding injury risk in their children (42).
good communication between organisations and target audiences, involving local people and appropriate target- ing of the population. At the physical or environmental level facilitators included stable and child friendly accom- modation, having control over adapting the home to meet their child safety needs and having landlords that dealt with safety issues. Safety equipment use was also a facilita- tor and related to this was provision of appropriate and durable equipment, training in installation and mainten- ance of equipment. At the individual level the main facili- tators were parental awareness of child injury risks, mothers safeguarding work, and teaching children about safety. Other facilitators included delivering safety infor- mation that was culturally sensitive, building trust and social connectedness rather than isolation . A recent qualitative study highlighted that social networks are a fa- cilitator of child safety awareness .
Domestic environment could play a significant role particularly in-home ac- cidents , and poisoning . In the current study, the nature/place of residence significantly determined a child’s proneness to injury as most of the injuries oc- curred in children living in rural areas with possibility of overcrowding and lack of safety devices in the households. A child health and injury survey in Bangla- desh showed that children living in homes with exposed wires in the houses who were mostly rural dwellers tend to have more mortality following electrocution . Similar studies have posited that children resident in rural areas tended to be of lower socioeconomic background with increased likelihood of poor envi- ronmental infrastructure and as such more exposed to injuries as seen in the present study  .
Currently, it is not clear if different prevention strategies are needed for children with disabilities. Specific interven- tions for children with disabilities might potentially in- clude actions to provide assistive devices and modify inaccessible or hazardous environments (passive interven- tions). In the former category would be appropriate wheel- chairs and other mobility devices, as well as tools to enhance ability to reach. In the latter category would be provision of curb cuts and safe road crossings and barrier removal in the home. UNICEF ’ s 2013 State of the World ’ s Children report focused on enhancing societal parti- cipation of children with disabilities and calls for universal design in “ all children ’ s environments — early childhood centers, schools, health facilities, public transport, play- grounds, and so on” (UNICEF 2013). Environmental fac- tors, including stairs, curbs, and rough terrain, were identified as injury trigger factors in a study of pediatric mobility aid-related injuries (Barnard et al. 2010). Re- ducing the use of institutionalization, increasing support for families and involving children with disabilities indeci- sion making are also addressed in the UNICEF report (UNICEF 2013). Future studies considering intervention effectiveness should include children with disabilities. As well, future research should be geared toward enhancing social participation and improving the safety of children ’ s environments, as opposed to restricting activities. The goal is to improve the quality of life for children with dis- abilities, and at stake is the principal of equity (UNICEF 2013).
Five studies (Brannen, 1992, US, [-]; Carr, 2005, UK, [-]; Brussoni et al, 2006, UK, [-]; Gibbs et al. 2005 Australia, [+]; and Mull et al, 2001 US [+]) explicitly cited perceived legal or policy barriers to unintentional injury prevention programmes. Particular weaknesses identified in carrying out fire safety interventions included work being too short-term and fragmented due to lack of coordination of homesafety in one central organisation (Brussoni et al, 2006), Weak legislation for landlords of rented accommodation meant that recommendations were not necessarily implemented effectively (Gibbs et al, 2005; Brussoni et al, 2006). Weak regulation on containers of toxic products was a barrier to reducing unintentional injury in the home, as consumer choice allowed toxic products not always to be sold in child resistant containers (Gibbs et al, 2005). Facilitators for prevention programmes aimed at reducing unintentionalinjuries to children in the home included strong policy drivers or legislation – for example, an obligation under the Fire Services act to councils or landlords to implement services, and the provision of funding to enable this (Brussoni et al, 2006).
poor inner city African American community, using community workers and recruiting black representatives from the local community. This method of ‘cascade training’ was successful in getting households involved. The intervention included an educational programme, home visits and the provision of safety equipment. The intervention was partially effective for those home hazards requiring minimal or moderate effort to correct. No information was provided on baseline comparability of the areas and no data were collected on accident rates.
In any needs assessment or intervention, the views of children and local residents can further enable local authorities to identify the best approaches to preventing injury. Many local organisations use Child Safety Week, which takes place in June each year to engage with mothers, fathers and children of all ages (including the under-fives) in activities that promote injury prevention.
In addition, some important policy and implementa- tion issues related to home injury prevention and con- trol can be highlighted through this study. Firstly, it is important that in Pakistan standards for constructing houses should be followed. In the absence of such stan- dards variability in the height and width of the steps/ stairs constructed within homes is common. There is also generally lack of safety gates/grills/locks for the stairs; some houses may not even have a stair banister. In Pakistan, there is a common to build multi-level houses that further increase the risk of falls among chil- dren. Secondly, the local government needs to take mea- sures to control the stray dogs present in the city. Thirdly, traffic calming and speed reducing measures needs to be enforced in the residential areas and around parks and playgrounds so that children do not risk their lives while playing on the roads and streets.
a multi-faceted community-based programme to reduce the incidence of falls in an elderly population . Applying the ecological framework, Clemson and colleagues studied the impact of improving individual falls self-efficacy and lower-limb balance and strength, while improving home and communal environmental and behavioural safety. In addition, attention to regular vision screening and medication reviews was encouraged. Compared to a control group, the intervention group experienced a 31% reduction in falls. A similar home-based intervention to prevent falls among community- dwelling frail older people, which included a home environmental assessment, facilitating any recommended changes, and training in the use of adaptive equipment, especially among previously frequent fallers, was effective in reducing falls rates among those with a history of recurrent falling .
The current study suffers from the struggle for cross- sectional analysis to assign causality. It may also be limited by recall bias because the flood-affected respondents were not in a normal mental state due to increased socioeconomic and survival pressures. In such a state it becomes difficult to recall events accurately, and this may extend to enumerating child injuries and reporting abuse of their children inaccurately. It is therefore likely that the injury epidemiology highlighted in this study is actually under- reported. The mortality figure could not be reported accurately.
The MFB has many programs to help keep you, your family, your home, and your workplace safe from ﬁ re. These include programs for children, retired groups and multicultural groups. The MFB also provides training and advice for safety in the workplace.
TPIs and HTIs were compared by demographics, injury type, body part injured, and disposition. Several injury types were grouped together for analysis into the following categories: concussion (concussion, internal organ injury to head, headache), contusion or abrasion (contusion or abrasion, hematoma, crush injury), fracture (fracture, nerve damage with fracture), laceration (laceration, puncture wound, skin avulsion), pain (pain or injury to a certain body part without other specified injury), sprain (sprain or strain), and other (all remaining injuries not previously specified). Body parts were grouped in the following categories: head (head, eyeball, face, mouth, ear), upper extremity (shoulder or clavicle, arm, elbow, hand, wrist, finger), lower extremity (ankle, toe, foot, leg, knee, hip), neck, chest or trunk, and other (internal injury or affecting whole body). Mechanism of injury was determined from narrative comments for TPI cases. Injury type, body part injured, and disposition were analyzed by age group, with pediatric patients divided by age <6 years and 6 to 17 years, because previous studies have shown higher risk for certain types of trampoline injuries in children <6 years of age. 13
Results. Of the 314 fatally injured children, 37% sus- tained inflicted injury, 13% sustained a fall, and 49% sustained an MVC. At admission, 6.8% of all children had a GCS score of >7, and 1.9% presented with a GCS score of >12 (lucid). The incidence of admission a GCS score of >7 varied by mechanism. Overall, children with inflicted injury were 3 times more likely to present with a GCS score of >7 than those injured in MVCs (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.2–10.3), but incidence of a GCS score of >7 did not differ between inflicted injuries and falls. Similarly, when considering only those children > 24 months old, a GCS score of >7 did not differ by mechanism. In contrast, in those <24 months old, children who died as a result of inflicted injury were >10 times more likely to have a GCS score of >7 than those who died as a result of a MVC (OR: 9.36; 95% CI: 1.3– 80.9).
according to their health awareness in general and of injuries in particular. The recall period of 1 year used in the study for nonfatal falls might be too long especially, if the fall did not result in a signi ﬁ cant injury. As Ujjain is a typical regional city of India with the rising new middle class of India, which is quite diverse geographically and socially, 18 we feel the results are generalizable to similar regional cities of India and other middle-income countries. However, to substantiate these results, a nationwide survey through multi-centre sur- vey project is needed in India.
This review considered the effect of homesafety education and provision of safety equipment on a variety of interventions to reduce childhood injuries. In total eighty studies were included, forty of which reported a range of outcomes related to poisoning prevention. Of these 40, there were 18 which were included in at least one of the meta-analyses of poisoning prevention outcomes. (14 RCTs, 3 non-RCTs and 1 controlled before-and after study.) Individual participant level data was obtained from 9 of these studies. The poisoning prevention interventions considered were: storage of medicines and cleaning products out of children‟s reach, possession of syrup of ipecac (Note: now no longer recommended) and having the poison control centre number accessible. The reviewers found that homesafety education was effective in increasing all of these safety practices and that provision of equipment, as well as education (e.g. by providing childproof cupboard catches) was more effective than education alone. The reviewers found there was a lack of evidence that homesafety education, with or without the provision of safety equipment was effective in reducing rates of thermal injuries, poisoning or a range of injuries, but note that the number of studies and the number of person years included in the meta-analyses for injury outcomes were relatively small. They explained that it was unlikely that this meant that safety education was not beneficial and reported on a number of observational studies supporting this point of view.