A Long-term Evaluation of Interventions on

Preschool Children’s Injury in a Community

in Shanghai from 2009 to 2014

QU SHUANGXIAO

2015.11.23

2

Methods

Results&Discussion

Background

Conclusion

Contents

Background

3

Injury and violence is a major killer of children throughout the world.

Source: The Lancet. 2015 Jan 31;385(9966):430-40. doi: 10.1016/S0140-6736(14)61698-6.

Epub 2014 Sep 30.

Figure 1: Global causes of child deaths in 2013 (1- 59 months)

Injury 5.2%

Rank 5

Background

4

The community based intervention for injury prevention has

become an accepted part of the overall injury control strategy.

Source: WHO (2008), Global Burden of Disease: 2004 update.

The top 15 of disability-adjusted life years (DALYs) lost for children aged 0–14 years included

road traffic crashes and falls.

Background

5

Study Time frame for intervention Results

Studies designed with controlled community

Schlesinger et al,196613 January 1962-June 1963 No differences found

Guyer et al,19891 September 1980– June 1982 No differences found

Davidson et al,199415 Safe

Kids/Healthy

Neighbourhoods Coalition

First three years of intervention: 1989–

91.Injury rates from 1983–88 (pre-intervention)

with injury rates during intervention period.

Central Harlem. RR 0.56 (95% CI 0.45 to 0.71).

Washington Heights RR 0.68 (95% CI 0.52 to 0.87

Svanstrom et al,199516 1984–91

No differences found

Petridou et al,199717 1994 No differences found

Coggan etal,20001 Evaluation over three year period 1995–97 Significant improvement in children (p<0.05)

Lindqvist et al,200219 Program started in 1985. Pre-data collected

1983–84. Post-data collected 1989

All injury intervention: OR 0.74 (95% CI 0.68 to 0.81)

Studies designed with the intervention community as an historical control

Jeffs et al, 199320 Baseline data collected 1987. Community

information campaign 1990–91

Noted significant reductions in injury rates

Tamburro et al,200221 1990–97 Noted significant reductions in injury rates

Source: Community based prevention programs targeting all injuries for children(systematic review)

Injury Prevention 2004;10:180–185. doi: 10.1136/ip.2003.004903. Published by Spinks.

Table2 Studies of community based prevention programs targeting all injuries in children aged 0–14 years

Study with the intervention community as an historical control

6

Methods

Participants: 9 kindergartens were

chosen with the method of simple cluster

sampling in a community in Shanghai.

All the students’ parents were investigated.

Indicators

1. Preschool children’s injury rate

Criteria of morbidity for inclusion in the project : an injury incident that caused a child to seek medical care,

or caused him/her to miss half day or more of kindergarten in last year. Injury categories classified as ICD-10.

2. Parents’ injury related health belief

SUS/ SER/ BEN/ BAR/ CTA/ MHM

There were 5 options that were defined from 1 score to 5 score.

Community-based Interventions

2009.7 2011.12 2014.12

Interventions----Implementation of WHO Safe Communities model.

School

‘‘Safe way to school’’ program

School education

Safety education competition

Environmental maintenance of

playgrounds, schools

7

Methods

Police

Road safety

Developing safer

roadway infrastructure

Carry out fire drills

Surveillance

First-aid training

Injury surveillance

Hospital

Distribution of printed materials

and brochures

Educational seminars for parents

Mass media/television campaigns

Neighborhood committee

Formation of

interdisciplinary

group

8

Results Survey 1

N=1129

Survey 2

N=1576

Survey 3

N=1735 P value

Children age(m±sd), year 4.14±0.97 4.59±1.16 4.86±0.94 <0.001*

Sex

Boy 614 (55.4%) 775 (51.2%) 855 (50.7%) 0.036

Girl 494 (44.6%) 740 (48.8%) 830 (49.3%)

Education level of father

Junior middle school 126 (11.4%) 141 (9.2%) 67 (3.9%) <0.001

Senior middle school 186 (16.8%) 228 (14.8%) 200 (11.7%)

≥ college 793 (71.8%) 1170 (76.0%) 1443 (84.4%)

Education level of mother

Junior middle school 174 (15.7%) 191 (12.4%) 106 (6.2%) <0.001

Senior middle school 200 (18.1%) 226 (14.7%) 200 (11.7%)

≥ college 733 (66.2%) 1125 (73.0%) 1407 (82.1%)

Registration of father

Shanghai 683 (61.8%) 998 (65.6%) 1152 (67.6%) 0.007

Non-shanghai 422 (38.2%) 523 (34.4%) 552 (32.4%)

Registration of mother

Shanghai 629 (57.2%) 928 (61.1%) 1071 (63.8%) 0.003

Non-shanghai 470 (42.8%) 590 (38.9%) 609 (36.3%)

Family per capita monthly income

low 118 (16.3%)%) 137 (14.0%) 171 (15.5%) <0.001

middle 459 (63.4%) 628 (64.3%) 582 (52.7%)

high 147 (20.3%) 212 (21.7%) 352 (31.9%)

Table 3 Characteristics of the study participants from three surveys

*t test，others are Pearsonc2 test

9.45%

13.55%

9.12%

7.29%

10.14%

8.07%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

2009 2011 2014

Incid

ence o

f in

jury

Figure 2 The incidence of preschool children’s injury

Boy

Girl

9

OR=0.628 (0.456, 0.865)

2009 2011 2014

8.68% 11.80% 8.64%

Total injury rates

----Incidence of preschool children’s injury

Results&Discussion

10

OR=0.371 (0.227, 0.607)

2009 2011 2014

OR=0.397 (0.229, 0.689) Falls

0.62% 0.51%

0.12%

4.52% 4.95%

3.23%

0.53% 0.38%

0.51%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

2009 2011 2014

Incid

en

ce o

f in

jury

Figure 3 The incidence of Top 3 injury type

Road traffic injuries

Falls

Fire-related burns

----Incidence of preschool children’s injury

Results&Discussion

11

Results&Discussion

3.85

3.91

4.09

3.89

3.94

4.11

3.80

3.85

3.90

3.95

4.00

4.05

4.10

4.15

4.20

2009 2011 2014

Healt

h b

elief

sco

re

Figure4 The Health belief score of preschool children's parents in different years

Boy's parents

Girl's parents

Health belief Score（ M±SD）

p 2009 2011 2014

SUS 3.94±0.64 4.05±0.57 4.12±0.51 <0.001 a

SER 4.03±0.64 4.14±0.62 4.23±0.56 <0.001 b

BEN 4.12±0.60 4.13±0.59 4.22±0.58 <0.001 b

BAR 3.05±1.02 3.03±1.04 3.20±1.10 <0.001 a

CTA 3.86±0.66 3.91±0.63 4.03±0.58 <0.001 a

MHM 4.20±0.63 4.20±0.63 4.28±0.60 <0.001 b

HB 3.86±0.43 3.93±0.42 4.10±0.44 <0.001 b

a:Kruskal-Wallis H test b:one-way ANOVO

Table3 6 aspects of health belief score of preschool children's parents

---- Parents’ injury related health belief

12

Conclusion

It was advisable that the community kept carrying out these interventions

Injury data surveillance system should be better established.

Limitations：It is difficult to solely attribute the reduction in injury rates

to the intervention program without a comparison community.

The community-based interventions were effective in reducing

preschool children’s injuries and improving parent’s injury-related

health belief.

Suggestion

THANKS FOR YOUR ATTENTION