ChildhoodChildhood

IInjurynjury((ACCIDENTS IN CHILDRENACCIDENTS IN CHILDREN))

Dr mohammad nurul huq

I am Handle me with care!

In HICsIn HICs

HIC: high income country

At the end of this you will learnAt the end of this you will learn Impact of injury is Impact of injury is devastatingdevastating 95% child injuries (CI) occur in L&MICs95% child injuries (CI) occur in L&MICs Drowning Drowning is a great killeris a great killer

Control of Control of CI CI waswas essential to achieve MDG4 essential to achieve MDG4 ID and Mn. are controlled, but ID and Mn. are controlled, but CI CI is clearly a big problemis clearly a big problem Px program is a must in all child health programsPx program is a must in all child health programs

CI: child injuries.CI: child injuries. Px: preventionPx: prevention

L&MIC:L&MIC: low-income -, MIC: middle-income countrieslow-income -, MIC: middle-income countries

InjuryInjury

is the intentional/un- damage to body from is the intentional/un- damage to body from ac. exposure to thermal, mechanical, ac. exposure to thermal, mechanical, electrical, or chemical energy or from the electrical, or chemical energy or from the absence of such essentials as heat/O2absence of such essentials as heat/O2

Why Children are at Greater Risk?Why Children are at Greater Risk?

Children live in a world built for adults: Children live in a world built for adults: strong association strong association between between CICI and and– his age, developmental stagehis age, developmental stage– his interactions and activitieshis interactions and activities– lack of supervision, access to protective materialslack of supervision, access to protective materials

Px. strategies for adults may not work for childrenPx. strategies for adults may not work for children World is dangerous for them: cleaning chemicals, outlets, World is dangerous for them: cleaning chemicals, outlets,

ovens, sharps, bodies of water, traffic, etc.ovens, sharps, bodies of water, traffic, etc.

90% of CI are unintentional90% of CI are unintentional >2k U-18y dieU-18y die/d ofof CICI:: (= (= to death from DPT, measles, polioto death from DPT, measles, polio.).)

>50%: >50%: RTA , RTA , drowning. drowning. Burns, falls, homicide, poisoningBurns, falls, homicide, poisoning 720/d die from RTA720/d die from RTA 480 … from drowning. 480 … from drowning. >98% in L&MICs>98% in L&MICs 260 … from burns260 … from burns 130 … from falls; 130 … from falls; 125 … from poisoning125 … from poisoning

>95% of world CI deaths occur in L&MICs>95% of world CI deaths occur in L&MICs

World Figure of CI: World Figure of CI: >12% of disease burden>12% of disease burden

Tens of millions are admitted/y for non-fatal Tens of millions are admitted/y for non-fatal CI. CI. A great A great number develop life-long disabilitiesnumber develop life-long disabilities

CI CI is is a significant MM since 1y age a significant MM since 1y age It is It is the leading c/of death for >9y-old childrenthe leading c/of death for >9y-old children In HICs:In HICs: many have reduced many have reduced CIs CIs by 50% by 50% Effective Px measures can save >1k/d child livesEffective Px measures can save >1k/d child lives CI CI has not received enough attention and the issue is often has not received enough attention and the issue is often

absent from child survival initiativesabsent from child survival initiatives

MM: morbidity and mortalityMM: morbidity and mortality..

World Figure … World Figure …

Poor children face the greatest risks:Poor children face the greatest risks:– they have less access to protectionthey have less access to protection– reside in homes with open fires, unprotected windows, reside in homes with open fires, unprotected windows,

unsafe roofs and stairs, or near dense, fast-moving unsafe roofs and stairs, or near dense, fast-moving traffictraffic

– often lack spaces and facilities for safe playoften lack spaces and facilities for safe play Hazards are everywhere: cleaning chemicals, outlets, Hazards are everywhere: cleaning chemicals, outlets,

ovens, sharp corners, kerosene lamps and bodies of ovens, sharp corners, kerosene lamps and bodies of water, to name a fewwater, to name a few

World Figure …World Figure …

CIs are strongly related to social determinantsCIs are strongly related to social determinants

Impact of CI is devastating!Impact of CI is devastating!• Losing a child has a huge impact on familiesLosing a child has a huge impact on families• Disabled Disabled children may have poor social dev., children may have poor social dev.,

education, work, etc.education, work, etc.

• CIs CIs place significant strain on overstretched place significant strain on overstretched health care systems in L&MICshealth care systems in L&MICs

Injury Px is a v. cost-effective!Injury Px is a v. cost-effective!

RTA: RTA: leading c/of death in 10-19yleading c/of death in 10-19y• 720 children die/d (commonest: 720 children die/d (commonest: head injuries and fracturehead injuries and fracture))• 10 million non-fatally injured/y 10 million non-fatally injured/y • The biggest killer in 15-19y and the 2The biggest killer in 15-19y and the 2ndnd in 10-14y in 10-14y• RTA and falls are main c/of disabilitiesRTA and falls are main c/of disabilities• HICs: HICs: most victims are occupants of vehicles most victims are occupants of vehicles • L&MICs: L&MICs: most are pedestrians or cyclistsmost are pedestrians or cyclists

RTI: road traffic injury. RTA: - - accidentsRTI: road traffic injury. RTA: - - accidents

RTI: What works?RTI: What works? Road safetyRoad safety Helmets. Minimum drinking-age lawsHelmets. Minimum drinking-age laws Lower BAC for novice drivers and zero toleranceLower BAC for novice drivers and zero tolerance Graduated driver licensing systemsGraduated driver licensing systems Seat-belts, child-restraints, helmets. Speed reduction (Seat-belts, child-restraints, helmets. Speed reduction (school, residence, play school, residence, play

areas)areas) Separating road users: Separating road users: bicycle and pedestrian lanesbicycle and pedestrian lanes Daytime running lightsDaytime running lights Enforce traffic law, straighten roadsEnforce traffic law, straighten roads

BAC: blood alcohol concentration

BAC: BAC: blood alcohol concentrationblood alcohol concentration

11

Falls:Falls: the leading c/of ED visitthe leading c/of ED visit

• 47k children die /y47k children die /y• For every fatal fall 690 For every fatal fall 690

children miss schoolchildren miss school• Falls are the leading c/of Falls are the leading c/of

long term disabilitylong term disability

c/of: cause of. ED: emergency deptc/of: cause of. ED: emergency dept

Falls: Falls: World FactsWorld Facts

130 die/d: 60% from a height130 die/d: 60% from a height Non-fatal falls: Non-fatal falls: significant DALY lostsignificant DALY lost 50% children ED visits may be for fall50% children ED visits may be for fall

Bangladesh: Bangladesh: falls falls are leading are leading CI CI and 1 of the major c/of permanent disabilityand 1 of the major c/of permanent disability 770 children are injured/d and 770 children are injured/d and 5 die5 die Infants have the highest fatal fallsInfants have the highest fatal falls

DALY: Disability-adjusted life year: measure of totaldisease burden: number of yrs. lost due to ill-health, disability or early death. It compares overall health and life expectancy of a country

Children playing on roofs is a common sight in Children playing on roofs is a common sight in many Asian countriesmany Asian countries

Commonest falls: Commonest falls:

– prams, baby walkers, changing tables prams, baby walkers, changing tables – cots, beds, bunk bedscots, beds, bunk beds– trees; sports, roofs, windowstrees; sports, roofs, windows– stairs, playground equipmentsstairs, playground equipments– cliffs, buildings, furniturecliffs, buildings, furniture– jumping/diving into waterjumping/diving into water

The roads in villages and concrete slabs around tube-wells The roads in villages and concrete slabs around tube-wells become slippery when wetbecome slippery when wet

Children fall from their beds, or slip from the lap of Children fall from their beds, or slip from the lap of another childanother child

Young children also fall when they learn how to walkYoung children also fall when they learn how to walk

Falls: What works?Falls: What works?

All should be careful about childrenAll should be careful about childrenRedesigning nursery furniture and alikeRedesigning nursery furniture and alikeSafe playground: appropriate surface, material, height of Safe playground: appropriate surface, material, height of equipment and maintenanceequipment and maintenanceLegislating for stair, window, roof guardsLegislating for stair, window, roof guards

Multifaceted community programs: Multifaceted community programs: ‘Children can't fly’/they ‘Children can't fly’/they protected by angelsprotected by angelsPrevent them from climbing and slippery surfacesPrevent them from climbing and slippery surfacesHold children on rickshawsHold children on rickshawsEnsure children’s shoes are not slipperyEnsure children’s shoes are not slippery

Burns: Burns: only CI more common in girlsonly CI more common in girls

Burns: World FactsBurns: World Facts 260 die from burn/d260 die from burn/d

– x11 in L&MICsx11 in L&MICs Infants are at highest riskInfants are at highest risk Smoke inhalation alone can be fatalSmoke inhalation alone can be fatal 25% from fire, 75% from hot liquids, steam, electricity, etc25% from fire, 75% from hot liquids, steam, electricity, etc Many children are disfiguredMany children are disfigured

Burns in Bangladesh Burns in Bangladesh

Risk factors for burn in BangladeshRisk factors for burn in Bangladesh

Young children are the most vulnerableYoung children are the most vulnerable Rural children: >4 times at riskRural children: >4 times at risk Homes are the most common placeHomes are the most common place The kitchen is the most hazardousThe kitchen is the most hazardous KupiBati KupiBati (kerosene lamp): 10% of the total flame burns(kerosene lamp): 10% of the total flame burns

Burns: What works?Burns: What works? Laws for smoke alarmsLaws for smoke alarms Child-resistant lightersChild-resistant lighters Laws for tap water temp.Laws for tap water temp. Educating the publicEducating the public Caution in transporting hot water, drinksCaution in transporting hot water, drinks Rx at a dedicated burns centreRx at a dedicated burns centre

Poisoning: Poisoning: World FactsWorld Facts

>45K die/y or >45K die/y or 125/d.125/d. Highest for U-1y, but peaks again at Highest for U-1y, but peaks again at 15y and older (experiment with substances)15y and older (experiment with substances)

Fatal poisoning is x4 in L&MICs: commonest are paraffin, Fatal poisoning is x4 in L&MICs: commonest are paraffin, household products and drugshousehold products and drugs

In HICs: OTC drugs, household In HICs: OTC drugs, household products, prescription drugsproducts, prescription drugs

Substances found in and around the home are most Substances found in and around the home are most commonly involved in childhood poisoningcommonly involved in childhood poisoning

• Many millions of calls are made to poison control centres, Many millions of calls are made to poison control centres, most resolved over the phonemost resolved over the phone

Poisoning: What works?Poisoning: What works? Toxin free home. Toxin free home. Removing the toxic agentRemoving the toxic agent Child-resistant packaging of drugs and poisonsChild-resistant packaging of drugs and poisons Packaging drugs in non-lethal quantityPackaging drugs in non-lethal quantity Store out of reach of childrenStore out of reach of children Air pollution, smoking, arsenic mitigationAir pollution, smoking, arsenic mitigation Poison control centresPoison control centres

U-5 MR from ID is now low: U-5 MR from ID is now low: CI CI is ais a major killer major killer CI: CI: 14% of all death: 50/100k (53% among 5-17y)14% of all death: 50/100k (53% among 5-17y) CI: U-18y MRCI: U-18y MR: : 30k/y30k/y

– Drowning: Drowning: 17k (46 /d) 17k (46 /d) – RTA 3,400RTA 3,400– Animal bite 2,600Animal bite 2,600– SuicideSuicide 2,200 (15-17y; 6/d) 2,200 (15-17y; 6/d)– OthersOthers 4,800 4,800

U-18y CI morbidity: U-18y CI morbidity: 9,55,500/y9,55,500/y (30% of all morbidity}:(30% of all morbidity}:

Bangladesh ScenarioBangladesh Scenario

U-18y CI morbidity: 9,55,500: 13k permanent disability

– Fall 2,81,500– Burn 1,73,000– Cut 1,22,500– RTA 1,11,500– Near drowning 68,800– Others 1,98,200

CI: oneCI: one/2min. Lack of care/supervision are main reasons/2min. Lack of care/supervision are main reasons Caregivers are often preoccupied (poor, both parents Caregivers are often preoccupied (poor, both parents

working, living in cities)working, living in cities)

Low awareness of or indifference to risksLow awareness of or indifference to risks Harmful practices often make situations worse with Harmful practices often make situations worse with

absence of first-aid knowledgeabsence of first-aid knowledge

Bangladesh …Bangladesh …

Impact of CI (BD)Impact of CI (BD)

38k are orphaned/y38k are orphaned/y 36/d are disabled 36/d are disabled (bleak future, trapped in poverty, denied (bleak future, trapped in poverty, denied

for Rx, education, protection; can’t cope with environ.)for Rx, education, protection; can’t cope with environ.) It brings devastation for the poorIt brings devastation for the poor Many families are pushed to poverty or even family Many families are pushed to poverty or even family

dissolution due to Rx and rehab. costdissolution due to Rx and rehab. cost

RTA loses 2% GDPRTA loses 2% GDP

Why must we act now?Why must we act now?

Burden ofBurden of CI CI is on riseis on rise We have better/more resources, health knowledgeWe have better/more resources, health knowledge

We can make our roads safe for children; plan cities, We can make our roads safe for children; plan cities, caution against flood or mud flows, desertification, caution against flood or mud flows, desertification, droughts, or rises in sea leveldroughts, or rises in sea level

Overall RecommendationsOverall Recommendations

Develop Develop CICI prevention policy prevention policy Integrate Integrate CICI to all child health programs to all child health programs

Strengthen Strengthen health systemshealth systems to address to address CICI Enhance Enhance datadata for for CICI prevention prevention Priorities for Priorities for researchresearch Invest Invest for for CI CI preventionprevention

CI prevention is cost effectiveCI prevention is cost effective

Child injuries are preventableChild injuries are preventable 12 Proven interventions can save >1000 children/d12 Proven interventions can save >1000 children/d Many HICs have been able to reduceMany HICs have been able to reduce CI CI deaths by 50%deaths by 50%

Challenges in CI Px in BangladeshChallenges in CI Px in Bangladesh

Perception that CI is a chance!Perception that CI is a chance! Lack of Lack of datadata Lack of Lack of political willpolitical will Poor collaboration and cooperation between agenciesPoor collaboration and cooperation between agencies Lack Lack of fundof fund, human , human resourcesresources Appropriate Appropriate technologytechnology

WHO

“The cost of doing nothing for CI is unacceptable”

It would be tragic to achieve significant gains in child survival only to lose to CI

Make CI top PH policy and practice

PH: public health

World Child Health ProjectsWorld Child Health Projects

Convention on Rights of a Child: Convention on Rights of a Child: 19891989 Protect childrenProtect children. They have the right to the best health . They have the right to the best health

care and a safe environ., free from injury and violencecare and a safe environ., free from injury and violence

WHA resolutionsWHA resolutions Children are frequently mentioned in all Children are frequently mentioned in all resolutionsresolutions

8 MDGs: 48 MDGs: 4thth

to cut 2/3to cut 2/3rdsrds U-5MR; not attainable if CI is not controlled U-5MR; not attainable if CI is not controlled

UNGA: UNGA: A world fit for children A world fit for children (including(including CI) CI)

Child Survival Child Survival is an important issue globally. It is “the is an important issue globally. It is “the most pressing moral dilemma”most pressing moral dilemma”

The Bellagio PapersThe Bellagio Papers CI Px should be integrated into all child health initiativesCI Px should be integrated into all child health initiatives 2/32/3rdsrds of 11million U-5MR can be reduced by adding 23 of 11million U-5MR can be reduced by adding 23

proven cost-effective interventions for CIproven cost-effective interventions for CI

Drowning Drowning

and and Near DrowningNear Drowning

Drowning: death within 24 hrs of submersion

Near drowning: survival after 24 hrs of submersion (may die later)

Drowning: World FactsDrowning: World Facts 480 children die/d. 480 children die/d. >98% in L&MICs, usually in open >98% in L&MICs, usually in open

water bodies; most in and around the homewater bodies; most in and around the home 2-3million/y get into trouble in water (close to drowning)2-3million/y get into trouble in water (close to drowning)

1111thth U-5MR; 4 U-5MR; 4thth among 4-14y-age. 1 among 4-14y-age. 1stst in 1-4y in 1-4y U-5 children are at greatest risk – infants can drown in a U-5 children are at greatest risk – infants can drown in a

few CM of waterfew CM of water

In HICs: most drowning happen in swimming poolsIn HICs: most drowning happen in swimming pools

Bangladesh Scenario Bangladesh Scenario Drowning is number 1 killer in 1-4y ageDrowning is number 1 killer in 1-4y age 2007 flood: 87% of U-5MR was from drowning2007 flood: 87% of U-5MR was from drowning In pre-vax. era, it was equal to measles as killerIn pre-vax. era, it was equal to measles as killer

Most Drowning Occur Most Drowning Occur in pools:in pools:>75% within 20m of house, in the monsoon>75% within 20m of house, in the monsoon, , during flood; during flood;

between 9am to noon: between 9am to noon: mother is busy!mother is busy!

46% were <4y: 46% were <4y: cant swimcant swim

Male Female RatioMale Female Ratio

overall overall 3:1 3:1Teenagers Teenagers 10:110:1

Age of drowningAge of drowning <1 y<1 y 5% 5% 1-4y1-4y 37%37% 5-9y5-9y 15%15%10-14y10-14y 15%15%15-19y15-19y 28%28%

Age 1-4 y: most D occur in residential poolsAge 1-4 y: most D occur in residential pools

PlacesPlaces

PondsPonds Bath tubsBath tubs BucketsBuckets Swimming poolsSwimming pools LakesLakes

StreamsStreams FloodFlood RiverRiver Ocean beachesOcean beaches

Infants mostly drown in bathtubs, buckets, or toiletsInfants mostly drown in bathtubs, buckets, or toiletsBucket drowning is 24% of all toddler drowningBucket drowning is 24% of all toddler drowning

Risks Factors of DrowningRisks Factors of Drowning Lack of supervision: Lack of supervision: most drowned childrenmost drowned children

– were last seen in home in care of parents!were last seen in home in care of parents!– had been out of sight for had been out of sight for <5 min!<5 min!

Water recreation, alcohol, illicit drugsWater recreation, alcohol, illicit drugs Epilepsy (x13 rise)Epilepsy (x13 rise) Child abuseChild abuse

Most pediatric drowning victims drown silentlyMost pediatric drowning victims drown silently

Recreation waters: Recreation waters: majority >15y. Boating: majority >15y. Boating: hypothermia, trauma, CO poisoning, etchypothermia, trauma, CO poisoning, etc..

Alcohol:Alcohol: in 25-50% of teenager and adult drowningin 25-50% of teenager and adult drowning affects balance, coordination, judgmentaffects balance, coordination, judgment effect is effect is by sun and heat by sun and heat

Epilepsy:Epilepsy: drowning is the greatest c/of death (bathtub drowning is the greatest c/of death (bathtub highest risk)highest risk)

Pathophysiology Pathophysiology

Immediate hypoxiaImmediate hypoxia– cardiac arrest (? catechol. induced fatal arrhythmia): cardiac arrest (? catechol. induced fatal arrhythmia):

ischemia to all tissuesischemia to all tissuesLaryngospasmLaryngospasmPulmonary aspirationPulmonary aspiration (absent in 15%)(absent in 15%)

HypothermiaHypothermiaComaComaTerminal apnea Terminal apnea (medullary depression)(medullary depression)

HeartHeart– Cardiac arrestCardiac arrest– Initial tachycardia, severe hypertensionInitial tachycardia, severe hypertension

bradycardia and arrhythmiasbradycardia and arrhythmias

CNSCNS:: fails in 3min of hypoxiafails in 3min of hypoxia– Cerebral edemaCerebral edema– Increased ICPIncreased ICP

LiverLiver:: raised transaminasesraised transaminases

LungsLungs– ARDS; aspiration pn. (gastric, caustic, fluid)ARDS; aspiration pn. (gastric, caustic, fluid)– Pulmonary edemaPulmonary edema

Kidneys: Kidneys: ATN, cortical necrosisATN, cortical necrosis

CirculationCirculation:: DIC, hemolysis, low plateletDIC, hemolysis, low platelet

GITGIT:: abrasions, bloody stools, infxabrasions, bloody stools, infx..

PancreasPancreas: : raised serum enzymesraised serum enzymes

FE ImbalanceFE Imbalance (uncommon)(uncommon)

– Sea waterSea water: hemoconcentration, : hemoconcentration, hypernatremiahypernatremia– Fresh waterFresh water: water intoxication: water intoxication

hemodilution, hyponatremiahemodilution, hyponatremia hemolysis: ARF, hyperkalemiahemolysis: ARF, hyperkalemia

– SIADHSIADH

Temperature: Temperature: commonly hypothermiacommonly hypothermia

Bradycardia, Bradycardia, myocardial contraction myocardial contractionloss of vasomotor tone, hypotension, shockloss of vasomotor tone, hypotension, shock

Resuscitation Resuscitation Clear airwaysClear airways Don’t press abdomen!Don’t press abdomen! Vomits commonly Vomits commonly M2M/M2N breathingM2M/M2N breathing IntubationIntubation Temp. maintenanceTemp. maintenance Venous catheterVenous catheter ECGECG Correction of Correction of hypoglycemiahypoglycemia

Prognosis: depends onepends on

– Circumstances of the incidentCircumstances of the incident– Duration of submersionDuration of submersion– Speed of rescueSpeed of rescue– Effectiveness of resuscitationEffectiveness of resuscitation

Cardiac arrest requires aggressive prolonged Cardiac arrest requires aggressive prolonged resuscitationresuscitation

A: adult supervisionA: adult supervision

Must watch children with a distance of an arm’s lengthMust watch children with a distance of an arm’s length

Look in the pool first if a child is missingLook in the pool first if a child is missing

Get a lifeguard for social gatheringsGet a lifeguard for social gatherings

Prevention: ABCDPrevention: ABCD

Adult supervision is critical! Adult supervision is critical! A lapse of <5min is seen in most drowningA lapse of <5min is seen in most drowning May drown in 1-2in. of waterMay drown in 1-2in. of water Frequently occurs in bath tubs, buckets, toilets, diaper pails Frequently occurs in bath tubs, buckets, toilets, diaper pails

and wading poolsand wading pools Taking an eye off a Taking an eye off a

child in water for child in water for 2 sec puts a child at risk!2 sec puts a child at risk!

A swimming teacher teaches children to swim

B means BarriersB means Barriers A non-climbable (4F) fence for pool/spa. No items usable A non-climbable (4F) fence for pool/spa. No items usable

for climbing near fencefor climbing near fence Self-closing, -latching gates to pool/spa, Self-closing, -latching gates to pool/spa, (latches above a (latches above a

child's reach)child's reach) Secure locks for all openings to pool/spa when not in useSecure locks for all openings to pool/spa when not in use Doors and windows could be alarmed when openedDoors and windows could be alarmed when opened Power operated pool safety coversPower operated pool safety covers

Fence keeps children away from water

Use of waist bells

C means Classes C means Classes (swimming, CPR)(swimming, CPR)

Swimming by an instructorSwimming by an instructor Teach children toTeach children to

– leave the water if adult leavesleave the water if adult leaves– enter the water only with a swim suitenter the water only with a swim suit– first enter the water in the shallow endfirst enter the water in the shallow end

Teach adults CPR, rescue techniques, Teach adults CPR, rescue techniques, risks ofrisks of– Bath tubs, buckets, commodes, washing machineBath tubs, buckets, commodes, washing machine– Close toilet and bath doorsClose toilet and bath doors– Cover commodeCover commode

D means DevicesD means Devices

Poolside emergency phonePoolside emergency phone Install a life saving ring, shepherd's hook and CPR poster Install a life saving ring, shepherd's hook and CPR poster

by the poolby the pool Children must wear Personal Flotation Device (PFD) Children must wear Personal Flotation Device (PFD)

when at water siteswhen at water sites Wear PFD while in a boatWear PFD while in a boat

Also, never…Also, never…

leave full bucket/tubs, nor leave full bucket/tubs, nor leave a child alone near leave a child alone near water or let swim alone, nor use "floaties" or inflatable water or let swim alone, nor use "floaties" or inflatable toys as life jackets or substitutes for supervisiontoys as life jackets or substitutes for supervision

leave toys in or around the pool/spaleave toys in or around the pool/spa consider a child as consider a child as ''drown-proofdrown-proof' ' despite despite

swimming skills, or experienceswimming skills, or experience use alcohol or drugsuse alcohol or drugs swim in thunder or lightningswim in thunder or lightning dive into unfamiliar or shallow bodies of waterdive into unfamiliar or shallow bodies of water

MessagesMessages

Children have the right to a safe environment. Children have the right to a safe environment. Many lives could be saved by Many lives could be saved by CICI Px measures Px measures

Child-friendly ED can reduce consequences of Child-friendly ED can reduce consequences of CICI Enforce safety laws: child-resistant packagingEnforce safety laws: child-resistant packaging Modify stairway railings, so children will not try to Modify stairway railings, so children will not try to

squeeze through or get stuck in the gapssqueeze through or get stuck in the gaps Fence around poolsFence around pools Public awareness campaigns about Public awareness campaigns about CICI prevention prevention

MCQMCQ

Drowning is the greatest injury-death among children Drowning is the greatest injury-death among children Near drowning means there is no aspiration in the lungsNear drowning means there is no aspiration in the lungs

Drowning in sea water causes water intoxicationDrowning in sea water causes water intoxication The brain can tolerate hypoxia up to 9 minThe brain can tolerate hypoxia up to 9 min

Most children in this country drown in out door poolsMost children in this country drown in out door pools Preventing drowning can achieve MDG4Preventing drowning can achieve MDG4

NEXT LECTURE

THANKTHANK YOUYOU

2015-2030: SDG 2015-2030: SDG (Sustainable dev. Goals): to end (Sustainable dev. Goals): to end poverty, promote prosperity and well-being for all, protect poverty, promote prosperity and well-being for all, protect the environment and address climate changethe environment and address climate changeGoal 1. End povertyGoal 1. End povertyappropriate social protection systems and measures for appropriate social protection systems and measures for all. by 2030 achieve substantial coverage of the poor and all. by 2030 achieve substantial coverage of the poor and the vulnerable By 2030, build the resilience of the poor and the vulnerable By 2030, build the resilience of the poor and those in vulnerable situations and reduce their exposure those in vulnerable situations and reduce their exposure and vulnerability to climate-related extreme events and and vulnerability to climate-related extreme events and other economic, social and environmental shocks and other economic, social and environmental shocks and disastersdisastersGoal 2. End hunger and sustainable agricultureGoal 2. End hunger and sustainable agricultureAchieve by 2025, targets on stunting and wasting in U5, Achieve by 2025, targets on stunting and wasting in U5, and meet nutritional needs of adolescent girls, pregnant and meet nutritional needs of adolescent girls, pregnant and lactating women and older personsand lactating women and older persons

Goal 3. Healthy lives and well-being for allGoal 3. Healthy lives and well-being for all MMR to <70/100k live births. NMR to 12/1,000 lb and U5MR to 25MMR to <70/100k live births. NMR to 12/1,000 lb and U5MR to 25 end the epidemics of AIDS, TB, malaria and NTDs and combat hepatitis, water-borne and other communicable dend the epidemics of AIDS, TB, malaria and NTDs and combat hepatitis, water-borne and other communicable d

reduce by 1/3reduce by 1/3rdrd premature death from NCDs and promote mental health and well-being premature death from NCDs and promote mental health and well-being Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of

alcoholalcohol3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmesinformation and education, and the integration of reproductive health into national strategies and programmes3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for allservices and access to safe, effective, quality and affordable essential medicines and vaccines for all3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contaminationsoil pollution and contamination3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control 3.a Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriatein all countries, as appropriate3.b Support the research and development of vaccines and medicines for the communicable and 3.b Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries, provide access to affordable essential noncommunicable diseases that primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, medicines and vaccines, in accordance with the Doha Declaration on the TRIPS Agreement and Public Health, which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related which affirms the right of developing countries to use to the full the provisions in the Agreement on Trade Related Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide Aspects of Intellectual Property Rights regarding flexibilities to protect public health, and, in particular, provide access to medicines for allaccess to medicines for all3.c Substantially increase health financing and the recruitment, development, training and retention of the health 3.c Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing Statesworkforce in developing countries, especially in least developed countries and small island developing States3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction 3.d Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risksand management of national and global health risks

Goal 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for allGoal 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all 4.5 By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and 4.5 By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and

vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vocational training for the vulnerable, including persons with disabilities, indigenous peoples and children in vulnerable situationsvulnerable situations4.a Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, 4.a Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, nonviolent, inclusive and effective learning environments for allnonviolent, inclusive and effective learning environments for all

NTDs: neglected tropical diseases NTDs: neglected tropical diseases

Goal 5. Achieve gender equality and empower all women and girlsGoal 5. Achieve gender equality and empower all women and girls 5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation

5.3 Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation5.3 Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation5.6 Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and 5.6 Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferencesthe Beijing Platform for Action and the outcome documents of their review conferences

Goal 6. Ensure availability and sustainable management of water and sanitation for allGoal 6. Ensure availability and sustainable management of water and sanitation for all 6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all

6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations Goal 7. Ensure access to affordable, reliable, sustainable and modern energy for allGoal 7. Ensure access to affordable, reliable, sustainable and modern energy for all 7.1 By 2030, ensure universal access to affordable, reliable and modern energy services7.1 By 2030, ensure universal access to affordable, reliable and modern energy services Goal 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for allGoal 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all 8.5 By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value8.5 By 2030, achieve full and productive employment and decent work for all women and men, including for young people and persons with disabilities, and equal pay for work of equal value

8.7 Take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including 8.7 Take immediate and effective measures to eradicate forced labour, end modern slavery and human trafficking and secure the prohibition and elimination of the worst forms of child labour, including recruitment and use of child soldiers, and by 2025 end child labour in all its forms recruitment and use of child soldiers, and by 2025 end child labour in all its forms 8.8 Protect labour rights and promote safe and secure working environments for all workers, including migrant workers, in particular women migrants, and those in precarious employment8.8 Protect labour rights and promote safe and secure working environments for all workers, including migrant workers, in particular women migrants, and those in precarious employment

Goal 10. Reduce inequality within and among countriesGoal 10. Reduce inequality within and among countries 10.2 By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status10.2 By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status

10.7 Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies10.7 Facilitate orderly, safe, regular and responsible migration and mobility of people, including through the implementation of planned and well-managed migration policies Goal 11. Make cities and human settlements inclusive, safe, resilient and sustainableGoal 11. Make cities and human settlements inclusive, safe, resilient and sustainable 11.1 By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums11.1 By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums

11.2 By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in 11.2 By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older personsvulnerable situations, women, children, persons with disabilities and older persons11.5 By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, 11.5 By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situationsincluding water-related disasters, with a focus on protecting the poor and people in vulnerable situations11.7 By 2030, provide universal access to safe, inclusive and accessible, green and public spaces, in particular for women and children, older persons and persons with disabilities11.7 By 2030, provide universal access to safe, inclusive and accessible, green and public spaces, in particular for women and children, older persons and persons with disabilities11.b By 2020, substantially increase the number of cities and human settlements adopting and implementing integrated policies and plans towards inclusion, resource efficiency, mitigation and adaptation to 11.b By 2020, substantially increase the number of cities and human settlements adopting and implementing integrated policies and plans towards inclusion, resource efficiency, mitigation and adaptation to climate change, resilience to disasters, and develop and implement, in line with the Sendai Framework for Disaster Risk Reduction 2015-2030, holistic disaster risk management at all levelsclimate change, resilience to disasters, and develop and implement, in line with the Sendai Framework for Disaster Risk Reduction 2015-2030, holistic disaster risk management at all levels

Goal 12. Ensure sustainable consumption and production patternsGoal 12. Ensure sustainable consumption and production patterns 12.4 By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle, in accordance with agreed international frameworks, and significantly reduce their release 12.4 By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle, in accordance with agreed international frameworks, and significantly reduce their release

to air, water and soil in order to minimize their adverse impacts on human health and the environmentto air, water and soil in order to minimize their adverse impacts on human health and the environment Goal 13. Take urgent action to combat climate change and its impacts*Goal 13. Take urgent action to combat climate change and its impacts* 13.3 Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning13.3 Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning Goal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levelsGoal 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children

16.9 By 2030, provide legal identity for all, including birth registration16.9 By 2030, provide legal identity for all, including birth registration Goal 17. Strengthen the means of implementation and revitalize the global partnership for sustainable developmentGoal 17. Strengthen the means of implementation and revitalize the global partnership for sustainable development 17.18 By 2020, enhance capacity-building support to developing countries, including for least developed countries and small island developing States, to increase significantly the availability of high-quality, timely 17.18 By 2020, enhance capacity-building support to developing countries, including for least developed countries and small island developing States, to increase significantly the availability of high-quality, timely

and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contextsand reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts