Harborview Injury Prevention & Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA.
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Injury. 2021 Jul;52(7):1757-1765. doi: 10.1016/j.injury.2021.04.050. Epub 2021 Apr 16.
Childhood household injuries incur a major proportion of the global disease burden, particularly in low- and middle-income countries (LMICs). However, household injury hazards are differentially distributed across developed environments. Therefore, we aimed to compare incidence of childhood household injuries and prevalence of risk factors between communities in urban and rural Ghana to inform prevention initiatives.
Data from urban and a rural cluster-randomized, population-based surveys of caregivers of children <5 years in Ghana were combined. In both studies, caregivers were interviewed about childhood injuries that occurred within the past 6 months and 200 meters of the home that resulted in missed school/work, hospitalization, and/or death. Sampling weights were applied, injuries and incidence rate ratios (IRRs) were described, and multi-level regression was used to identify and compare risk factors.
We sampled 200 urban and 357 rural households that represented 20,575 children in Asawase and 14,032 children in Amakom, Ghana, respectively. There were 143 and 351 injuries in our urban and rural samples, which equated to 594 and 542 injuries per 1,000 child-years, respectively (IRR 1.09, 95%CI 1.05-1.14). Toddler-aged children had the highest odds of injury both urban and rural communities (OR 3.77 vs 3.17, 95%CI 1.34-10.55 vs 1.86-5.42 compared to infants, respectively). Urban children were more commonly injured by falling (IRR 1.50, 95%CI 1.41-1.60), but less commonly injured by flame/hot substances (IRR 0.51, 95%CI 0.44-0.59), violence (IRR 0.41, 95%CI 0.36-0.48), or motor vehicle (IRR 0.50, 95%CI 0.39-0.63). Rural households that cooked outside of the home (OR 0.36, 95%CI 0.22-0.60) and that also supervised older children (OR 0.33, 95%CI 0.17-0.62) had lower odds of childhood injuries than those that did not.
Childhood injuries were similarly common in both urban and rural Ghana, but with different patterns of mechanisms and risk factors that must be taken into account when planning prevention strategies. However, the data suggest that several interventions could be effective, including: community-based, multi-strategy initiatives (e.g., home hazard reduction, provision of safety equipment, establishing community creches); traffic calming interventions in rural community clusters; and passive injury surveillance systems that collect data to inform violence and broader prevention strategies.
儿童家庭伤害在全球疾病负担中占很大比例，尤其是在低收入和中等收入国家（LMICs）。然而，家庭伤害危险在不同的发达环境中分布不均。因此，我们旨在比较加纳城乡社区儿童家庭伤害的发生率和危险因素的流行率，以为预防工作提供信息。
将加纳城乡社区、基于人群的、以儿童为中心的 caregiver 调查的数据进行了合并。在这两项研究中， caregiver 都被问及过去 6 个月内和家庭半径 200 米范围内发生的导致缺课/旷工、住院和/或死亡的儿童伤害事件。应用了抽样权重，描述了伤害和发病率比值比（IRR），并使用多水平回归来确定和比较危险因素。
我们分别对加纳阿萨瓦塞和阿玛科姆的 200 个城市和 357 个农村家庭进行了抽样，代表了 20575 名和 14032 名儿童。我们的城市和农村样本中分别有 143 例和 351 例伤害，相当于每 1000 名儿童年发生 594 例和 542 例伤害（IRR 1.09，95%CI 1.05-1.14）。幼儿在城市和农村社区受伤的几率最高（OR 3.77 与 3.17，95%CI 1.34-10.55 与 1.86-5.42，分别与婴儿相比）。城市儿童更常因跌倒受伤（IRR 1.50，95%CI 1.41-1.60），但较少因火焰/热物质（IRR 0.51，95%CI 0.44-0.59）、暴力（IRR 0.41，95%CI 0.36-0.48）或机动车（IRR 0.50，95%CI 0.39-0.63）受伤。在家外做饭的农村家庭（OR 0.36，95%CI 0.22-0.60）和也监督较大儿童的家庭（OR 0.33，95%CI 0.17-0.62）受伤的几率低于不做饭的家庭。
在加纳城乡地区，儿童伤害同样常见，但伤害机制和危险因素的模式不同，在规划预防策略时必须考虑这些因素。然而，数据表明，几种干预措施可能是有效的，包括：基于社区的、多策略的举措（例如，家庭危险减少、提供安全设备、建立社区托儿所）；农村社区集群的交通减速干预；以及收集数据以告知暴力和更广泛的预防策略的被动伤害监测系统。
