摘要：Objectives. We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). Methods. We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. Results. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. Conclusions. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children’s safety and underscoring the need for intensified context-appropriate injury prevention. Injuries cause upwards of 5 million deaths each year, of which unintentional injuries account for approximately 80% (3.9 million). 1 Unintentional injuries kill approximately 830 000 children every year, and more than 95% of child injury deaths (both intentional and unintentional) occur in low- and middle-income countries (LMICs). 2 The 5 most common unintentional injuries reported by the World Health Organization (WHO) are road traffic injuries (RTIs), falls, burns, drowning, and poisoning. 2 Global aggregate data reveal that the burden of childhood unintentional injuries is highest in South-East Asia and Africa, with a cause-specific mortality of 64 and 55 children per 100 000 population, respectively. 1,2 The disproportionate share of the burden of unintentional childhood injury in LMICs results from a number of factors. First, children are more susceptible to injuries because of their curious nature, which, combined with their low capacity to assess and comprehend risks, and a general lack of safe play spaces in many LMICs, puts them at high risk. 3 Second, global economic trends have uprooted communities and traditional forms of subsistence, necessitating persons from rural areas moving to urban slums and at times forcing children into labor, some in hazardous conditions, to contribute to a household’s income. For instance, it has become increasingly dangerous for children to share the road with the ever-growing number of motor vehicles. 2,3 In this light, unintentional injuries not only affect children themselves, leaving them temporarily hospitalized or with short- or long-term disabilities, but also adversely affect their families and society as a whole. 2,4–6 The WHO has called for better data collection on child injury and its determinants for the purposes of national research and investment priority settings, as well as the targeting of high-risk groups. 2 Reductions in child injury mortality have been observed in several high-income countries (HICs) as a result of the implementation of evidence-based programs. 2,7,8 Likewise, a number of studies have provided reliable information to characterize the pattern of injuries in HICs. 9,10 Despite the high burden of unintentional injuries in LMICs, there are few studies that provide standardized data from multiple sites. In the absence of reliable national population data, hospital-based data are an important source of injury information, particularly for children. 11,12 In response, the Global Childhood Unintentional Injury Surveillance (GCUIS) study was initiated to collect standardized child injury data from emergency departments (EDs) at 5 sites: Bangladesh, Colombia, Egypt, Malaysia, and Pakistan. 4,13 The objectives of the GCUIS study were (1) to determine the epidemiology of 5 major childhood unintentional injuries in 5 EDs in urban LMIC sites; (2) to explore potential risk factors and determinants of injury severity and outcomes, based on the injury records in the GCUIS study; and (3) to briefly summarize the characteristics of injuries sustained in homes, based on GCUIS data. 6 In 2009, partial data from GCUIS were analyzed to report the initial pattern of injuries in 4 sites. 13 This article adds data from an additional site and further analyses; therefore, it provides more insights into key unintentional injuries.
