Child Injury

OVERVIEW

Child injury is increasingly recognized as an important public health problem and Road traffic injuries are the second leading cause of deaths for children aged 0–17 in social issue. According to WHO estimates, in 2016 alone, injuries and violence led to China and the first leading cause of deaths for children aged 15–17. The SDGs more than 640,000 deaths among children aged 0–14 worldwide, accounting for 9.6 propose to “halve the number of deaths caused by road traffic accidents globally by per cent of all child deaths. Among all deaths caused by injuries, the proportion of 2020” (SDG 3.6). Road traffic injuries not only lead to mortality but result in unintentional injuries exceeded 90 per cent.1 disabilities and injuries that can hinder child development and deprive children of opportunities for education and social development. With the drastic increase in the In China, it is estimated that more than 10 million children aged 0–17 are injured number of vehicles and the rapid development of transportation systems, effective each year, and over 60,000 children among them die from these injuries. The leading prevention of road traffic injuries for children has become an urgent issue. causes of injury-related deaths are drowning, road traffic injuries, falls and poisoning,2 and the ranking of causes varies among different age groups. As China Child injury prevention has received greater attention among policymakers and the has made progress in reducing infectious diseases and improving maternal and child general public. The National Programme of Action for Children (2011–2020) set a health care, child injury has risen to become the leading cause of fatality among target to reduce the injury-related mortality rate in 2010 by one-sixth among children children aged 1–17, yielding significant losses to families and the society at large. aged 0–17, which is indicated as one of the main goals in promoting child health. In recent years, the child injury prevention work in China has achieved positive results, In addition to fatality, child injury is also one of the direct causes of disability. but there are still several challenges. Governments at all levels have insufficient According to the second National Sample Survey on Disability in 2006, the understanding of the importance of child injury prevention, with inadequate prevalence of children with disabilities due to injury was 14.2 per ten thousand, investments in the issue. A comprehensive coordination mechanism for child injury accounting for 8.9 per cent of all children with disabilities.3 prevention has not yet been established, due to insufficient policy support. Moreover, child injury monitoring data is limited, and the quality of monitoring data needs to be The prevalence of child death and disability caused by injury reveals gender, urban- improved. rural, and regional differences, with the prevalence higher in boys than in girls, higher in rural areas than in urban centers, and higher in the western region than in the central and eastern regions. In 2013, the five provinces with the highest injury-related mortality rates and disease burden among children aged 0–14 years are located in the western region of China, namely Xinjiang, Tibet, Gansu, Qinghai and Ningxia.4 Existing surveys and the meta-analysis of the incidence of injuries among children left-behind indicate that children left-behind and migrant children are at higher risk of injuries.

Figure 6.1 Figure 6.2 Causes of deaths among children aged 0–17, Injury-related mortality rate among children aged 0–17, by age, 2014 by urban-rural and sex, 2014

Per cent Deaths per 100,000 children

100 40

Total Male Female

34.5 80 30 28.9

60 22.9 20 20.9 19.8

40 17.0 16.1

13.1 10

20 8.8

0 0 0 1–4 5–9 10–14 15–17 0–17 1–17 National Urban Rural Age (years))

Others Non-communicable diseases Communicable,23. maternal, perinatal Source: LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017 Source: LIANG Xiaofeng of China CDC, et al., and7 nutrition-related conditions China Child Injury Report, 2017 Injuries

Figure 6.1 Figure 6.2 Injury is one of the main causes of deaths among children in China. If the infant In 2014, the injury-related mortality rate among children aged 0–17 was 22.9 per mortality rate is not accounted for, injury is the main cause of deaths among children 100,000. The child injury mortality rate is higher among boys than girls, and higher in over age 1, and accounts for more than half of the deaths among children aged 1–17. rural areas than in urban areas. 88 Child Injury

Figure 6.3 Figure 6.4 Causes of injury-related deaths among children aged 0–17, Leading causes of injury-related deaths among by age, 2014 children aged 0–17, 2014

Per cent

100

14 19 18 19 24 27 3 80 3 8 5 4

10 6 5 8 4 Other injuries 6 21.4% 8 75 60 31 Drowning 26 32.5% 28 32 Violence 1.6% 29 45 Suicide 3.1% 40 Burn 1.1% Poisonings 3.7%

3 44 45 20 5 40 37 Falls 7.5% 33 Road traffic 13 19 injuries 29.0% 4 0 0 1–4 5–9 10–14 15–17 0–17 1–17

Other injuries Poisonings Falls Source: LIANG Xiaofeng of China CDC, et al., Road traffic injuries Source: LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017 China Child Injury Report, 2017 Drowning

Figure 6.3 Figure 6.4 In China, common causes of injury-related deaths are drowning, road traffic injuries, Drowning and road traffic injuries were the two main causes of deaths from injuries falls and poisonings, while other causes include burn, suicide, violence, asphyxiation among children aged 0–17. The drowning mortality rate was 7.5 per 100,000, and blunt injury. The ranking of causes varied in different age groups. In 2014, the accounting for 32.5 per cent of injury-related child deaths. The road traffic injury death main cause of injury-related deaths among children aged 1–14 was drowning, and rate was 6.7 per 100,000, accounting for 29 per cent of injury-related child deaths. among children aged 15–17 was road traffic injury. 89

Figure 6.5 Figure 6.6 Leading causes of injury-related deaths among children Road traffic injury death rate among SDG aged 0–14 in the world, upper-middle-income countries children aged 0–17, by age and region, 3.6.1 and China, 2016 2014

Per cent Deaths per 100,000 children

100 20

Eastern Central Western

16 42.4 16.1 75 52.9 57.5

50 10.0 27.6 9.2 9.0 8 8.4 8.6 8.7 26.9 22.8 6.4 6.2 6.3 25 5.3 4 4.7 4.5 4.5 4.0 3.9 30.1 3.4 3.0 19.7 20.3

0 0 Global Upper-middle-income countries China 1–4 5–9 10–14 15–17 0–17 1–17 Age (years)) Others Road traffic injuries Drowning23.7

Source: WHO, ‘Global Health Estimates 2016 Summary Tables’, 2018 Source: LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017

Figure 6.5 Figure 6.6 According to WHO global health estimates in 2016, globally, drowning and road traffic From analysing data in different regions, except children aged 1–4, all other age groups injuries are the two leading causes of deaths among children aged 0–14, accounting for of children residing in the eastern region have relatively low road traffic injury death 42.5 per cent; the percentage in upper-middle-income countries is 47.1 per cent; while rate, followed by the central region, with the western region having relatively high road in China, this percentage is 57.6 per cent. Foundational data used by WHO for traffic injury death rate. Children aged 15–17 residing in the western region have the estimation are provided by individual countries, however, due to the use of different highest road traffic injury death rate. estimation methods and age groups, the WHO estimates differ from those published by China CDC. 90 Child Injury

Figure 6.7 Figure 6.8 Figure 6.9 Composition of different types Prevalence of injury-related disabilities Prevalence of injury-related disabilities of injury-related disabilities among children aged 0–17, among children aged 0–17, among children aged 0–17, 2006 by urban-rural and sex, 2006 by age and sex, 2006

Injury related disabilities per 10,000 children Injury related disabilities per 10,000 children

25 30

Total Male Female Total Male Female

Hearing 24 8% 20

Mental 18% 15 18

Physical Speech 1% 49% Visual 2% 10 12

Multiple 22%

5 6

0 0 Urban Rural 0 1–4 5–9 10–14 15–17 Age (years))

Source: LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017

Figure 6.7, 6.8 and 6.9 The second National Sample Survey on Disability in 2006 showed that the prevalence of children with disabilities due to injury was 14.2 per ten thousand, of which physical disabilities accounted for 49 per cent of all disabilities due to injury, followed by multiple disabilities (22 per cent) and intellectual disabilities (18 per cent). The prevalence was higher in rural areas (15.8 per ten thousand) than urban areas (9.9 per ten thousand), and higher among boys (16.3 per ten thousand) than girls (11.9 per ten thousand). Moreover, the older children tend to have a higher prevalence of disabilities due to injury than the younger children. 91

Child Injury

Data sources and references

1 WHO, ‘Global Health Estimates 2016 Summary Tables’, Disease Burden and Mortality Estimates, http://www.who.int/healthinfo/global_burden_disease/estimates/ en/, accessed June 2018.

2 LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017, p. 3.

3 LIANG Xiaofeng of China CDC, et al., China Child Injury Report, 2017, pp. 4–5.

4 YE Pengpeng, et al., ‘Disease Burden of Injuries in Chinese Children Aged 0–14- year-old in 1990 and 2013’, Chinese Journal of Epidemiology, vol. 38, no.10, 2017, pp. 1334–1341.