A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP).

INTRODUCTION: This study presents a systematic approach-assessment of child injury prevention policies (A-CHIPP)-to assess and track policies on effective child injury interventions at the national level. Results from an initial pilot test of the approach in selected countries are presented. METHOD: A literature review was conducted to identify conceptual models for injury policy assessment, and domains and indicators were proposed for assessing national injury policies for children aged 1-9 years. The indicators focused on current evidence-supported interventions targeting the leading external causes of child injury mortality globally, and were organised into a self-administered A-CHIPP questionnaire comprising 22 questions. The questionnaire was modified based on reviews by experts in child injury prevention. For an initial test of the approach, 13 countries from all six WHO regions were selected to examine the accuracy, usefulness and ease of understanding of the A-CHIPP questionnaire. RESULTS: Data on the A-CHIPP questionnaire were received from nine countries. Drowning and road traffic injuries were reported as the leading causes of child injury deaths in seven of these countries. Most of the countries lacked national policies on interventions that address child injuries; supportive factors such as finance and leadership for injury prevention were also lacking. All countries rated the questionnaire highly on its relevance for assessment of injury prevention policies. CONCLUSION: The A-CHIPP questionnaire is useful for national assessment of child injury policies, and such an assessment could draw attention of stakeholders to policy gaps and progress in child injury prevention in all countries.

The design and evaluation of a system for improved surveillance and prevention programmes in resource-limited settings using a hospital-based burn injury questionnaire.

BACKGROUND: Limited and fragmented data collection systems exist for burn injury. A global registry may lead to better injury estimates and identify risk factors. A collaborative effort involving the WHO, the Global Alliance for Clean Cookstoves, the CDC and the International Society for Burn Injuries was undertaken to simplify and standardise inpatient burn data collection. An expert panel of epidemiologists and burn care practitioners advised on the development of a new Global Burn Registry (GBR) form and online data entry system that can be expected to be used in resource-abundant or resource-limited settings. METHODS: International burn organisations, the CDC and the WHO solicited burn centre participation to pilot test the GBR system. The WHO and the CDC led a webinar tutorial for system implementation. RESULTS: During an 8-month period, 52 hospitals in 30 countries enrolled in the pilot and were provided the GBR instrument, guidance and a data visualisation tool. Evaluations were received from 29 hospitals (56%). KEY FINDINGS: Median time to upload completed forms was <10 min; physicians most commonly entered data (64%), followed by nurses (25%); layout, clarity, accuracy and relevance were all rated high; and a vast majority (85%) considered the GBR 'highly valuable' for prioritising, developing and monitoring burn prevention programmes. CONCLUSIONS: The GBR was shown to be simple, flexible and acceptable to users. Enhanced regional and global understanding of burn epidemiology may help prioritise the selection, development and testing of primary prevention interventions for burns in resource-limited settings.

Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis.

Drowning has been a neglected health issue, largely absent from the global health and development discourse, until the UN General Assembly adopted its first resolution on global drowning prevention in 2021. This policy analysis examines the role of issue characteristics, actor power, ideas, and political contexts in the emergence of drowning prevention, and it also identifies opportunities for future actions. We identified three factors crucial to enhancing prioritisation: (1) methodological advancements in population-representative data and evidence for effective interventions; (2) reframing drowning prevention in health and sustainable development terms with an elevated focus on high burdens in low-income and middle-income contexts; and (3) political advocacy by a small coalition. Ensuring that the UN resolution on global drowning prevention is a catalyst for action requires positioning of drowning prevention within global health and sustainable development agendas; strengthening of capacity for multisectoral action; expansion of research measuring burden and identifying solutions in diverse contexts; and incorporation of inclusive global governance, commitments, and mechanisms that hold stakeholders to account.

Drowning prevention: turning the tide on a leading killer.

Drowning is a leading killer, particularly of children and young adults, yet has been greatly neglected. Despite accounting for a higher number of deaths than many other substantial public health issues, drowning has not benefitted from the targeted attention it requires, which is particularly tragic because low cost and effective drowning prevention interventions exist. Therefore, the recent UN General Assembly's adoption of a resolution on global drowning prevention is a historic first, and offers an exciting opportunity by providing a comprehensive framework and a practical roadmap that a range of actors and sectors, including governments, can follow to address the challenge of drowning prevention.

Exposure to physical and sexual violence and adverse health behaviours in African children: results from the Global School-based Student Health Survey.

OBJECTIVE: To examine associations between exposure to physical violence (PV) or sexual violence (SV) and adverse health behaviours among a sample of children in five African countries. METHODS: In a cross-sectional analysis of data from Namibia, Swaziland, Uganda, Zambia and Zimbabwe - countries that participated in the Global School-based Student Health Survey in 2003 or 2004 - we compared the relative frequency of several adverse health behaviours among children (primarily students 13-15 years of age) who did and who did not report exposure to PV or SV. We estimated odds ratios (ORs) for such behaviours and their 95% confidence intervals (CIs) after adjusting for age and sex. FINDINGS: Exposure to PV during the 12 months preceding the survey was reported by 27-50% (average: 42%) of the children studied in the five countries, and lifetime exposure to SV was reported by 9-33% (average: 23%). Moderate to strong associations were observed between exposure to PV or SV and measures of mental health, suicidal ideation, current cigarette use, current alcohol use, lifetime drug use, multiple sex partners and a history of sexually transmitted infection (P < 0.05 for all associations). For example, the odds of being a current cigarette smoker were higher in children involved in one fight (OR: 2.20; 95% CI: 1.77-2.75), 2-5 fights (OR: 3.43; 95% CI: 2.54-4.63), or 6 fights or more (OR: 5.95; 95% CI: 4.37-8.11) (P for trend < 0.001) during the 12 months preceding the survey than in children unexposed to PV. CONCLUSION: Childhood exposure to PV and SV is common among African children in some countries and is associated with multiple adverse health behaviours. In developing countries, increased awareness of the frequency of exposure to violence among children and its potential health consequences may lead to heightened attention to the need for health promotion and preventive programmes that address the problem.

World Health Organization's TEACH-VIP: contributing to capacity building for youth violence prevention.

Youth violence is a major public health problem in every region of the world, yet it is especially prevalent in specific settings. Youth homicide rates exceeding 10.0/100,000 occur most often in countries that are low or middle income, or which are experiencing rapid economic or social change. Particularly in low- and middle-income countries, the capacity to develop and implement the comprehensive, multisectoral strategies to prevent youth violence is only just emerging. The prevention of youth violence requires multidisciplinary approaches and a variety of trained professionals. A public health approach to training in the area of injury prevention focuses on providing professionals and paraprofessionals a common understanding of essential skills and knowledge. One important benefit of this is that it addresses a major gap in current public health training that until recently has devoted relatively little attention to injury prevention. Another benefit is that it allows professionals from a variety of backgrounds to work together more effectively to reduce injury. This article will provide a broad overview of youth violence in low- and middle-income countries and will discuss the existing level of capacity within healthcare and public health sectors for responding to these problems. It concludes with a discussion of next steps for increasing capacity and a profile of the World Health Organization (WHO) training curriculum on injury and violence prevention called TEACH-VIP, an acronym for Training, Education, and Advancing Collaboration in Health on Violence and Injury Prevention, as one important effort undertaken by WHO and global injury partners to build capacity.

E-mentoring for violence and injury prevention: early lessons from a global programme.

To address the growing burden of violence and injuries, especially in low- and middle-income countries, in 2007 the World Health Organization launched MENTOR-VIP, a global violence and injury prevention (VIP)-mentoring programme. The programme aims to develop human resource capacity through 12-month mentoring arrangements between individual VIP experts (mentors) and less-experienced injury practitioners (mentees). In this paper, we review the first five years of the programme (2007-2011) using a systems analysis and SWOT (Strengths, Weaknesses, Opportunities and Threats) frameworks, discuss programme findings and make recommendations. A well-defined programme with clear instructions, successful matching of mentorship pairs with similar interests and language, a formal accord agreement, institutional support and effective communication were identified as programme strengths. Overambitious projects, lack of funds and difficulties with communications were identified as programme weaknesses. Mentorship projects that require institutional permissions or resources could be potential threats to the success of mentorship. The study resulted in the four following recommendations to strengthen the programme: (1) institute additional steps in selection and matching mentor-mentee pair; (2) train mentors on e-mentoring; (3) conduct special orientation for mentees to the programme; and (4) maintain effective and open communication throughout the programme.

Depleted uranium in Kosovo: an assessment of potential exposure for aid workers.

BACKGROUND: During the Kosovo conflict approximately 11 tons of depleted uranium munitions were used against armored targets, predominantly in the west. Potential exposure to uranium amongst employees of the International Red Cross and Red Crescent Movement in western Kosovo was assessed. METHODS: Individuals (n = 31) who had resided at least 3 mo in western Kosovo provided 24-h urine collections and completed an administered questionnaire. Specimens were analyzed for creatinine concentration, and uranium concentration was determined using inductively coupled mass spectrometry. FINDINGS: Subjects ranged in age from 22 to 45 y, and 77% were male. Mean duration of residency was 11 mo, and 14 individuals were in western Kosovo throughout the hostilities. Almost three quarters of subjects reported seeing destroyed tanks or vehicles, predominantly while passing by within a vehicle. Two individuals spent time within 50 m of a destroyed tank or vehicle while outside of a vehicle. Urinary uranium concentrations ranged from 3.5 to 26.9 ng of uranium per liter of urine (median 8.9 ng L(-)). Creatinine normalized values ranged from 2.9 to 21.1 ng of uranium per gram of creatinine (median 7.4 ng g(-1) creatinine). These results fall toward the lower end of urinary uranium determinations made amongst non-exposed populations drawn from a literature review. INTERPRETATION: These results do not indicate an increased exposure to uranium amongst adults living and working in western Kosovo who do not spend time in proximity to destroyed vehicles. Environmental sampling and replication of these results amongst a sample including children and individuals reporting intensive exposure to destroyed vehicles would further develop the exposure assessment.

The value of credible data from under-resourced areas.

Data collection requires a substantial investment in human resources and infrastructure, but it is essential that it is accurate to ensure the credibility of its use. These issues are explored in the light of data from injuries in 'disorganized' settings based on the experiences of field hospitals staffed by the International Committee of the Red Cross. Such data was influential in the campaign to ban landmines and can be used in the legitimate questioning of states' foreign policies. It is important to distinguish between combatant and non-combatant weapons injuries. A significant proportion of civilian weapons injuries in combat zones, particularly post-conflict, occur in a domestic context; some widely quoted figures for civilian war-related injuries are too high, though the correct figures are still far too high. While reducing the supply of arms, the importance of other social factors such as education, poverty and the provision of health care is stressed-provision of health care is affected in combat zones.

Child injury prevention: an overlooked challenge for child survival.

Those interested in child survival frequently cite and follow the under-five mortality rate. While a useful measure, the under-five mortality rate lumps together neonatal and post-neonatal mortality with deaths in the 1-4 year period. Unfortunately, this hampers public health decision making about the most appropriate child survival strategies as children survive beyond their first year of life.

MENTOR-VIP: Piloting a global mentoring program for injury and violence prevention.

Injuries occur as the result of a confluence of factors: environmental, social, biological, economic, and behavioral. To effectively address the burden of injuries, especially in low- and middle-income countries, a focus is needed on developing the human resource capacity for injury prevention. MENTOR-VIP is a global mentoring program that the authors developed with this need in mind. MENTOR-VIP approaches developing human resources in injury prevention by providing mentoring opportunities for junior professionals involved in its practice, research, and/or programs. MENTOR-VIP entails a 12-month working relationship between junior injury prevention practitioners (mentees) and more experienced individuals in the field (mentors). Its general objective is to improve global human resource capacity to effectively prevent and control injury and violence through the enhanced development of relevant skills. The program is currently in its pilot phase and is nearing the end of its second formal mentoring cycle, which began on September 1, 2008. This article discusses mentoring professionals as a key strategy to developing the human resource component of capacity, and one which complements existing approaches to capacity development. The authors also provide an overview of the rationale, modalities, objectives, and evaluation of MENTOR-VIP. This article highlights the importance of capacity building in the injury prevention field and situates MENTOR-VIP within the larger context of capacity building for global public health.