Development of Policy-Relevant Indicators for Injury Prevention in British Columbia by the Key Decision-Makers.

Indicators can help decision-makers evaluate interventions in a complex, multi-sectoral injury system. We aimed to create indicators for road safety, seniors falls, and 'all-injuries' to inform and evaluate injury prevention initiatives in British Columbia, Canada. The indicator development process involved a five-stage mixed methodology approach, including an environmental scan of existing indicators, generating expert consensus, selection of decision-makers and conducting a survey, selection of final indicators, and specification of indicators. An Indicator Reference Group (IRG) reviewed the list of indicators retrieved in the environmental scan and selected candidate indicators through expert consensus based on importance, modifiability, acceptance, and practicality. Key decision-makers (n = 561) were invited to rank each indicator in terms of importance and actionability (online survey). The IRG applied inclusion criteria and thresholds to survey responses from decision-makers, which resulted in the selection of 47 road safety, 18 seniors falls, and 33 all-injury indicators. After grouping "like" indicators, a final list of 23 road safety, 8 seniors falls, and 13 all-injury indicators were specified. By considering both decision-maker ranking and expert opinion, we anticipate improved injury system performance through advocacy, accountability, and evidence-based resource allocation in priority areas. Our indicators will inform a data management framework for whole-system reporting to drive policy and funding for provincial injury prevention improvement.

Community-Based Study on Family-Related Contributory Factors for Childhood Unintentional Injuries in an Urban Setting of Sri Lanka.

A community-based descriptive cross-sectional study was carried out among children aged 1 to 4 years residing in an urban setting of Sri Lanka to assess the incidence and associated family-related factors of unintentional injuries. A total of 458 children were recruited using simple random sampling technique, giving a response rate of 91.6%. The incidence of unintentional injuries that needed medical attention during the study period of 3 months was 28.1 per 100 children (95% CI = 19.46-36.74). The factors that were significantly associated with the occurrence of unintentional injuries among children are low monthly income of the family (P = .045), low social support to the mother of index child (P = .022), nonauthoritative type of parenting of the mother of index child (P = .039), cared by person other than mother during day time (P = .002), frequent arguments between parents (P = .004), and frequent alcohol consumption of father (P = .001).

Prevalence of externalizing behavior problems in Sri Lankan preschool children: birth, childhood, and sociodemographic risk factors.

PURPOSE: There is dearth of epidemiological data on externalizing behavior problems among preschool children in many developing countries. The aim of this study was to examine the prevalence and associated birth, childhood, and sociodemographic factors of externalizing behavior problems among a community sample of preschool children in Sri Lanka. METHODS: Maternal ratings of child behavior were obtained from a community-based sample of 1,117 in the age group of 4-6 years using the Child Behaviour Assessment Instrument, which was developed and validated to assess externalizing behavior problems of preschool children. In addition, mothers responded to a questionnaire on birth and childhood related factors of the index child and sociodemographic status of the family. RESULTS: The prevalence of externalizing behavior problems was estimated as 19.2% (95% CI 17.5-20.9%) with the proportion being significantly higher among boys (p < 0.0001). Breast-feeding less than 3 months, low socioeconomic status, and child living with only one parent were identified as independent predictors of externalizing problems of preschool children. CONCLUSIONS: The study suggests the need for implementation of strategies and policies focusing at population and family level to reduce the burden associated with externalizing behavior problems in preschool children in Sri Lanka and similar developing countries.

The Child Behaviour Assessment Instrument: development and validation of a measure to screen for externalising child behavioural problems in community setting.

BACKGROUND: In Sri Lanka, behavioural problems have grown to epidemic proportions accounting second highest category of mental health problems among children. Early identification of behavioural problems in children is an important pre-requisite of the implementation of interventions to prevent long term psychiatric outcomes. The objectives of the study were to develop and validate a screening instrument for use in the community setting to identify behavioural problems in children aged 4-6 years. METHODS: An initial 54 item questionnaire was developed following an extensive review of the literature. A three round Delphi process involving a panel of experts from six relevant fields was then undertaken to refine the nature and number of items and created the 15 item community screening instrument, Child Behaviour Assessment Instrument (CBAI). Validation study was conducted in the Medical Officer of Health area Kaduwela, Sri Lanka and a community sample of 332 children aged 4-6 years were recruited by two stage randomization process. The behaviour status of the participants was assessed by an interviewer using the CBAI and a clinical psychologist following clinical assessment concurrently. Criterion validity was appraised by assessing the sensitivity, specificity and predictive values at the optimum screen cut off value. Construct validity of the instrument was quantified by testing whether the data of validation study fits to a hypothetical model. Face and content validity of the CBAI were qualitatively assessed by a panel of experts. The reliability of the instrument was assessed by internal consistency analysis and test-retest methods in a 15% subset of the community sample. RESULTS: Using the Receiver Operating Characteristic analysis the CBAI score of >16 was identified as the cut off point that optimally differentiated children having behavioural problems, with a sensitivity of 0.88 (95% CI = 0.80-0.96) and specificity of 0.81 (95% CI = 0.75-0.87). The Cronbach's alpha exceeded Nunnaly's criterion of 0.7 for items related to inattention, aggression and impaired social interaction. CONCLUSIONS: Preliminary data obtained from the study indicate that the Child Behaviour Assessment Instrument is a valid and reliable screening instrument for early identification of young children at risk of behavioural problems in the community setting.