Publications

Drowning is a leading cause of death among children in low- and middle-income countries (LMICs) in Asia, but current data greatly underestimate mortality due to drowning. This is due to the way drowning data is collected, classified and reported as well as the difficulty in correcting and adjusting the data. The sum of all the biases and uncertainties has masked the fact that drowning is a leading cause of child death in LMICs in Asia. Cost-effective, affordable and sustainable interventions appropriate for LMICs are available to address this newly recognized and significant killer of children. Large numbers of these deaths could be prevented annually if these drowning interventions were included in current country programmes. When implemented at national scale and as an integral part of country programmes, the prevention of these drowning deaths, which mostly occur in early childhood, would result in a rapid decrease in early childhood mortality.

Special Series on Child Injury no. 1.

This paper presents an overview of the IRC Child Injury Series, a working paper series on child injury that has its first focus on injury in developing countries. The series summarizes the findings of 6 national and sub-national surveys in Asia, in Bangladesh, China, Philippines, Thailand and Vietnam. Undertaken using a new methodology resembling a census, the surveys found that injury is the leading cause of death after infancy in children through 17 years of age in all five countries reviewed. The methodology involved creating a very large, representative sample of households in each national/sub-national survey and directly counting all mortality events in the previous three years and all morbidity events that required missing work, school, or being hospitalized from injury in the previous year. The results show that current estimates of child mortality miss most injury deaths in early childhood. Current estimates do not include children five years and over. As a result, injury, which is a leading cause of death in children under five, and the leading cause of death in children five years and over, is currently invisible to policymakers and is not included in child health programmes.

Special Series on Child Injury no.2

This paper presents a more detailed description of the survey methodology for technical specialists interested in understanding the major differences between the surveys and the methods previously used to estimate child deaths. A detailed description is provided for survey governance, sampling design, survey instruments, the classification scheme for mortality and morbidity measured in the surveys, the fieldwork procedure, the analytic framework, weighting and adjustments, and survey costs. Following this, a number of methodological lessons are addressed, such as: the need to count all children and not only those under five years of age; the need to count all clearly identifiable causes of death in those same groups; the need to count morbidity as well as mortality; and the need to count the deaths in the community where they occur to avoid the various biases associated with facility-based counting. A number of examples from the surveys are shown to illuminate the issues so that they are clear to non-technical readers.

Special Series on Child Injury no.3

This paper presents a detailed description of the survey results which were introduced in the Overview Paper. Detailed results are presented first for proportional mortality in children by age group for a population-weighted composite of the surveys, and then for the individual surveys. Following this, detailed results are presented for fatal injury by national or sub-national area, region (urban/rural), and gender for the 0-17 age group. After this the types of fatal injury that occur in the different stages of childhood are presented. The second part of the paper presents both fatal and nonfatal injury by type of injury for the composite of the surveys as well as the individual surveys themselves. The results show that the leading causes of nonfatal injury differ from those of fatal injury, and the greatest burden is caused by the more serious categories of nonfatal injury. Finally, the ratio of the two leading causes of fatal injury in children, drowning and road accidents, are presented for each of the surveys. Drowning is shown to be the leading cause of fatal childhood injury in each survey. The paper concludes with a discussion of the major issues highlighted by the results of the surveys.

Special Series on Child Injury no.4

This paper presents a summary of the findings of the national and sub-national surveys and discusses the implications of the results on child health policy and programmes.The principal finding is that injury has generally been unrecognized as a leading cause of child death. This is largely because the previous estimates of child mortality causality were unable to include injury due to technical issues. The surveys provide convincing evidence that injury is a leading cause of child death after infancy and the types of injury vary with the age group of the child. Similar convincing evidence shows that it is a leading cause of serious morbidity and permanent disability in children The implications discussed are 1) the need to develop an effective measure of child mortality that includes all ages of childhood; 2) prevention of mortality and serious morbidity from injury in children will require a life-cycle approach; 3) continued progress on child survival programming in children under five years of age will require injury reductions; 4) that drowning is the single injury cause responsible for about half of all injury deaths and targeting it for reduction would be an efficient strategy; and 5) there are efficient strategies for targeting other sub-types of child injury as well.

The first part of this paper documents the striking changes in population size and structures which have occurred since the beginning of transition, and which have led to a substantial reduction in the child population. It is argued that they have been mainly driven by the drop in birth rates which has characterised the whole region, but which has been most dramatic in the CEE and Western CIS. Some countries in these subregions now rank among those with the lowest levels of fertility in the world, and the shrinking cohorts of children in these countries face the prospect of a growing old-age dependency burden. The second part of the paper discusses recent data on infant and under-five mortality, which are direct measures of child well-being, and of the success of policy measures aimed at improving child survival and development. The paper highlights the marked differences not only in levels, but also in progress in reducing mortality rates across the CEE/CIS.

There are worrying indications that official infant mortality counts, based on administrative data, may underestimate the true gravity of the problem in 15 countires in the CEE / CIS region, including 11 out of 12 CIS countries. However, the paper also finds that surveys are rather blunt instruments, and that the confidence intervals that surround estimates from these surveys are often large.

This book glimpses the leadership and achievements of Jim Grant during his period as Executive Director of UNICEF (1980-1995). Each chapter is written by one of his close colleagues - one of those who was privileged to share in the excitement of the efforts and victories for children during those intense years. Jim Grant was a professional and a visionary, an analyst with vast experience and an activist of almost unlimited commitment. At the time of his death it was estimated that, because of his influence, at least 25 million children were alive who would otherwise have died in early life.

In every single industrialized country, injury has now become the leading killer of children between the ages of 1 and 14. Taken together, traffic accidents, intentional injuries, drownings, falls, fires, poisonings and other accidents kill more than 20,000 children every year throughout the OECD. Despite these statistics, and the rising worries of parents everywhere, the likelihood of a child dying from intentional or unintentional injury is small and becoming smaller. For a child born into the developed world today, the chances of death by injury before the age of 15 are approximately 1 in 750 - less than half the level of 30 years ago. The likelihood of death from abuse or intentional harm is smaller still - less than 1 in 5,000. On the roads of the industrialized world, child deaths have been declining steadily for more than two decades.

Of the many changes that have taken place in Western society during the past two centuries, few have been more significant than the steep fall in infant and child mortality. However, the timing and causes of the decline are still poorly understood. While some scholars attribute it to general improvements in living standards, others emphasize the role of social intervention and public health reforms. Written by specialists from several disciplinary fields, the twelve essays in this book break entirely new ground by providing a long-term perspective that challenges some deep-rooted ideas about the European experience of mortality decline and may help explain the forces and causal relationships behind the still tragic incidence of preventable infant and child deaths in many parts of the world today.

After the collapse of the communist system in 1989, most Eastern European countries experienced a mortality and health crisis. However, this did not hit the traditionally most vulnerable groups - children, adolescents, women and the elderly - but male adults in the 20-59 age group. The Report indicates that the surge is largely dependent on three transition-related factors: widespread impoverishment, erosion of preventive health services, sanitary and medical services and social stress. Although infants, children and young adolescents have not been greatly or directly affected by the mortality crisis, the Report points out that their situation has been severely threatened by more frequent sickness and greater nutritional imbalances, while the upturn in adult deaths is leading to a considerably heightened risk of poverty, abandonment or orphanhood.

After the collapse of the communist system in 1989, most Eastern European countries experienced a mortality and health crisis. However, this did not hit the traditionally most vulnerable groups - children, adolescents, women and the elderly - but male adults in the 20-59 age group. The Report indicates that the surge is largely dependent on three transition-related factors: widespread impoverishment, erosion of preventive health services, sanitary and medical services and social stress. Although infants, children and young adolescents have not been greatly or directly affected by the mortality crisis, the Report points out that their situation has been severely threatened by more frequent sickness and greater nutritional imbalances, while the upturn in adult deaths is leading to a considerably heightened risk of poverty, abandonment or orphanhood.