Publications

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.