Preventing childhood injuries in Uganda - development of a child safety kit; preparation for a cluster randomised controlled trial

伤害是世界各地儿童死亡的主要原因。在全球范围内，每年有近65万名15岁以下儿童死于伤害和暴力。这一负担在中低收入国家和高收入国家之间分配不均，低收入和中等收入国家的意外伤害死亡率几乎是高收入国家的两倍。尤其是撒哈拉以南非洲地区，5岁以下儿童死亡的比例是世界上最高的，其中70%以上是非交通意外伤害或“意外”伤害。有证据表明，很大比例的儿童意外伤害发生在家庭内部和周围，在那里，儿童通常被认为得到了很好的监督。儿童，特别是5岁以下儿童，大部分时间呆在家里和周围，这使他们暴露在各种伤害危险中，例如没有安全格栅的楼梯和窗户，接触有毒物质和化学品，开放水域，使用底层炉灶。尽管过去20年来全球儿童伤害死亡率总体下降，但现有数据表明，低收入和低收入家庭的下降速度要慢得多，低收入和低收入家庭之间的差距正在扩大。这在一定程度上是由于风险较高、预防措施不足以及小岛屿发展中国家得不到及时的医疗护理。儿童家庭伤害的性质在HIC中有很好的记录，但在LMIC中知道的要少得多。关于在家中防止儿童受伤的许多已知知识来自于在HIC中进行的研究，在这些研究中，预防措施已被证明是有效的，例如安全帽、烟雾报警器、楼梯大门以及对父母/照顾者的教育。目前尚不清楚这些措施在低收入国家的有效性。这项研究旨在测试儿童安全工具包(通过共同设计开发，以反映不同的风险概况、文化适当性和可获得性/可负担性)相对于传统教育的有效性。这项研究将在乌干达金贾进行，分两个阶段进行：第一阶段(这项发展赠款的重点，为期一年多)将侧重于了解儿童受伤问题的背景情况，并通过混合方法开发儿童安全工具包(审查医院数据、与父母/照顾者的重点小组、与主要信息提供人的深入访谈、可负担性/可获得性调查和市场调查，以确定购买安全设备的意愿)；第二阶段将通过分组随机对照试验衡量行为变化和伤害的减少。我们将评估两个村(群)在3年内减少儿童伤害的情况-一个村将拥有完整的儿童安全工具包，外加教育材料、工作坊和家长宣传活动，而另一个群组仅受过教育。第一阶段的一个关键组成部分将是支持科学研究人员、政策制定者和家长之间的合作研究，以便参与5岁以下S健康的所有利益攸关方有机会全面参与从概念构思到结果交流的过程。共同设计办法将导致制定一项整体干预措施，包括儿童安全工具包、教育材料、为家长举办的培训讲习班和以社区为基础的提高认识运动。从一开始就让社区参与进来，将通过分享意见和经验来提高知识和意识，并将在第二阶段优化设备使用。第一阶段的结果将确定实施干预措施的任何挑战，提供准确的数据来计算CRCT的样本量，并确定关键结果。据我们所知，这将是第一次在非洲开展关于儿童安全设备和教育的CRCT。

Injuries are a leading cause of death among children around the world. Globally, nearly 650,000 children under the age of 15 lose their lives every year to injuries and violence. This burden is unequally distributed between low- and middle-income countries (LMIC) and high-income countries (HIC) with the mortality rate from unintentional injuries in LMICs being nearly double that of HICs. In particular, Sub-Saharan Africa has the highest proportion of under 5 deaths in the world.More than 70% of these injuries are non-transport unintentional or "accidental" injuries. Evidence shows that a large proportion of childhood unintentional injuries take place in and around the home, where children are generally believed to be well supervised. Children, especially those under 5 years, spend a significant amount of their time in and around the home which exposes them to various injury hazards e.g. stairs and windows without safety grills, access to poisonous substances and chemicals, areas of open water, access to ground level stoves.Despite an overall global reduction in child injury mortality rates over the past two decades, available data indicates that the rate of decline has been much slower in LMICs and the gap between LMICs and HICs is widening. This is due in part to higher risks, inadequate preventive measures and a lack of access to timely medical care in LMICs. The nature of household injuries among children has been well documented in HICs but much less is known in LMICs. Much of what is known about preventing child injuries in the home stems from research conducted in HICs where preventive measures have been shown to be effective e.g. safety caps, smoke alarms, stair gates coupled with education of parents/carers. What is not known is how effective these measures would be in LMICs.This study aims to test the effectiveness of a child safety kit (developed through co-design to reflect differing risk profiles, cultural appropriateness and availability/affordability) against traditional education. The study will be carried out in Jinja, Uganda and will involve two phases: Phase 1 (the focus of this development grant, conducted over 1 year) will focus on contextualizing the child injury problem and developing the child safety kit through mixed methods (a review of hospital data, focus groups with parents/carers, in-depth interviews with key informants, an affordability/availability survey and a market survey to ascertain willingness to pay for safety equipment); and Phase 2 which will measure behaviour change and reductions in injuries through a cluster Randomised Control Trial (cRCT). We will assess the reduction in child injuries in two villages (clusters) - one which will have the full child safety kit of equipment plus educational material, workshops and awareness campaign for parents versus the other cluster with only education - over 3 years.A key component of Phase 1 will be to support collaborative research between scientific researchers, policy makers and parents such that all stakeholders involved in the health of under 5's have the opportunity to be full participants from conceptualisation to communication of results. The co-design approach will result in the development of a holistic intervention to include the child safety kit, educational material, training workshops for parents and a community-based awareness campaign. Engaging the community from the beginning will result in improved knowledge and awareness through the sharing of opinions and experience and will optimise equipment usage during Phase 2. The results of Phase 1 will identify any challenges to implementing the intervention, provide accurate data on which to calculate sample sizes for the cRCT and determine the key outcomes. To our knowledge, this will be the first cRCT on child safety equipment and education conducted in Africa.