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岁以下的儿童因受伤和暴力而丧生。这一负担在中低收入国家和高收入国家之间分布不均，中低收入国家的意外伤害死亡率几乎是高收入国家的两倍。特别是撒哈拉以南非洲地区，5岁以下儿童死亡比例居世界首位，其中70%以上的伤害是非交通意外或“意外”伤害。有证据表明，很大一部分儿童意外伤害发生在家庭内部和周围，而人们普遍认为，在家庭中，儿童得到了很好的监督。儿童，特别是5岁以下的儿童，在家中和周围花费大量时间，使他们面临各种伤害危险，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，接触地面炉灶。尽管过去二十年来全球儿童伤害死亡率总体下降，现有数据表明，低收入国家的下降速度要慢得多，低收入国家与高收入国家之间的差距正在扩大。部分原因是低收入国家风险较高，预防措施不足，无法及时获得医疗服务。在高收入国家，儿童家庭伤害的性质已有详细记录，但在低收入国家，这方面的情况就少得多。关于防止儿童在家中受伤的大部分知识来自在高收入国家进行的研究，在这些国家，预防措施已被证明是有效的，例如安全帽、烟雾报警器、楼梯门以及对父母/照顾者的教育。目前尚不清楚这些措施在中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，以反映不同的风险状况，文化适当性和可用性/可负担性）对传统教育的有效性。这项研究将在乌干达金贾进行，分两个阶段进行：1期（这项发展赠款的重点，进行了一年多）将侧重于儿童伤害问题的背景，并通过混合方法开发儿童安全工具包（对医院数据的审查，与父母/照顾者的焦点小组，与关键知情人的深入访谈，可负担性/可用性调查和市场调查，以确定支付安全设备的意愿）;以及第二阶段，将通过群集随机对照试验（cRCT）衡量行为变化和伤害减少。我们将评估两个村庄儿童受伤的减少情况（集群）-其中一个集群将拥有完整的儿童安全成套设备以及针对家长的教育材料、讲习班和宣传活动，而另一个集群仅提供教育-为期3年。第一阶段的一个关键组成部分将是支持科学研究人员之间的合作研究，政策制定者和家长，使所有涉及5岁以下儿童健康的利益攸关方都有机会充分参与从概念化到结果交流的过程。共同设计办法将导致制定一项综合干预措施，其中包括儿童安全工具包、教育材料、家长培训讲习班和社区宣传运动。从一开始就让社区参与，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1阶段的结果将确定实施干预的任何挑战，提供准确的数据，以计算cRCT的样本量并确定关键结局。据我们所知，这将是在非洲开展的第一个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.