Risk Elimination on Walks to School (REmWAlkS)

每个孩子都有受教育的权利和人生最好的开端。安全干净的上学之旅是他们最起码的期望。然而，由于上学路途不安全和不干净，许多儿童失去了生命或长期存在健康问题。全世界每年有超过35万名儿童死于道路交通事故和与交通有关的空气污染物，其中93%的儿童生活在低收入或中等收入国家。儿童步行上学的风险尤其大，因为他们经常走在拥堵、不安全的道路上，车辆高速行驶，排放大量污染物。学校也经常位于繁忙的高速公路沿线。虽然非洲国家正在进行一些工作，让上学的孩子更安全，但据我们所知，尽管有一些重叠的干预措施，但没有一项工作同时解决道路安全和空气污染的问题。因此，这项研究旨在通过一种新颖的参与式方法，开发一套干预措施，以降低马拉维布兰太尔上学儿童受伤的风险和暴露在糟糕空气质量中的风险。马拉维目前的道路交通死亡率为每10万人31人，是世界上死亡率最高的国家之一，细颗粒物水平至少是世卫组织建议水平的两倍。行人伤害，特别是儿童的伤害，在过去十年中急剧增加，占因碰撞而入院的儿童的一半以上。我们知道，在安全系统方法之后，有一些干预措施减少了行人的伤害和死亡，世卫组织通过其拯救现场道路安全干预措施包来促进这些干预措施。其中一些干预措施，尤其是车辆减速和车辆排放政策，对安全和空气污染具有双重影响。这项研究将建立在NIHR资助的非洲儿童空气污染概况研究的基础上，该研究也在马拉维的布兰太尔进行，并将获得儿童步行上学的空气污染数据(和GPS坐标)。我们将使用一种混合的方法来更好地了解马拉维布兰太尔上学的儿童所经历的风险，以及如何最好地改善这些风险。我们将从4所有目的的抽样学校邀请所有12-16岁的儿童参加，并选择16名儿童使用PhotoVoice方法以摄影方式记录他们在上学途中遇到的风险。将与儿童及其家长和老师举行小组讨论，以进一步了解他们面临的挑战和如何补救这些挑战的想法。我们将与当地和国际专家一起使用德尔福流程来确定干预措施的优先顺序，然后将这些干预措施带给家长/教师讨论可接受性。由于道路安全和个人空气污染暴露之间有许多相互重叠的因果因素，因此有很大的机会采取配套的缓解措施来促进儿童健康、安全和福祉的改善。因此，通过这项研究提出的干预措施对鼓励非机动化运输的其他低收入和中等收入国家具有重大影响。

Every child has the right to an education and the best start in life. A safe and clean journey to school is the least they should expect. However, many children lose their lives or sustain long-lasting health problems as a result of unsafe and unclean journeys to school. More than 350,000 children around their world lose their lives to road traffic crashes and traffic-related air pollutants every year, with 93% of these children living in low- or middle-income countries. Children walking to school are at particular risk as they often walk along congested, unsafe roads with vehicles travelling at high speeds and emitting high levels of pollutants. School are also frequently located along busy highways. While some work is being conducted in African countries around making the journey to school safer for school children, none, to our knowledge are addressing the issue of both road safety and air pollution despite some overlapping interventions.This study therefore aims to develop a set of interventions, through a novel participatory approach, that would reduce both the risk of injury and exposure to poor air quality for children who walk to school in Blantyre, Malawi. The current road traffic death rate in Malawi is 31 per 100,000 population - one of the highest in the world and the levels of fine particulate matter are at least twice the level recommended by WHO. Pedestrian injuries, particularly among children, have seen a dramatic increase in the last decade and account for more than half of children admitted to hospital as a result of a collision.There are a number of interventions, following the Safe Systems Approach, that we know reduce pedestrian injuries and deaths and are promoted by WHO through their Save LIVE package of road safety interventions. Some of these interventions, most notably vehicle speed reduction and vehicle emission policies, have a dual impact on safety and air pollution. This study will build on a NIHR-funded Children's Air Pollution Profiles in Africa study which is also being conducted in Blantyre, Malawi, and will obtain air pollution data (and GPS coordinates) from children walking to school. We will use a mixed methods approach to better understand the risks that children who walk to schools in Blantyre, Malawi, experience and how these can best be ameliorated. We will engage all children aged 12-16 years from 4 purposefully sampled schools and select 16 children to photographically document the risks they encounter on their walk to school using PhotoVoice methodology. Discussion groups will be held with children their parents and teachers to further understand their challenges and ideas about how these can be remedied. We will use a Delphi process with local and international experts to prioritize interventions which we will then take to parents/teachers to discuss acceptability. Due to the many overlapping causal factors linking road safety and personal air pollution exposure, there are significant opportunities for complementary mitigation measures driving improvements in child health, safety and well-being. The interventions proposed through this study therefore have significant implications for other low- and middle-income countries who are encouraging non-motorized transport.