Childhood injuries in Hong Kong : from epidemiology to community intervention

Abstract

Injury is a major cause of mortality, morbidity, and disability in children. Despites the serious nature of the problem, research and funding for childhood injury prevention is still inadequate. Although there have been some studies on the epidemiology of childhood injuries in Hong Kong, research on how to identify usable data from existing databases and a coherent and practical way to translate such data for prevention is lacking.

Over the past four decades, there have been significant decreases in the childhood injury mortality and morbidity rates. However, in recent years (2001-2012), there have only been slight improvements in the rates, which were insignificant after discounting for the impact of the 2003 SARS outbreak. In each year of the study period, around 60 children aged 0 to 19 years died amounting to 4,500 years of life lost at the 75-year endpoint, 62,000 attendances at Accident and Emergency Departments (AEDs) for injuries, and 12,000 admissions to public hospitals. The cost of injury to society is enormous. The annual direct medical cost was HK$230 million but indirect cost was not calculated, which would have been two to three times higher. There were wide variations in injury burdens among the 18 districts in Hong Kong, which were related to socio-economic disparities. On the assumption that all districts could achieve the lowest rates in Hong Kong, the potentially avoidable injury burden was estimated to be 33 fewer deaths, 1,946 less years of life lost, 3,953 fewer hospitalizations, 19,488 fewer AED attendances, and a saving of HK$50 million per year. Due to inequities in injury burden among different districts associated with socio-economic status, a comprehensive proportionate universal safety approach that also targets the most vulnerable is needed in addition to the traditional risk or environmental approaches.

Effective interventions have already been established through international and local studies, including our own, but the major challenge is how to raise awareness and empower communities to implement evidence-based interventions in a systemic and sustainable way. Establishment of a good injury surveillance system that can inform local decision makers in prioritizing resources and empower communities to implement evidence-based intervention programmes are keys to success. However, most injury surveillance systems suffer from a lack of timeliness, relevancy, and sustainability. Hong Kong is fortunate to have an excellent public hospital system that electronically captures patient information.

Using new geo-spatial and internet technology, an electronic geo-information injury surveillance system has been developed that satisfies most of the criteria for an injury surveillance system according to the World Health Organization and the Center of Disease Control and Prevention. The information can be translated into useful information for the development of injury intervention programmes through the Safe Community platform. PRECEDE-PROCEED and collaborative multiplier were found to be useful tools for implementing interventions.

A three-pronged approach at the policy, district, and local levels was proposed for the coordination and implementation of child safety strategies using information collected from the geo-spatial injury surveillance system with Safe Community as a the coordinating platform.