Socioeconomic inequality in child injury in Bangladesh – implication for developing countries

<p>Abstract</p> <p>Background</p> <p>Child injury is an emerging public health issue in both developed and developing countries. It is the main cause of deaths and disabilities of children after infancy. The aim of this study was to investigate the socioeconomic inequality in injury related morbidity and mortality among 1–4 years children.</p> <p>Materials and methods</p> <p>Data used for this study derived from Bangladesh Health and Injury Survey. A multistage cluster sampling technique was conducted for this survey. In this study quintiles of socioeconomic status were calculated on the basis of assets and wealth score by using principle component analysis. The numerical measures of inequality in mortality and morbidity were assessed by the concentration index.</p> <p>Results</p> <p>The poorest-richest quintile ratio of mortality due to injury was 6.0 whereas this ratio was 5.6 and 5.5 for the infectious diseases and non-communicable diseases. The values of mortality concentration indices for child mortality due to infection, non-communicable diseases and injury causes were -0.40, -0.32 and -0.26 respectively. Among the morbidity concentration indices, injury showed significantly greater inequality. All the concentration indices revealed that there were significant inequalities among the groups. The logistic regression analysis indicated that poor children were 2.8 times more likelihood to suffer from injury mortality than rich children, taking into account all the other factors.</p> <p>Conclusion</p> <p>Despite concentration indices used in this study, the analysis reflected the family's socioeconomic position in a Bangladesh context, showing a very strong statistical association with child mortality. Due to the existing socioeconomic situation in Bangladesh, the poor children were more vulnerable to injury occurrence.</p

Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands

Occupational health service (OHS) for small-scale enterprises (SSEs) is still limited in many countries. Both Japan and the Netherlands have universal OHS systems for all employees. The objective of this survey was to examine the activities of occupational physicians (OPs) in the two countries for SSEs and to investigate their proposals for the improvement of service. Questionnaires on types and sizes of the industries they serve, allocation of service hours (current and desired), sources of information for occupational health activities etc. were mailed in 2006 to 461 and 335 Japanese and Dutch OPs, respectively, who have served in small- and medium-scale enterprises. In practice, 107 Japanese (23%) and 106 Dutch physicians (32%) replied, respectively. Total service time per month was longer for OPs in the Netherlands than OPs in Japan. Japanese OPs spent more hours for health and safety meetings, worksite rounds, and prevention of overwork-induced ill health (14-16% each). Dutch OPs used much more hours for the guidance of absent workers (48%). Thus, service conditions were not the same for OPs in the two countries. Nevertheless, both groups of OPs unanimously considered that employers are the key persons for the improvement of OHS especially in SSEs and their education is important for better OHS. The conclusions should be taken as preliminary, however, due to study limitations including low response rates in both groups of physician

Employers' views on the promotion of workplace health and wellbeing: A qualitative study

Background: The evidence surrounding the value of workplace health promotion in positively influencing employees' health and wellbeing via changes to their health behaviours is growing. The aim of the study was to explore employers' views on the promotion of workplace health and wellbeing and the factors affecting these views. Methods: Using a qualitative phenomenological approach, 10 focus groups were conducted with employers selected from a range of industries and geographical locations within Western Australia. The total sample size was 79. Results: Three factors were identified: employers' conceptualization of workplace health and wellbeing; employers' descriptions of (un)healthy workers and perceptions surrounding the importance of healthy workers; and employers' beliefs around the role the workplace should play in influencing health. Conclusions: Progress may be viable in promoting health and wellbeing if a multifaceted approach is employed taking into account the complex factors influencing employers' views. This could include an education campaign providing information about what constitutes health and wellbeing beyond the scope of occupational health and safety paradigms along with information on the benefits of workplace health and wellbeing aligned with perceptions relating to healthy and unhealthy workers

Child Mortality and Injury in Asia: Survey results and evidence

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.child health; child mortality; demographic change; developing countries; disabilities; infant mortality; morbidity; right to health and health services; under five mortality rate;South East Asia;

Child Mortality and Injury in Asia: Survey methods

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.child health; child mortality; demographic change; developing countries; disabilities; infant mortality; morbidity; right to health and health services; under five mortality rate;South East Asia;

Child Mortality and Injury in Asia: An overview

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.child health; child mortality; demographic change; developing countries; disabilities; infant mortality; right to health and health services; under five mortality rate;South East Asia;

Child Mortality and Injury in Asia: Policy and programme implications

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.child health; child mortality; demographic change; developing countries; disabilities; infant mortality; morbidity; right to health and health services; under five mortality rate;South East Asia;

Willingness to administer mouth-to-mouth ventilation in a first response program in rural Bangladesh

Background: Timely mouth-to-mouth ventilation is critical to resuscitate drowning victims. While drowning is frequent, there are no lay persons trained in cardio-pulmonary resuscitation (CPR) in rural Bangladesh. As part of a feasibility study to create a first response system in a conservative Islamic village environment, a pilot was undertaken to examine willingness to provide mouth-to-mouth ventilation for drowning resuscitation. Methods: A questionnaire was administered to 721 participants at the beginning of a village-based CPR training course. Trainees were asked regarding willingness to administer mouth-to-mouth ventilation on a variety of hypothetical victims. Responses were tabulated according to the age, sex and relationship of the trainee to the postulated victim. Results: Willingness to deliver mouth-to-mouth ventilation was influenced by sex of a potential recipient and relationship to the trainee. Adolescent participants were significantly more willing to perform mouth-to-mouth ventilation on someone of the same sex. Willingness increased for both sexes when the postulated victim was an immediate family member. Willingness was lower with extended family members and lowest with strangers. Adult trainees were more likely to perform mouth-to-mouth ventilation than adolescent trainees in any scenario. Conclusion: Adults express more willingness to resuscitate a broader range of drowning victims than adolescents. However in rural Bangladesh, adolescents are more likely to be in close proximity to a drowning in progress. Further efforts are needed to increase willingness of adolescents to provide resuscitation to drowning victims. However, despite potential cultural limitations, trained responders appear to be willing to give mouth-to-mouth ventilation to various recipients. Final determination will require evidence on response outcomes which is being collected