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Paediatric Trauma: Epidemiology, Prevention, and Control 159

• Enugu, Nigeria – 107 department care for nonfatal submersion injuries. The multiple causes
of drowning are age and location related. Children younger than 1 year
• Harare, Zimbabwe – 104
of age most often drown in bathtubs, buckets, or toilets. Drowning in
It is estimated that in the Red Cross Children’s Hospital in Cape bathtubs or water tanks or containers usually results from inadequate
Town, South Africa, about 650 to 900 paediatric burns are admitted per supervision. Children aged 1 to 4 years are likely to drown in swimming
year. In the African literature, children aged less than 5 years are at the pools, ponds, and wells; this usually also happens when they are left
greatest risk of sustaining burn injuries; more young boys than girls are unsupervised. Older children, in contrast, are likely to drown in fast-
burned—a ratio of about 2:1. flowing streams, rivers, canals, and lakes; in such instances, alcohol
The most common causes of paediatric burns in Africa are flames, use has been cited to be involved with 25–50% of adolescent drownings
hot liquids, and chemicals, with regional variations. For example, the associated with water recreation. Male children are consistently more
most common cause of burns in Ghana is hot water, contact with hot
represented in drowning incidents than females.
objects, and flame burns, whereas in Southeastern Nigeria, it is hot
liquids, followed by flames, petrol, kerosene explosions, and chemical Poisoning
burns. A vast majority of the burns in children occur in those younger A majority of unintentional poisoning injuries occur among children
than 6 years old, mostly at home and in the mornings when, for younger than 6 years old, and almost all exposures occur at home.
example, hot water is boiled to bathe the children. Such children commonly ingest household products, such as clean-
Burn injuries are also due to electricity, caustic soda used in ing substances, foreign bodies, drugs, and other substances (e.g.,
households for making soap, acid from vehicle batteries, and friction caustic soda used in manufacturing local soap). About half of the
(e.g., from being dragged along a rough surface or tarred road). poisonings among teenagers, however, may be considered as inten-
Explosions from kerosene or petrol are also reported among burn tional suicide attempts.
injuries. Others
Bites Other unintentional injuries include suffocation and gunshot wounds
Bites are also a cause of injury in children in sub-Saharan Africa, even on hunting expeditions from stray bullets or from children playing
though not much has been written about these injuries in the avail- with guns.
able literature. The most common causes are bites by dogs and other Intentional Injuries
animals, envenomation by poisonous snakes (when children go to the A big burden of injury-related disability and death in both high-income
bush alone or with adults to hunt for bush meat and put their hands into and less-developed countries is from self-inflicted injuries and inter-
holes to retrieve animals such as rats), and stings by scorpions. Human personal violence. These include violence against children, suicide,
bites do occur, especially among quarrelling children. These are usually homicide, gunshot wounds, and war.
intentional, however, or as a means of defence. Assaults
Animal bites (e.g., dogs or snakes), insect stings, or injury sustained Assault can take many forms: blunt or sharp instruments, rape or sexual
from a farm animal, such as goring of shepherds (mainly boys) by abuse, and human bites, among others. Assault injuries can take the
cattle, are sources of injury.
form of an adult molesting a child or a child maltreating another child.
Agricultural injuries There is not much written in the literature about injuries as a result of
Agricultural injuries occur when children either accompany parents assault in children in sub-Saharan Africa. Injuries as a result of assaults
or go alone to the farm to help or to cut firewood. The children use are known to occur with the use of sharp objects (knives, machetes,
implements such as hoes, cutlasses, machetes, and other sharp instru- cutlasses, nails, glass or broken bottles, pens and pencils, scissors) or
ments to work. In the process, they injure their hands, legs, or feet. The blunt objects (sticks, stones, rocks). Boys are more involved in assault
most common activity on the farm is weeding or clearing the land in injuries than girls.
preparation for sowing and planting, or harvesting the crops; because Violence
this labour is not mechanised, serious injuries do not occur very often. The WHO defines violence as the intentional use of physical force or
Most farm injuries are unintentional and nonfatal in the African subre- power, threatened or actual, against oneself, another person, or against
gion but do lead to severe morbidity. There is the need for community
a group or community that either results in or has a high likelihood
education and public advocacy in relation to agricultural injury preven-
of resulting in injury, death, psychological harm, maldevelopment or
tion in children.
deprivation. Types of violence include self-directed, interpersonal, and
Agricultural injuries include lacerations of various parts of the body,
collective. Such violence can take the form of child abuse or assault.
piercing of the sole of the foot by thorns or other objects, and falls from
Child abuse takes various forms, such as child labour, sexual abuse
trees when harvesting fruits or cutting firewood on the farm.
(vaginal, anal, oral, or even poking the finger or objects into the anal or
Submersion or drowning vaginal orifice of children); or burning a child.
Drowning is a process resulting in primary respiratory impairment from A child may be burned as a disciplinary measure for one reason or
submersion or immersion in a liquid medium. The victim may live or another. This takes the form of putting the child’s hands in an open
die after this process. The victim can be rescued at any time during the fire or on burning charcoal, or the use of a hot metal (e.g., a pressing
drowning process, thus interrupting the progression. iron) or a burning stick to press on the child’s body with the purpose of
In the United States, drowning is the second cause of death from causing harm. A child also may be burned to bring it out of a state of
unintentional injuries in children aged 1–14 years. For sub-Saharan convulsion or any catatonic state. In the latter case, the hands or feet of
African countries, there is lack of information on drowning or near- a child who has convulsed for one reason or another are dipped into hot
drowning among children. However, WHO data show that Africa water to get the child out of that state.
has the highest rates of drowning in the world for all ages considered Injury Prevention and Control
together. The rate of death for drowning for the entire world (all ages)
is 6.8 deaths per 100,000 people per year; for Africa, it is 14.2 deaths Injuries are a global problem in all countries of the world. Data on
per 100,000 people per year. the extent and characteristics of injuries have to be collected in every
According to figures from the United States regarding near- country, especially in sub-Saharan African countries, to allow bet-
drowning, for every child who drowns, at least five receive emergency ter targeting of interventions and assessment of their success. It will