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Paediatric Trauma: Epidemiology, Prevention, and Control 161
Table 25.2: Examples of the interactions of phases and influencing factors within the Haddon matrix.

Phase Human/host Vector/vehicle Environment: social and physical

Speed limits and related
Condition of brakes, tyres. enforcement.
Pre-event Driver intoxication
Window bars to prevent falls Highway design (road curvature,
intersections, road conditions)

Use of safety belts and child Airbags
Event restraints (e.g., car seats and Highway design (guard rails,
breakaway poles)
booster seats) Side impact protection
Integrity of fuel system/
Post-event Age Trauma care systems
fireproof gasoline tanks

labour needs to be eliminated totally; if there is still the need to employ 2. Prevention: Directly counsel injured children and their parents on
children, measures should be taken to ensure that they use protective safe behaviours that could prevent similar injuries from occurring.
clothing, gloves, and footwear, and they also should be coached on There are also opportunities for surgeons to become involved with
how to use agricultural implements properly and safely. All hazardous other, broader injury prevention campaigns.
agricultural chemicals should be properly stored away from children, 3. Research: Collaborate with others or be the main person conducting
and children should be prevented from touching them for any purpose. research on causes of childhood injury.
In the African subregion, most children are poisoned when they
inadvertently take drugs that are not properly stored out of reach, or 4. Advocacy: Provide facts and figures on the extent and nature of the
when chemicals such as caustic soda (used in the manufacturing of child injury problem and bear witness to the horrible toll of suffering
soap) are placed in such a way that toddlers can gain access to them that such injuries cause. Probably the biggest role that surgeons can
and drink them. To prevent such occurrences, all potentially poisonous play is through advocacy. This advocacy can then lead to greater
household products and substances should be stored safely out of the societal and political commitment to injury prevention.
reach of children or disposed of carefully if they are no longer needed. For all of the above activities, there is much that surgeons can do
It is necessary to teach children to respect stray animals, especially alone. There is even more that can be done by forming alliances and
dogs, and prevent children from playing with stray animals, which may working in partnership with others committed to the same goal of
lead to bites or other forms of injury. Children should be discouraged lowering rates of child injury. As just one example of how this can be
from going out to the bush to hunt—either alone or even in the done, in Ghana, the Building and Roads Research Institute (BRRI), the
company of adults. The risk is high of being bitten by snakes or insects, branch of the government involved with gathering crash statistics and
or even holding poisonous plants or twigs, which may result in various recommending safety measures for dangerous sections of the roadways,
degrees of injury. has worked closely with surgeons at the Komfo Anokye Teaching
For many of the types of injuries discussed here, we have an Hospital (KATH) for several years. This has involved many activities,
inadequate understanding of causative factors and there is very little including collaborative research on the extent and nature of the injury
experience with prevention programmes oriented for the African problem, identification of opportunities to improve injury surveillance,
context. This lack of data points out the need for better research into and advocacy. The BRRI already had statistics from police crash reports,
the extent and nature of the problem, causes and risk factors, and pilot and KATH surgeons were also able to provide data from research done
prevention programmes. at their hospital on the economic costs of injury. Such economic figures
showed a huge loss to the government and the economy from road
What Can Be Done? The Role of the Surgeon traffic crashes. These data were highlighted together by both the BRRI
To confront the growing problem of childhood injury in Africa, a range and KATH, which resulted in greater governmental support for finally
of activities are needed, as shown in Table 25.2. This includes activities fixing dangerous sections of the roadway that the BRRI had previously
to provide better information on injuries through surveillance; promote identified, but which, for lack of such governmental support, had not
road safety, for which there are a number of well-developed strategies; yet been corrected.
undertake research to better understand the causes of other types of In conclusion, the old adage that “prevention is better than cure” is
injuries, such as burns, drownings, and falls, in the African context; certainly the case with child injury, as with any other disease or health
and promote better organisation and planning for trauma care services. problem. There is much that surgeons who care for the injured child
Table 25.2 identifies factors that can lead to injuries and indicates fac- can do to help make such prevention a reality, and thus to prevent the
tors that can be controlled to prevent injuries. needless suffering caused by child injuries.
This book and this chapter are primarily oriented for surgeons.
Although many of the needed activities noted above may be done by Evidence-Based Research
others, there are numerous ways in which surgeons can become involved Table 25.3 presents a review of the problem of children’s injuries in
and help to move the process along. These include, among others: low-income countries. Table 25.4 presents research that examined the
characteristics of childhood burns in Ghana.
1. Surveillance: Promote better data gathering in hospitals so that the
extent of the problem of child injury can be better understood.