Injury Situation And Intervention Strategy At Community Level

Injury is a serious public health issue. Though the main causes of mortality and morbidity are as old as the human species, it is only recently that the public health sector has begun to regard violence and injuries as preventable. The community-based approach to injury prevention programs was developed in the 1980s and has since become an essential component of injury prevention. Community-based programs are characterized by collaboration among different community sectors and the involvement of community members to define the safety problem and find solutions. However literature review showed that very few researches and studies have been done in this field in China.Objective:To explore injury status and its characteristics and the suitable injury surveillance methods as well in community level. To explore what type of injury has high incidence rate, what kind of place is most common in terms of injury events, what population is vulnerable to injury, what are the characteristics for those high incidence injuries, vulnerable places and populations, and what are the external causes for those situations. To explore risk factors which may influence the happening of injury with statistic models, and to propose intervention strategies and plans for community injury prevention.Methods:1. All the residents in a community in Shanghai were as targeted population who has been living in this community at least for two years. Household survey was conducted. Two questionnaires were designed according to WHO's "Guidelines for conducting community surveys on injuries and violence" and "International classification of external causes of injuries". The first questionnaire was "Survey on resident's KAP on injury and related factors" and the second one was "Survey on injury event and related information". The person who's birthday was most close to the date of investigation was chosen to answer to the questionnaire and who's age must be over 16 years old and less than 70 years old. For the first questionnaire each family filled one form, however for the second one each injury case one form should be filled which recorded injury cases from 1st January to 31 December 2007. In total 9760 households were investigated and 25209 individual's information was recorded.2. All the patients who visited the community health center from 1st January of 2007 to 31 December of 2008 were target population. Anyone who was diagnosed as a kind of injury would be interviewed by a nurse with filling an injury report form.3. All the residents living in this community or anyone passing through this community for any reason were target population. The time period was from 1st January to 31 December, 2008. The local traffic policemen were responsible for collecting all the information related to traffic accident event occurred in this community which included cased reported to them through people, interphone, patrol and 110 emergency call. A form of "Information collection on traffic accidents" was asked to answer.4. All five kindergartens located in this community were investigated with targeting on parents and teachers. In total 966 parents and 121 teaches were interviewed. The questionnaires were self-designed. There were two types of questionnaire. One was for parents and one was for teachers. The parent's questionnaire had five parts including basic information, injury related awareness and perspectives, habits and behaviors, home safety and injury situation. The teacher's questionnaire had three parts including basic information, injury related awareness and perspectives and indentifying on risk factors.Results:1. The household survey showed that among the local residents the injury incidence rate was 0.52%. The female had higher incidence rate than male but no significant difference was observed. The elderly with age of 65 or above had the highest injury incidence rate (1.15%), the following was people aged between 45 years old to 64 years old (0.77%). As the age getting older the injury incidence rate getting higher with P value less than 0.05. The higher the education level the less the injury (P<0.05). Among all types of injures the fall had the highest incidence rate (0.25%), then the traffic injury (0.15%). The road/street and home were the most common places where injury happened accounted for 37.12 % and 27.27 % for each.2. The injury report from community health center showed that the injury patients who visited the center were floating population dominated who accounted for 59.16% of all injury visitors. The occupational distribution suggested that people who worked with transportation, production and manufacture were the most vulnerable. The places that injury happened most were industry and construction field (50.62%) and home (21.80%). Working listed as first activity when injury happened (62.01 %). The top two reasons for injury were struck or hit by an object (77.58%) and fall (16.90%).3. Analysis of "information collection on traffic accidents" showed the identified top three causes for traffic incidents were the drivers of motor vehicles who were turning the corner didn't let the other vehicles or pedestrians go first straight forward (30.59%); the drivers of motor vehicles disturbed other driver's driving (12.88%); the drivers of non motor vehicles drove in converse direction (8.77%). At the time of traffic accident the mode of transportation of involved people were mostly car drivers, followed by drivers of scooter, motorcycle and cyclist. The population vulnerable to injury or even death were: male and aged less than 20 years old, floating population, drivers of non-motor vehicles, pedestrians and passengers.4. The survey to children's parents showed: the injury incidence of children was 7.20% without significant difference between boys and girls and between different age groups. Unintentional injury was accounted for the majority of injury (94.69%). In terms of the places of injury 15.04% cases happened at home and 14.16% at school. The highest proportion of injury happened during sports related activities (47.79%), followed by travelling, daily life and leisure time. The nature of injury was mostly of bruise or superficial injury (54.87%). Fall was the first in term of injury mechanism (54.87%) followed by stuck or hit by person or object (17.70%). Head or face had highest frequency of getting injury (40.71%), followed by shoulder and upper limbs, lower limbs and toes or fingers which accounted for 19.47% for each. In terms of severity minor or superficial injury was the most (56.64%).5. Logistic regression analysis showed that the bigger the square meters per person occupying at home the less the children's injury. The positive relationship was found between children's injury and their family's income per person, whether their parents as registered local residents, and their mother's education degree. That means the higher the family income per person the more the children's injury; children with their parents from outside Shanghai had higher injury incidence; the higher the children's mother's education level the higher the children's injury incidence. Compare the score of home establishments and children's behavior it was suggested that the group of children with injury had lower score significantly than that of group without injury.6. The survey of resident's perspectives on importance and preventability of injury showed that the top three type of injuries that they thought which were important and preventable were gas poisoning (66.14%), electricity (63.30%) and fire (57.77%). The last three type of injuries were animal bite (21.13%), leisure or play (25.09%) and crime (33.28%). Analysis with multiple level model showed that family-related and householder-related factors had significant influence to home safety, such as the number of family members, square meters per person living, education years and type of occupation.Conclusion:1. Injury events were very common in community. Community based injury intervention should consider first the high risk population (the elderly, personnel working on manufacture, construction and transportation, children and adolescents) and high risk setting (city road/street, road within residential area, home and industry and construction field). The education and training on first aid should be part of basic education with concerned regulation and policy to guarantee the enforcement of this kind of education.2. Among people, vehicles and road/street which are three factors related to traffic accident the intervention priority should be put on people especially on drivers of motor vehicles and drivers of scooters. By making use of epidemiologic principles we may point at risk factors related to host, agent, vector and environment at different stages of injury event in order to find ways to reduce or eliminate those risk factors.3. Home injury and sport injury should be given priority in children's injury prevention, especially in home establishments and sports protection. Children's parents or care givers had misunderstanding in terms of injury prevention and intervention so more attention should be paid to them including nurserymaid.4. At the moment the injury surveillance system both at national and municipality level has not been well established yet a set of injury data resources can be useful for collecting injury data including household survey, injury report from community health center, and data from related government departments so that more completed injury situation and characteristics can be understood. However human and material resources must be considered too at the same time.5. Ecological model that is both individual-related factors and the physical and social environments that people live should be considered when we think about community injury intervention including education strategy and environment intervention strategy. Education strategy should be theory-based and environment improvement or renovation should be evaluation-based.