‘Physical damage to the body or part of it’ or injury as it is commonly referred to, is most common among those living in hazardous environments, risky circumstances or those using dangerous tools or equipments. But more than that, it is children who are clearly more susceptible to injuries including from accidents or acts of violence—whether at home, school or on the road—due to their cognitive, physical and psychological development. According to the United Nations Convention on the Rights of the Child (CRC), any person below the age of 18 years is considered to be a child.
In 2002, United Nations Special Session on Children adopted a resolution on "A World Fit for Children (WFFC)." This resolution recommended ‘reduction in child injuries from accidents or other causes through the development and implementation of appropriate preventive measures’ in order to achieve the goal of ‘promoting healthy lives and protecting children from abuse, exploitation and violence.’ Since Nepal is a part of the CRC and WFFC, it is relevant to see where Nepal stands a decade after the adoption of these resolutions.
Children´s exposure to possible injuries varies according to their stages of childhood. For example, injuries during infancy and pre-school ages differ from those during early adolescence and teenage. The main causes of injuries include falls, burns, drowning, road accidents, poisoning and animal attacks. A recent report jointly published by the World Health Organisation (WHO) and United Nations Children´s Fund (UNICEF) found that worldwide 2,300 children die from such injuries every day. It has also been estimated that 90 percent of all child injury deaths occur in low and middle income countries (LMICs). Injuries are broadly of three types: minor and treatable, permanently disabling, or fatal. Injuries in childhood result in highest loss of quality of life because children have a longer lifespan to survive with the consequences of an injury, compared to adults. Tragically, most of these injuries are preventable but instead of focussing on pre-empting them, they are dismissed as regarded as inevitable accidents or ascribed to fate.
According to WHO estimates, about 2,100 children (0-14 years) die from injuries in Nepal each year, which is about 5 percent of all child deaths. The Nepal Demographic Health Survey (NDHS), 2006 found that injuries were the cause of 11 percent of all deaths in the 1-4 age groups. A nationwide study conducted in 11 major hospitals by the National Health Research Council (NHRC) found that about a quarter of all injury patients who went to the emergency department were children (0-14 years). This figure suggests that about 9,000 children visited 11 study hospitals for injury treatments. There are about one hundred hospitals in Nepal. It is also known that all injured children do not even get to reach a hospital for treatment due to various reasons. A community based survey of child injuries conducted by the author found that two-thirds of all injured children were not taken to the hospital.
Children during their infancy are at lower risks of injuries compared to those above a year because they are unable to move around much on their own. This risk rises sharply as they begin to crawl, walk and explore the world around. Children are also more vulnerable because they have to live in an environment that may not be entirely conducive and secure for them.
It is also a fact that injuries are not considered as a major public health problem in Nepal. With progress in medical science, multilateral cooperation and community mobilisation, many diseases have been brought under control or are declining while injuries continue to because they remain neglected. More recently, road traffic injuries (RTIs) are getting more attention from people and government because of widespread media coverage.
Nepal has a diverse geography, mixed socio-economic conditions and seasonal variation which correspond to varied risk-factors for injuries. Prevention is the best treatment for injuries and prudent, comprehensive actions at individual, community or national level can go a long way in serving this purpose. The experiences of developed countries tell us that all kinds of injuries can be prevented or minimized either by modifying the environment or by changing behaviours of people. Further, poverty is found to be a major obstacle for providing an environment fit for the children.
According to WHO estimates, about 2,100 children (0-14 years) die from injuries in Nepal each year, which is about 5 percent of all child deaths.
Parents obviously do what they think is best to keep their children safe, depending on their capacity to do so. Lack of awareness of potential injuries and hazardous environment in which many are forced to live makes the situation more dangerous. For younger children (infant or pre-school age), appropriate supervision is essential. Adequate care including nutrition is also very important. When they start going to school, these responsibilities are shared by teachers and parents. Since schools are formal institutions that need to be established according to certain government standards, enforcement of children´s safety must be a strict pre-requisite. As they grow into teenagers, children develop risk taking attitudes and false bravado; they are involved in sports and sometimes even violent activities that come with even greater hazards.
While early childhood development theory says that children´s cognitive ability is very dynamic and constantly developing during the first two decades of their life, it is not possible to save children from accidents and injuries just by making talking to them about these risks. Children have immense capacity to learn by observing, they imbibe knowledge from their surroundings, particularly their parents or peers. Parents and other family members should be careful to act in a way that children learn the right things from their activities and behaviour. Apart from other traditions, it is also crucial to pass on a culture of ‘safety’ to our young ones.
Additionally, there are physical preventive measures like separating the hazards from the area where children tend to be more. For instance, chemicals, sharp tools and match boxes should be kept out of children’s reach, ponds and wells should be properly fenced, the main entrance of the house should be barricaded, rocks or pieces of glasses ought to be cleared from the playground and children should be allowed to enter the kitchen only under supervision. These activities may need some financial investments but that is nothing compared to the loss your child could face due to injury.
The author is a PhD student (child injury prevention) at the University of the West of England, Bristol