| Objectives: To evaluate the effectiveness of the intervention on unintentional injuriesamong children and adolescents using systematic review, to analysis the epidemiologicalcharacteristics and influencing factors of unintentional injuries among children in ruralChina, to discuss the pilot intervention effectiveness in a rural primary school, and toexplore the intervention model based on behavior change theory of Health Belief Model(HBM) for childhood unintentional injuries, to reduce the prevalence of childhoodunintentional injuries and to promote Safe Kids in rural China.Methods: Systematic review was applied to evaluate the effectiveness of theinterventions of unintentional injuries among children and adolescents. Meta-analyses wereused to analysis the effectiveness of bicycle helmet legislation to reduce the incidence rateof bicycle related head injury and to increase helmet use. The search strategy was made toretrieve the linkage-database, including Pubmed,Embase,Web of Science,Proquest, andJournals of Chinese Medical Association, China Academic Journals Net Database,Wanfang Data Information System, and VIP Information System. Meta-analyses wereprocessed by Review Manager 5.0 Software. Quantitative studies were used in Part 2 andPart 3. Questionnaires of unintentional injuries characteristics and injury knowledge wereused to interview children of left-behind and children living with 2 parents in 6 ruralschools. Data analysis was analyzed on SAS 9.0 statistic software.Discriptive methods, Chi-square tests, and Logistic regression model were used.Results:1. Part 1: Out of1410 prescreened articles, 112 were potentially relevant to the topicand 55 were finally included in the review. All were published articles. Of the 55 studies, 8were obtained by other related review articles. 10 were obtained the full articles fromexperts in USA. 27 were random controlled trials, 15 were controlled before after studies,10 were interrupted time series studies, and 3 were quai-experimental designs. The maintypes of unintentional injuries include: home injuries, motor-related injuries, bicycle relatedinjuries, pedestrian injuries and playground injuries. The participants were mainly childrenand adolescents, accounted for 69%, and children and their parents, accounted for 23.6%.The intervention of home injuries, including burning and scald, fall, and poisoning, etc,often aimed at increasing parents' awareness of injury prevention, the safety kits use andhome risk environment modification. Education, engineering and safe training were used asintervention methods. Parenting interventions, most commonly provided as part ofmulti-faceted interventions to improve a range of child (often maternal health) outcomesappear to be effective in reducing self-reported or medically attended injury among youngchildren. Motor-related injuries were often aimed at increase the use of safety equipment ofchildren, such as safe seats, booster seats. Children's pedestrian safety intervention oftenapplied pedestrian skill training to teach children and adolescents to walk in the right wayand in safe behavior, and cross the road correctly. Playground safety campaign in schoolreduced children's risk behavior and increased teachers' supervision on children bybehavior training. Bicycle helmet legislations were implemented in many developedcountries to reduce bicycle related injuries. While the effectiveness of bicycle helmetlegislation varied, all studies demonstrated higher proportions of helmet use followinglegislation targeted to children and adolescents. The effectiveness was evaluated bymeta-analyses that helmet legislation could reduce the bicycle related head injury almost 50% (OR=0.52, 95% CI: 0.40 to 0.66) and increase the helmet use 2.44 times (OR=3.44,95% CI: 3.13 to 3.79) than those of no helmet legislation.2. Part2(1) The proportion of left-behind children in rural primary and middle school: Thetotal number of participants was 3019 students. The sex ratio was 1.52:1. The number ofleft-behind children was 1182, of which, 727 were boys and 455 were girls. The overallproportion of left-behind children was 39.15%, and that of male and female were 39.92%and 37.98% respectively, there was no significant difference (χ~2= 1.14, p=0.28).(2) The injury prevalence rate: the overall injury prevalence rate was 17.19% (95% CI:15.46-18.92%). That of boys was 2 times than that of girls, were 21.75% (95% CI:19.86-23.64%) and 10.28% (95% CI: 8.88-11.66%) respectively, there was significantdifference (χ~2=66.89, p＜0.001) between boys and girls. The injury prevalence rate of leftbehind children was 25.29%, twice than that among children living with 2-parentS. Maleleft-behind children had the highest prevalence rate, 31.64% (95% CI: 29.50-33.80%), andthat of female left-behind children was 15.16% (95% CI: 13.50-16.80%).(3) Injury characteristics: Falls, mechanic injuries and animal bites were the samethree leading types of injuries for different supervisor, such as no parent at home, motheronly, father only and 2-parents,. The mechanic injuries were stab and cuts. The first threeleading locations of injury occurrence for left-behind children were home (31.99%), school(25.29%) and road (23.91%), and that of children living with 2-parents were school(30.00%), home (27.23%) and road (25.45%). The activities when the injury occurred wereplaying (left behind children/children with 2-parents: 40.4%/44.09%) and riding bicycle ormotor vehicle (left behind children/ children with 2-parents: 13.18%/12.46%). But theproportion of doing housework among left behind children was 12.46%, higher than that ofchildren living with 2-parents. The portion of sports related injuries was 9.09%. About73.74% of left-behind children suffered maltreatment, higher than that of children living with 2-parents (58.18%), there was significant difference (χ~2=13.86, p=0.0002). Theaverage cost of injuries for left behind children was 201 Yuan, and that of children livingwith 2-parent was 448 Yuan.(4) The influencing factors for injury: the factors affected injury prevalence wasanalyzed by type of injury. The results showed that risk factors related to falls were ageincreasing (OR=2.16), doing housework (OR=3.34), no good friend (OR=4.84) and homenear river or lake (OR=3.447), protective factors were mother's age increasing (OR=0.84)and never fighting (OR=0.40). When controlled age by 5-12 years, 13-15 years and 16-18years, risk factors for 5-12 years old children were no good friend (OR=3.12) and homenear river or lake (OR=2.78); risk factors for 13-15 years old children were no parents athome (OR=3.26), protective factor was female (OR=0.36).The risk factors of mechanic injuries were non-singleton (OR=2.49), protective factorswere grade increasing (OR= 0.71) and big household (OR=0.59). After Controlling age,protective factors for 5-12 years old children were female (OR=0.17) and big household(OR=0.32). Non-singleton (OR=18.83) and underachieving in study (OR=2.988) were riskfactors for mechanic injuries. And for 13-15 years children the risk factor was female(OR=7.06).The factor increasing the risk hazard for animal bite was diffidence personality(OR=4.474) and mother as caregiver (OR=4.385). After controlled age, the risk factor for13-15 years old children was found, that was mother as caregiver (OR=28.327).3. The result of Part 3: The injury prevalence of left-behind children increased from18.47% before intervention to 46.67% after intervention. Those of children living with2-parents increased from 7.84% to 14.91% after intervention. The first leading injuries wereanimal bite, falls, drowning and road traffic injuries among left-behind children, those forchildren living with 2-parents were falls, animal bites and drowning. The length of stay inhospital increased from 1.3 days to 5 days for left-behind children, the average medical cost increased from 156 Yuan to 665 Yuan, however the average medical cost decreased from418 Yuan to 183 Yuan for children living with 2-parents.4. The results of Part 4. To construct the intervention model based on behavior changetheory-Health Belief Model to prevent unintentional injuries for rural children. Throughpromote the awareness of injury susceptibility, injury severity, benefits and barriers toprevent injury, education, behavior and living skill training and home and schoolenvironment modification were applied, combined with safety behavior regulation, todevelop peer help and teacher supervision for left-behind children, construct theintervention model of unintentional injuries for rural children, and to make children safe.Conclusions: There are well rounded intervention methods and reliable effectivenessfor childhood unintentional injuries. Health education, training, legislation, and engineeringwere the main methods. The main types of injuries for children were home injuries, bicyclerelated injuries, motor-vehicle injuries, and pedestrian injury, etc. Rural children have highinjury prevalence rate, especially among left-behind children. The first three leadinginjuries were falls, mechanic injuries and animal bites. The influencing factors were variedby types of injuries and children's age. There was significant association between types ofguardian and injury type. Education could not reduce the prevalence rate; we shoulddevelop a comprehensive intervention model to reduce the occurrence of unintentionalinjuries, to increase the awareness of prevention and cognition to injury; training should beused to elevate the safe behavior and living skills for the children. The intervention modelbased on Health Belief Model should be developed to reduce injury occurrence.
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