| BackgroundsOver the past decades, injuries have been critical threats to children’s health and life quality in mainland China. Child injuries are been recognized in many researches that they are related with their individual factors and environmental factors. People have realized that injuries could be prevented after analyzing the epidemiologic characteristics and related factors of injuries. It has been confirmed that ’Safe School’ model could effectively reduce injury incidence rates of children in foreign countries, which this model was developed on ’Safe Community’. However, there are no safe schools in mainland China until now. Therefore, it is very urgent to explore the effectiveness of ’Safe School’ model for preventing of injuries in Chinese children. The results might have better theoretical and application value on injury prevention and control. Difference-in differences model (DID) is frequently-used in economic areas, because it could estimate the effect of intervention measures. This DID model is still not performed in injury epidemiology in mainland China.Objectives1. To describe the characteristics and related factors of child injuries in Huaiyin urban district by baseline investigation in order to provide baseline information for the establishment of ’Safe School’2. On the base of the certification criteria of ’Safe School’, the detail intervention measures of ’Safe School’ model would be constituted according to the baseline information. After a period of intervention, the final effect evaluation should be perfomed by scientific methods.MethodsThe urban area in Huaiyin district of Jinan was selected. It was conducted a baseline investigation from children’s guardians who were asked to fulfill investigation questionnaires which included injury information of children in the past year and KAP information on injuries of guardians. Then injury status and related factors of children in the past year were analyzed. Furthermore, the guardians’KAP level on injury and related factors were also analyzed.On the base of baseline results, detail intervention measures of’Safe School’ were constituted by experts. Intervention group and control group were divided with main comparable variables. Intervention group was applied with ’Safe School’ but control group was not. The control mode was designed with two different methods. The second investigation was carried out with the same questionnaire as baseline investigation after a period intervention. Changes of KAP level in childrens’ guardians and changes of injury incidence rates of children were separately analyzed to evaluate the effectiveness of’Safe School’by DID model.Results1. The main results from baseline investigation(1) The total KAP scores on injuries of guardians were28in this study. Only0.18%of the guardians achievd the total scores of KAP. The average score was21.56±2.02and about60.43%of guardians had reached the average level or good score(more than22scores). About65.56%of guardians whose children were in primary school and55.04%of guardians whose children were in junior middle school had a higher score than the average score. Among the guardians whose children were in primary school, who were younger than35years old, who were engaged in professionally technical and management jobs, who had a better education level and a better economic status, the scores of their KAP on injury were higher than other guardians in the same categories. In addition, important factors statistically related with KAP scores were education level, guardian’s category, guardian’s job and guardian’s age by Optimal Scaling analysis.(2) The incidence rate of childrens’ injury was24.23%while the incidence events rate was34.13%. Among the childrens who had been injured, the annual frequency of injury was1.41. No one child was dead by injury. The incidence rate was30.18%in boys while27.04%in girls (P>0.05), while the incidence events rate of boys was higher than girls (P<0.05). Besides, the incidence rate of injury in pupils was26.67%, which was higher than that among junior school students (21.67%, P<0.05). No significant difference was observed among pupils and junior school students in different grades. The types of injuries which had a higher incidence events rate were respectively falling (8.08%), extrusion (7.85%) and sprain (5.31%), which covered62.27%of the whole injuries events. The childrens’ injury happened in each month during a year and mostly occurred when childrens were at school (which covered37.94%of the whole injuries places).93.78%of the childrens’ injuries were minor and82.64%was treated in medical institute while17.36%was treated by someone in an emergency. The direct cost of injuries was175,462Yuan and the cost for each injury case was156.10Yuan. Moreover, the indirect cost of injury was146,232Yuan and the cost for each injury case was130.10Yuan. The direct cost per injury case of traffic accident was the biggest while its indirect cost was at the second place. On the other side, the average day for each child who dropped out school due to injury was6.64days, and the day for hospitalization with injury was10.40days while the leave day for each guardian accompanying children because of injury treatment was3.88days.(3) The protective factors for child injuries were guardians with higher scores of KAP (OR=0.450), children with problems due to always on internet (OR=0.709). Besides, the risk factors for child injuries were children with export-oriented character (OR=1.332) and children with the ability to get along with classmates easily (OR=1.259). The attributable risk proportion (AR%) were seperately54.95%,21.00%,24.94%, and20.57%. In addition, the protective factor for children who had happened more than one time during the past year was guardians with higher scores of KAP (OR=0.463). The risk factors were boys (OR=1.113) and children with the ability to get along with classmates easily (OR=1.350). The AR%was seperately51.54%,10.15%, and25.92%.2. The evaluation of ’Safe School’ model(1) Results from DID analysis, the ’Safe School’ model could significantly improve the KAP level on injuries among children guardians. Guardians’ KAP scores about injuries were elevated by2.34scores because of performance of the interventions. The proportion of qualifiers rose to89.16%, and that of the full score guardians rose from0.24%to14.23%. The net increaments of KAP scores differed among guardians with different demographic characteristics. Mothers, divorced/separated/widowed guardians, guardians of45-50years old, guardians worked in agriculture, forestry, animal husbandry and fishery, with junior high school education and those from families with monthly income of2000-5000yuan per capita scored poorly in the baseline survey; however, they got higher net increase of KAP scores than those in other categories.(2) Results from DID analysis, the injury incidence rates of childrens were reduced significantly. In the intervention group, the incidence rate decreased to13.72%, which was much lower than that before intervention and that in the control group. Furthermore, the net decrease of injury incidence rate in childrens was7.59%. The protection rate of interventions from child injuries was38.23%(95%CI:25.92%-48.19%), and the index of effectiveness was1.62(95%CI:1.35-1.93). The net decrease of injury incidence rate, the protection rate and the index of effectiveness among girls were higher than those of boys, and those of pupils were higher than those of junior high school students.(3) The incidence of each type of injury was changed after the establishment of ’Safe School’, which the main types of injuries of childrens were crush/extrusion, falling both before and after the establishment of ’Safe School’. Injury types with the best intervention effect were falling, crush/extrusion and stabbing, whose protective rates were higher than30%.(4) The direct costs of injury cases after the establishment of’Safe School’amounted to86019yuan, with average cost of287.68yuan per injury case. The indirect costs were58141yuan, with average cost of194.45yuan per injury case. The averages of both direct and indirect cost per injury case were higher than those in baseline investigation. Similar situation was also observed in the control group. The average direct cost per injury case of cutting/puncture and traffic accidents decreased after the establishment of ’Safe School’. The average indirect cost per injury case of traffic accidents and animal bites decreased either. The average days of suspension of schooling was6.94days before the establishment of ’Safe School’, and decreased to2.19days after the establishment of ’Safe School’. The average leave time of guardians for accompany with the children was5.78day per case, while it decreased to2.73after the establishment of ’Safe School’.Conclusions1. It could be concluded that the injuries status was relatively serious in Huaiyin urban district, Jinan. Therefore, injuries prevention should be actively pursued to protect the health and safety of children.2. It was suggested that the construction of ’Safe School’ model should be combined with the baseline investigation in the area. By this means, reasonably comprehensive interventions could be achieved.3. The injury incidence rate of childrens significantly decreased by7.59%after the establishment of ’Safe School’ model. The protection rate of interventions from child injuries was38.23%, and the index of effectiveness was1.62. It could indicate that the ’Safe School’ model could play an important role in preventing the child injury.4. After the establishment of ’Safe School’ model, the intervention effects were different among different characteristics of children, and the effects were also different in different type of injuries. Therefore, in this study, the ’Safe School’ model taking into account key factors and the categories of injuries could reduce the injuries of the risk children and the main categories of injuries.5. After the establishment of ’Safe School’ model, the KAP scores of guardians were significantly improved. Therefore, the guardians of children could have the better ability to participate in the establishment of the ’Safe School’ model.Innovation and Significance1. There is no ’Safe School’ in mainland China until now. This study might be the first time to explore the effectiveness of this model to prevent child injuries in mainland China.2. The DID model might be the first time to be introduced in injury epidemiology in mainland China, which the DID model was used in economic areas before. |
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