In a world in which more than 100 children die from injuries every hour, Dena Rashed finds out what the WHO is doing to help It was an unforgettable moment for any mother when Nevine Said, 32, seemed only seconds away from losing one of her two boys. Reading quietly on her laptop with her two children sitting on a couch, Said thought that her youngest boy, Amin, then aged 10 months old, was also with her other child. Suddenly, she heard him crying, but could not work out where he was. "He could not be found anywhere, and there was no way he could have fallen from the window, because he would never have been able to reach it," she said. What she later realised was that her older child, then almost two years old, had thought he had been helping his baby brother by helping him to climb up through the window. "I found Amin hanging near the outside of the window, stuck between the AC and the shutter," Said said. After saving him, Said went into shock, and since that day she has realised that her boys have a tendency to help each other, but not necessarily in the right direction. While Said was lucky enough to save her child, many mothers and fathers around the world live regretting the moment when they lose their child in an accident. Alarming figures from around the world indicate that avoiding children's accidents should be at the top of the agenda for every country. Across the world, 830,000 children die of injuries every year, representing more than 2,000 children a day. World Health Organisation (WHO) last month launched the Arabic version of the World Report on Child Injury Prevention. In the eastern Mediterranean region, unintentional injuries represent a leading cause of death and disability in children. According to the report, in 2004 about 12 per cent of deaths from unintentional injuries in those under 20 years of age occurred in the region, with 113,327 cases at a rate of 45.5 per 100,000 of the population. Trying to put these numbers in perspective, Margie Peden, coordinator of the Unintentional and Injuries Prevention Department at the WHO asked those present at the launch meeting to "try imagining that one day you wake up and find that Ismailia governorate does not exist with its one million population. That is about the number of children who die each year from unintentional injuries." Peden believes that the problem is due not just to the fact that children are not little adults, but also to the fact that they live in a world of adults. While child accidents happen all over the world, there is a 12 fold risk of fire-related burns associated with cooking and electrification in low-income countries, especially the poorest in Africa. Burns are the only unintentional injury in which the number of female injuries exceeds that of boys. However, Peden pointed out that boys are more prone to take risks than girls in the 15 to 19 year old age group, when there are two boys injured for every girl. The pattern of children's injuries until the age of 17 includes unintentional (30 per cent), road accidents (22 per cent), drowning (16.8 per cent), fire-related accidents (nine per cent), murder (8.5 per cent), fall (4.2 per cent), and poisoning (3.9 per cent). Alarmingly, 95 per cent of injuries due to road accidents and falling take place in low and middle-income countries. Yet even in high-income countries, 40 per cent of child deaths result from injury. It is no secret that accidents happen every day to children. Many people have early childhood stories about how they played with fire, jumped from a high place, or even dared a friend to do something crazy like running across the street in front of traffic. For this reason, the WHO's work in Egypt has focussed on raising awareness of risks among children, as well as among their parents. Present at WHO headquarters in Nasr City in Cairo during the launch were many children and teenagers, some as young as five and others as old as 18 and looking like responsible adults. According to the WHO, these children can act as advocates to raise other children's awareness in their schools and neighbourhoods. Sixteen-year-old Khadija was one of the Arab Girl Scouts present at the launch. With other children, she read the WHO declaration out loud to the guests, aiming to convey the demands of young people. As a teenager, she was hopeful that she could deliver the message to her colleagues and friends. "Yes I am a child, but I am conscious and aware of the importance of spreading awareness among children on injury prevention," she said. "I hope these recommendations are effective, because that is supposed to be the point of attending such events." Eight-year-old Adam Maged, who also read part of the declaration, also came out with a thought or two. "I think the most important thing to be aware of when playing is not to fiddle with the oven and not to look out of the window to avoid falling," he said. While Maged has taken a heavy dose of awareness from his parents and the WHO event, in the opinion of another speaker, Dina Louis, headteacher of the New Ramses College, more still needs to be done. As a result of her 15 years of supervising children, Louis believes that it is time that the Ministry of Education introduced an obligatory course for all school pupils on injury prevention. "Accidents happen. Even if you assign a teacher to every child in the playground, there are children who will still cause injury to others or fall. The answer is to raise their awareness," she told Al-Ahram Weekly. Alaa Sebie, programme and advocacy manager of the Save the Children charity, was also present at the launch, and he had some alarming numbers to add to those announced. "Latest studies conducted in Egypt have revealed that the number two cause of death for children from one to five years old has to do with unintentional injuries," Sebie said. It is not just the role of the Ministry of Health to deal with this, Sebie argued, and a multi-sectoral approach is needed. "At present, we do not have a national plan, clear policy or awareness, so we have to use the law to set up an organisation to ensure the safety of children," he said. Sebie said that television was the ideal way of reaching the population as a whole. However, because of the high cost of TV advertisements, it may not be possible to find adequate funds to launch an awareness campaign on television. In many middle and low-income families, where children have greater exposure to risk, Sebie argued that people needed to be shown how accidents could happen and if necessary parents reminded of their duties towards their children. Sebie is aware that the idea of a children's services office in Egypt could be the target of criticism, but he believes that such an office could be a way to ensure that children are adequately protected. According to Peden, the best way to save children from injury in road accidents, burns, falls, poisoning and fire is through adequate prevention efforts. "There should be playground standards applied in all countries, window guards should be legislated for to prevent children from falling, and companies should remove toxic agents from products. Drugs should be packaged in non-lethal quantities, and more poison- control centres should be established," she said. Recommendations exist in all these areas, and, as the WHO report indicates, legislation can be an effective tool in helping to prevent child injuries, and it has already decreased the number of injuries in many countries. Changing the child's environment can also help, and this can usually be done by parents and schools working together, with home visits by social workers being reinforced in cases where children have been exposed to risks. Reinforced emergency medical care should also be made available to any injured children.
