Child injury in rural area of Viet Nam – Identifying causes and risk factors leading to child injuries in Ba Vi, Ha Tay

Injuries are alarmingly climbing, which threaten people’s lives and health in all countries in the world and they are considered as a pressing public health problem. Especially in low- income countries, unintentional injuries are a cause of death and disability for millions of children every year. Unsafe environment, living condition, heavy traffic and lack of information are attributed to be increasing causes and risks of child injuries. However, it is too difficult to have a comprehensive picture of causes and risk factors of child injuries because of limited data and specific research at the community level of Vietnam.

This study conducted in Ba Vi district, a rural area, in northern Vietnam aims at describing a pattern of non-fatal unintentional injuries, identifying causes and risk factors leading to child injuries and recommending some preventive measures to decrease the number of injuries among children.

A cohort study was undertaken, which involved four cross-sectional household surveys among sampled community in the Ba Vi district during the year 2000, each asking about injuries in the preceding three months.

620 newly injured children of less than 15 years old were identified among 7,027 person- year sduring-this period, and contributed to nearly 30 percent of injuries of all ages. The observed overall incidence rate was thus 88 per 1,000 person-years. The major causes of child injuries were: traffic related injuries (29/1,000 person-years), fall-related (23/1,000 person- years) and by cuts/pierces (11/1,000 person-years). Old children are more likely to be injured than younger children. Gender differences in injury frequency are common in all age groups. Boys were nearly two times more injured than girls (rate ratio of boy to girl was 1.98:1). There was a significant association between causes of child injuries and other factors such as poor households and unsafe environment that could be exposed for children.

Some measures are suggested: (i) Improving knowledge of parents/siblings/caregivers and teachers of children who are the best people in educating and communicating with children thereby change their knowledge, behaviour and practice, (ii) Mobilising the participation and the advocacy of local authorities and entire society for injury prevention and all activities that should be implemented in the community need support by a resolution of the Party executive committee and should be considered as a regular activity of community, (iii) Promoting safe environment, home, and school for children living, learning and playing.

Key words: unintentional child injury, incidence rate of injuries, causes, risk factors, Vietnam

I would like to sincerely thank Associate Professor Urban Janert, Anders Emmelin, Curt Lofgren, Hans Stenlund, Miguel San Sebastian, Anna Karin Hurtig, Goran Lonnberg and all other teachers in MPH course, who brought me into the exciting fields of Epidemiology and public health.

I would like to kindly thanks and gratitude to Karin Johansson, Birgitta Astrom, Anna- Lena Johansson, Lena Mustonen, Jerzy Pilch and all staffs of Epidemiology department of Public Health – Umea University and Birgitta Linnanheimo at IHCAR – Karolinsa Institute – Stockholm for their kind assistance in administrative matters and your great hospitality.

I would like to sincerely thank Mr Nguyen Van Lam, director of Bavi District Health Centre and all my colleagues in the FilaBavi, for their help and support.

Many thanks to Mr Nguyen Xuan Thanh, and all research students in HSRP, for their help and encouragement.

Many thanks to my Institute, my Department and my Colleagues, I am so grateful for the time allowed for study and for extra work endured while covering for my absence.

Many thanks to Ari Probandari, Qi Zhao, and all friends in the MPH course for their help and encouragement.

The deepest thanks and gratitude to my mother and my parents in law and all members in my family, for the attention of your and support during the time of my absence.

_Xast, but not least my family, the deepest thanks to my husband – Nguyen Cong Bach and our sons: Nguyen Hoang Linh and Nguyen Hoang Nam Anh, for all the love, support, encouragement and understanding. You are my happiness, my source of energy and my comfort and thanks to all of you I can overcome difficulties in the life.

Ass. Prof. Lars Lindholm, PhD

Department of Public Health and Clinical Medicine, Umeả University, Sweden

CONTENTS

Abstract i

Acknowledgement ii

List of abbreviation iv

List of tables v

List of figures vi

I. INTRODUCTION 1

H. OBJECTIVES 5

HI. BACKGROUND 6

3.1. Vietnam geography, demography and basic health indicators 6

3.2. Health care organisation in Vietnam 8

3.3. Injuries – a public health problem in Vietnam and the launching a National 9 Policy on Injury Prevention in Vietnam

3.4. Child injuries – a problem in Vietnam – target group for injury prevention 11

IV. MATERIALS AND METHODOLOGY 12

4.1. Description about Bavi and Filabavi 12

4.2. Study subject 14

4.3. Study design 14

4.4. Sampling and sample size 14

4.5. Data collection 15

4.6. Definitions ‘ — ..=3===. -^5 … –

4.7. Data analyses 16

4.8. Ethical consideration 16

V. RESULTS 17

5.1. Patterns of non-fatal unintentional injury of children 17

5.2. Analysis causes of child injury by age and sex 20

5.3. Analysis risk factors leading to injury/accident among children 25 VL DISCUSSION 27

6.1. Pattern of non-fatal unintentional child injury 27

6.2. Causes of child injury and risk factors related to child injury 29

6.3. Methodology consideration 32 Vn. RECOMMENDATION 34 vm. CONCLUSION 36 IX. REFERENCES 37