Report Sounds Alarm on Child Accidents

by DONALD G. McNEIL Jr.

Around the globe, accidents kill 830,000 children — the equivalent of all the children in Chicago — every year, according to a report issued Tuesday by the World Health Organization and Unicef.

The report, the first to collect all known data on child injuries worldwide, makes broad estimates because many poor countries gather few health statistics, and many children are hurt or killed without ever seeing a doctor. But it relies on the kind of household surveys that have led to more accurate estimates for many health problems, including AIDS deaths.

The major types of fatal injuries are the same worldwide: drowning, burns, traffic accidents, falls and poisoning. But trends vary widely across countries.

Over all, although 95 percent of all injuries to children occur in poor and middle-income countries, injuries account for 40 percent of all child deaths in rich ones.

That is because wealthy countries have better childhood health care, but many fail to do enough about childhood accidents, said Dr. Etienne Krug, director of injuries and violence prevention at the World Health Organization, who oversaw the report.

”This is a huge public health problem, and it’s been ignored for a long time,” Dr. Krug said in a telephone interview. ”It’s a combination of ignorance about how big it is, and because of fatalism, of thinking, ‘Oh, it’s an accident, we can’t do anything about it.’ ”

In poor countries, newborns are much more likely to die of birth complications or diseases like pneumonia or measles. But as soon as toddlers learn to walk, accidents rise into the top 10 causes of death; drowning soon edges out meningitis and whooping cough. Wooden covers on wells and narrow-mouthed buckets for drinking water that toddlers cannot tumble into would save thousands of lives, the report said.

Also, about 5,000 children die each year from drinking the kerosene their parents use for cooking; childproof caps would save most of them.

But by the teenage years, road injuries become major killers in poor countries as in rich ones. In the 15 to 19 age group, for example, the leading causes of death are, in order: traffic accidents, suicide, homicide, pneumonia, drowning, tuberculosis, fire, AIDS, leukemia, meningitis, childbirth, falls, poison, abortion and epilepsy.

Only about 2 percent of all child deaths are from war injuries, the report said.

In wealthy countries, indigenous peoples like American Indians, Australian aborigines and New Zealand Maoris have injury rates more than double the country’s average.

In the United States, accidents kill 12,175 children a year — more than all diseases combined, according to a report from the Centers for Disease Control based on hospital records, which was released in conjunction with the W.H.O. and Unicef report.

Car crashes were the leading cause, except for infants under 1 year of age, who more often died of suffocation, and those age 1 to 4, who more often drowned.

The three changes that would save the most lives of American children, said Ileana Arias, the Centers for Disease Control’s chief of injury prevention, would be for more states to pass ”graduated driver’s license” laws, which forbid teenagers to drive at night or with teenage passengers, to enforce seat-belt laws on teenagers and to make all children younger than 8 ride in booster seats.

Domestic fatal injury rates were highest for American Indians, lowest for Asians and about equal for blacks and whites in the United States. Twice as many boys as girls died accidentally.

When the global data are divided by sex, boys die more often than girls in all accidents, except burns. That anomaly occurs, Dr. Krug said, because most burns happen in the kitchen and because girls in Asia are more likely to wear long garments of flammable material. Also, he said, it is impossible to be sure, but some of the burn deaths reported may not have been accidental, but attacks by suitors or families settling scores.

The report emphasizes the growing death toll from road accidents as globalization enriches poorer nations. In many poor countries, the streets are choked with a mix of large trucks, small motorcycles and bicycles and sometimes animal carts, often barely visible to truck drivers because of dust and a lack of daytime running lights. Helmets are not universally used, and it is common to see only a male driver on a moped wearing one while a wife and child sit sidesaddle on the back, bareheaded. Accidents involving overloaded buses, minivans and even dump trucks used to transport people often lead to multiple deaths in a single collision.

Even among rich countries, there are differences. Children killed in road accidents, for example, are most likely to be car passengers in the United States, Australia and Turkey; pedestrians in Britain, Switzerland and South Korea; and bicyclists in the Netherlands.

Some countries were singled out in the report for having done especially well.

Sweden, for example, has cut its death rate for children and teenagers by almost 80 percent since 1969. It did so by diverting traffic away from residential areas and schools, controlling speeders, teaching swimming, fencing pools, requiring helmets and seat belts, improving product safety, having nurses inspect homes and teaching safety at school. The report credited one pediatrician, Dr. Ragnar Berfenstam, with championing the cause.

Canada was praised for having its hospitals gather detailed data on each accident so causes could be addressed. Auditors were able to assess the impact of new bicycle-helmet laws, safer playground equipment and new rules allowing younger hockey players to body check each other. The reports have allowed investigators to assess all-terrain vehicles, trampolines, diving boards and hot-water plumbing.

Canada is the only country to ban baby walkers. It found that children were disproportionately hurt or killed in them.

The report was officially released in Hanoi to recognize Vietnam for making progress, despite its poverty. A year ago, Vietnam passed a mandatory helmet law, sending use over 90 percent. Rumors quickly spread that the helmets caused neck injuries in children and their use dropped. The country countered with a public education campaign and plans to fine drivers whose children were unprotected.

New York City was praised for its ”Children Can’t Fly” campaign of the 1970s, which mandated window guards. Deaths from window falls declined by 50 percent in the Bronx at the time.

The report found that dog bites are a more serious problem than had been realized. In China alone, dog ownership, illegal 20 years ago, is now common, as are bite injuries. Children are more likely to be bitten in the head or neck. In wealthy countries, dog bites are rarely fatal, but where rabies is endemic, including China, India and Africa, it causes about 55,000 deaths a year.