Abstract
Research shows that more than 44,000 Iranian children under the age of 15 died due to injuries between 2001 and 2006, making injuries the leading cause of death among children in Iran. The study, The burden of injuries in Iranian children in 2005, sought to estimate the impact of injuries on children in Iran.
Research findings
Injuries were the most important cause of death in children ages 1 to 14. Among injury types, road transport injuries were responsible for the highest death rate among all child injuries and falls and burns had the highest hospitalization and outpatient care incidence rates.
The number of injury-related deaths per 100,000 was 35 in children ages 0 to 1 year; 33.4 in children ages 1 to 4 years; 24.9 in children ages 5 to 9 years; and 22.9 in children ages 10 to 14 years. The number of road transport injuries per 100,000 was 15.5 in children ages 0 to 14 years, 16.1 in children ages 1 to 4 years, 16.3 in children ages 5 to 9 years, and 13.1 in children ages 10 to 14 years. Incidence rates of injuries leading to hospitalization were highest in children ages 1 to 4 years (530 per 100,000), followed by children ages 5 to 14 years (439 per 100,000). Similarly, the incidence of injuries leading to outpatient care were highest in children ages 1 to 4 years (2,390 per 100,000), followed by children ages 5 to 14 years (1,650 per 100,000).
Researchers concluded that the mortality rate from injuries likely decreases as children age because of their improved ability to avoid or escape dangerous settings, not because of an increase in the provision of safe environments for children.
The proportion of child deaths due to injuries, compared to all child deaths, increased from 1971 to the 2001 to 2006 time frame addressed in this research. The increase can be attributed to a decline in other causes of death, such as communicable diseases, as well as an actual increase in injury-related deaths.
Researchers also noted the difference in child death rates due to unintentional and intentional injuries between rural and urban areas in 2005, with death rates in rural areas being higher. These findings may be explained by limited access to hospital services and more unsafe environments in rural areas. Mortality rates for all external causes were also higher in rural areas than in urban areas, except those for injuries due to inanimate mechanical forces.
Analytical approach
The researchers gathered death registry data from 2001 to 2006 to estimate the trend of child injury mortality. In order to obtain population rates and remain consistent with age groups used in censuses and other types of demographic and epidemiologic studies, children were divided into four age groups: under 1 year; 1 to 4 years; 5 to 9 years, and 10 to 14 years.
Numbers of deaths were taken from the death registry of the Ministry of Health and Medical Education (MOHME), and ill-defined and garbage codes of death were corrected. Population figures for 2001 to 2006 were estimated based on published data from the 1996 national census by the Statistical Center of Iran, and birth and mortality rates were derived from the 2000 Demographic and Health Survey by MOHME.
A time-and place-limited sample of inpatient hospital admissions and outpatient care services were reviewed in 2005 for nonfatal outcomes of injuries in 12 provinces. Mortality data from the death registry system in 2005 were used to estimate years of life lost due to premature mortality (YLL). Years of life lived with disability (YLD) was estimated using inpatient and outpatient data. Disability-adjusted life years (DALYs) are the sum of YLL and YLD.
Research objective
Globally, injuries are the leading cause of death for 10- to 19-year-old children, with road transport injuries the leading cause of death for 15- to 19-year-olds and the second-leading cause in children ages 5 to 14. Injuries, and most notably road transport injuries, have been identified as a major health problem in Iran during this decade, when the coverage and quality of national death registration systems improved. The first Iranian national burden of disease study for 2003 indicates injuries had the second-highest DALY rate in the 0 to 4 age group, and road transport injuries led to the highest rate of DALYs in 5- to 14-year-old children. Thus, the purpose of this study was to examine the burden of injuries by their different types among Iranian children for 2005. This study is part of ongoing work by IHME to provide timely, accurate, and comparable health measurements.
Recommendations for future work
Prerequisites for effective child safety include, but are not confined to, accountable, transparent, and high-level political commitment to decrease the burden of injuries in all ages and effective management at middle and peripheral levels of government. Strong policies and political and community will are needed to reverse the trend of fatal and nonfatal outcomes of child injuries.
