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Injury a leading killer of children in Asia: Groundbreaking research highlights need for injury prevention

Dhaka, 11 March 2008: Children in Asia are at great risk of dying from injuries such as drowning and road accidents. Surveys from Bangladesh, China, the Philippines, Thailand and Vietnam reveal that injury is the leading cause of death and disability among children older than one year of age in these countries, with drowning taking the heaviest toll.
A child born in Asia is still at greatest risk of dying in the first month of life. But the survey findings confirm what has often been known within communities across the region: that the risk of dying from injury increases after infancy as children grow more independent and interact with their environment and as the threat of death from infectious and non- communicable diseases falls. Nearly half of all child deaths included in the studies happened after the age of five. The most easily preventable causes were suffocation and drowning which mostly occurred in children under five years of age.
Bangladesh was one of the first countries where such a survey was conducted in 2004, revealing that drowning claims 1 of 4 lives among children aged between 1 and 17 years. It is currently estimated that 46 children drown everyday in Bangladesh and 17,000 annually. The drowning death toll peaks during the floods. In 2007, drowning was responsible for 87 percent of the total child deaths caused by the floods.
“Given the high prevalence of injury in children, UNICEF undertook a pilot initiative to respond to this situation. After two years of implementation, this project has proved that most deaths could be averted by some simple safety interventions like giving swimming lessons to children, bamboo fencing of ponds, community awareness and daycare centres that provide supervised care for children,” said Iyorlumun Uhaa, Acting Country Representative of UNICEF Bangladesh.
The research, conducted over the last seven years, was spearheaded by UNICEF and The Alliance for Safe Children (TASC), working in partnership with local public health teams. Responses were gathered from face-to-face interviews done with more than half a million households covering more than 2 million people in the five countries. For the first time ever in the countries covered, the causes of death and disability among a representative sample of all children up to 18 years were reliably recorded. The results highlight injury – in its different forms – as an acute menace to children’s lives.
Over the past few decades, Asia has made major progress in cutting the number of deaths among children-under five, with extended vaccination coverage, better access to sanitation and good hygiene and improvements in nutrition playing a critical role.
“This evidence overwhelmingly confirms that injury is and has been a major killer. It is now time to make it a public health necessity and to reverse the tide of child injury related deaths” said Pete Peterson, President of TASC.
Findings from the five-country household surveys indicate that the causes of injury differ by age group and are associated with exposure to different types of risks:
  • Infants younger than 1 year have limited exposure to injury because mothers and caregivers tend to provide a protective environment. While the child is dependent upon them, the risks are limited to choking, suffocation and falls.
  • Toddlers aged 1-4 years, exposed to hazards in and around the home, are at greatest risk of drowning.
  • School-aged children aged 5–9 years spend a lot of time outside the home, either in school or engaged in social activities, and are thus at greatest risk from drowning and road traffic accidents.
  • Adolescents aged 10–17 years are navigating the difficult transition to adulthood and are thus more exposed to risk-taking behaviour in addition to exposure to violence.
    Alarmingly, most of the surveys indicated that intentional injury -- homicide and suicide -- was the leading cause of death among adolescents. Taking into account the difficulty and sensitivity in collecting such information through interviews, the researchers believe that even this new reported incidence is likely to underestimate the magnitude of the problem.
    Many injuries, especially those that are fatal, are rarely reported to hospitals. As a result, the cause of these deaths is often missing from national health statistics and civil registry systems. This creates a major challenges to accurately monitor child mortality, especially among children 5 years and older, and it underscores the need for adequate systems to track and record births and children’s deaths.
    “If we are ultimately going to meet the Millennium Development Goal to reduce child mortality, it is imperative that we take action to address the causes of childhood injury,” said Anupama Rao Singh, Regional Director of UNICEF East Asia and Pacific. “We know that with a judicious mix of public health interventions - from investing more in awareness campaigns to equipping children and their parents with knowledge and skills - we can prevent the majority of these deaths.”
    UNICEF and TASC are calling for better systems to record births and deaths as well as the expansion of child injury prevention programmes. These include campaigns for better road safety to lessen road traffic accidents, increased supervision and swimming lessons for children to prevent drowning and household safety education to prevent suffocation, falls, poisoning and animal bites.

    Note to editors:
    The new research and its findings are being published as working papers of UNICEF’s international research office, the Innocenti Research Centre (IRC) based in Florence, Italy. The papers are being compiled in a Special Series on Child Injury for rapid dissemination to policymakers, public health practitioners, the academic community and the public. The series is part of a joint initiative of UNICEF Programme Division, The Alliance for Safe Children, the UNICEF East Asia and the Pacific Regional Office and UNICEF IRC.
    The following papers, released in a single volume in Bangkok, are available at
    • Child Mortality and Injury in Asia: An Overview
    • Survey Methods
    • Survey Results and Evidence
    • Policy and Programme implications

    For more information:
    Christine Jaulmes Chief, Communication & Information Section
    UNICEF, Dhaka
    +880 2 9336701-10, Ext 209



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