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Base de datos de evaluación

Evaluation report

CEE/CIS 1998: Childhood Injuries: A Priority Area for the Transition Countries of Central and Eastern Europe and the Newly Independent States

Author: European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine

Executive summary


The health and welfare of children in the countries of Central and Eastern Europe and the Newly Independent States of the former Soviet Union has been of concern to many during the transition from communism in the 1990s. However, relatively little attention has been paid to the burden of injuries, poisoning and violence that children are subject to in this region. This report is a first step in highlighting the extent of this major problem in order to ensure that it gets the attention from policy makers that it deserves.

Purpose / Objective

The current project aims to determine the nature and extent of the problem of childhood accidents, injuries and violence in Central and Eastern Europe (CEE) and the Newly Independent States (NIS) and to identify the extent to which this problem is recognised and is being adequately addressed in the region.The project was designed to provide:
- an analysis of levels, trends and determinants of mortality from accidents and violence in children in CEE and NIS, set in the broader context of Europe as a whole
- an analysis of accessible information on non-fatal injuries and accidents in the region
- an assessment of the relative importance of injuries compared to other health problems in children in the CEE and the NIS
- a review of literature on the etiology and prevention of injury in childhood
- an initial assessment of the extent to which countries in CEE have in place, or are developing, policies for accident prevention in childhood


The project mainly utilises information on mortality rates already in the public domain such as WHO time series data; information on morbidity in the transition countries has proved very difficult to obtain. Through other projects, we also have access to more detailed and complete time series mortality data for Russia and other parts of the former Soviet Union including the Baltic states. In collaboration with the WHO European Centre on Environment and Health, we explore their data on sub-national mortality patterns. This enables mapping of childhood mortality rates by cause, including accidents and violence.

Key Findings and Conclusions

Injuries are a major unrecognised problem impairing the health and welfare of children and adolescents in the transition countries of Central and Eastern Europe and the Newly Independent States. Compared to the European Union, mortality rates from injuries, poisonings and violence are nearly 5 times higher in the Newly Independent States and 2.5 times higher in Central and Eastern Europe.

Death rates from injuries in childhood and adolescence are highest in the Newly Independent States, followed by the countries of South Eastern Europe, and then by Central Europe, where rates are only slightly higher than in Western Europe. The profile of childhood deaths from external causes differs from that in the West, with, for example, much higher death rates from drowning at all ages and from poisoning in young children in most transition countries.

Injuries account for much of the difference in mortality in childhood between East and West. If rates of mortality from these causes in childhood were reduced to the average for the European Union, depending upon age, up to 80% of the difference in total mortality in childhood between East and West would be eliminated, and nearly 32,000 deaths in the age group 1-19 (31% of all deaths at this age) would be prevented each year.

The scale and extent of this problem has not been appreciated either within the transition countries themselves or more broadly in the European or global community. This lack of visibility and the absence of ownership of the problem has meant that prevention programmes are either non-existent or poorly developed and uncoordinated within most transition countries. Moreover, international agencies and donors have yet to acknowledge the magnitude of this problem, and to begin to address it, alongside their other priorities for the transition countries.


Before improved intervention programmes become a reality, injuries need to have a higher public profile. Non-governmental organisations and local pressure groups could play a key role in advancing the issue, bringing it to the attention of the media and politicians, and in advocating appropriate public health and social policy approaches. The growing private sector should similarly be challenged to contribute to an enhancement of well-being and the promotion of greater safety and security through its efforts.

International donors and institutions can play a key role in these processes in helping bring the problem to light. They can also assist the development of an appropriate response through supporting the development of local capacity, advocacy, research, and facilitating linkages and partnerships with those working in the West, where effective injury control strategies have been implemented.

More detailed and precise information needs to be collected concerning the nature and determinants of injury in the transition countries and the results of such exercises need to be widely disseminated and debated.

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