lecture for MBBS students

5. ChildhoodChildhood
IInjurynjury
((ACCIDENTS IN CHILDRENACCIDENTS IN CHILDREN))Dr mohammad nurul huq

6. I am
Handle
me
with
care!

7. In HICsIn HICs
HIC: high income country

9. At the end of this you will learnAt the end of this you will learn
 Impact of injury isImpact of injury is devastatingdevastating
 95% child injuries (CI) occur in L&MICs95% child injuries (CI) occur in L&MICs
 DrowningDrowning is a great killeris a great killer
 Control ofControl of CICI waswas essential to achieve MDG4essential to achieve MDG4
 ID and Mn. are controlled, butID and Mn. are controlled, but CICI is clearly a big problemis clearly a big problem
 Px program is a must in all child health programsPx program is a must in all child health programs
CI: child injuries.CI: child injuries. Px: preventionPx: prevention
L&MIC:L&MIC: low-income -, MIC: middle-income countrieslow-income -, MIC: middle-income countries

10. InjuryInjury
is the intentional/un- damage to body fromis the intentional/un- damage to body from
ac. exposure to thermal, mechanical,ac. exposure to thermal, mechanical,
electrical, or chemical energy or from theelectrical, or chemical energy or from the
absence of such essentials as heat/O2absence of such essentials as heat/O2

11. Why Children are at Greater Risk?Why Children are at Greater Risk?
Children live in a world built for adults:Children live in a world built for adults: strong associationstrong association
betweenbetween CICI andand
– his age, developmental stagehis age, developmental stage
– his interactions and activitieshis interactions and activities
– lack of supervision, access to protective materialslack of supervision, access to protective materials
 Px. strategies for adults may not work for childrenPx. strategies for adults may not work for children
 World is dangerous for them: cleaning chemicals, outlets,World is dangerous for them: cleaning chemicals, outlets,
ovens, sharps, bodies of water, traffic, etc.ovens, sharps, bodies of water, traffic, etc.

13.  90% of CI are unintentional90% of CI are unintentional
 >2k U-18y dieU-18y die/d ofof CICI:: (=(= to death from DPT, measles, polioto death from DPT, measles, polio.).)
>50%:>50%: RTA ,RTA , drowning.drowning. Burns, falls, homicide, poisoningBurns, falls, homicide, poisoning
 720/d die from RTA720/d die from RTA
 480 … from drowning.480 … from drowning. >98% in L&MICs>98% in L&MICs
 260 … from burns260 … from burns
 130 … from falls;130 … from falls; 125 … from poisoning125 … from poisoning
>95% of world CI deaths occur in L&MICs>95% of world CI deaths occur in L&MICs
World Figure of CI:World Figure of CI: >12% of disease burden>12% of disease burden

14.  Tens of millions are admitted/y for non-fatalTens of millions are admitted/y for non-fatal CI.CI. A greatA great
number develop life-long disabilitiesnumber develop life-long disabilities
 CICI isis a significant MM since 1y agea significant MM since 1y age
 It isIt is the leading c/of death for >9y-old childrenthe leading c/of death for >9y-old children
 In HICs:In HICs: many have reducedmany have reduced CIsCIs by 50%by 50%
 Effective Px measures can save >1k/d child livesEffective Px measures can save >1k/d child lives
 CICI has not received enough attention and the issue ishas not received enough attention and the issue is
often absent from child survival initiativesoften absent from child survival initiatives
MM: morbidity and mortalityMM: morbidity and mortality..
World Figure …World Figure …

15.  Poor children face the greatest risks:Poor children face the greatest risks:
– they have less access to protectionthey have less access to protection
– reside in homes with open fires, unprotected windows,reside in homes with open fires, unprotected windows,
unsafe roofs and stairs, or near dense, fast-movingunsafe roofs and stairs, or near dense, fast-moving
traffictraffic
– often lack spaces and facilities for safe playoften lack spaces and facilities for safe play
 Hazards are everywhere: cleaning chemicals, outlets,Hazards are everywhere: cleaning chemicals, outlets,
ovens, sharp corners, kerosene lamps and bodies ofovens, sharp corners, kerosene lamps and bodies of
water, to name a fewwater, to name a few
World Figure …World Figure …

20. CIs are strongly related to social determinantsCIs are strongly related to social determinants

22. Impact of CI is devastating!Impact of CI is devastating!
• Losing a child has a huge impact on familiesLosing a child has a huge impact on families
• DisabledDisabled children may have poor social dev.,children may have poor social dev.,
education, work, etc.education, work, etc.
• CIsCIs place significant strain on overstretchedplace significant strain on overstretched
health care systems in L&MICshealth care systems in L&MICs
Injury Px is a v. cost-effective!Injury Px is a v. cost-effective!

23. RTA:RTA: leading c/of death in 10-19yleading c/of death in 10-19y
• 720 children die/d (commonest:720 children die/d (commonest: head injuries and fracturehead injuries and fracture))
• 10 million non-fatally injured/y10 million non-fatally injured/y
• The biggest killer in 15-19y and the 2The biggest killer in 15-19y and the 2ndnd
in 10-14yin 10-14y
• RTA and falls are main c/of disabilitiesRTA and falls are main c/of disabilities
• HICs:HICs: most victims are occupants of vehiclesmost victims are occupants of vehicles
• L&MICs:L&MICs: most are pedestrians or cyclistsmost are pedestrians or cyclists
RTI: road traffic injury. RTA: - - accidentsRTI: road traffic injury. RTA: - - accidents

24. RTI: What works?RTI: What works? Road safetyRoad safety
 Helmets. Minimum drinking-age lawsHelmets. Minimum drinking-age laws
 Lower BAC for novice drivers and zero toleranceLower BAC for novice drivers and zero tolerance
 Graduated driver licensing systemsGraduated driver licensing systems
 Seat-belts, child-restraints, helmets. Speed reductionSeat-belts, child-restraints, helmets. Speed reduction
((school, residence, play areas)school, residence, play areas)
 Separating road users:Separating road users: bicycle and pedestrian lanesbicycle and pedestrian lanes
 Daytime running lightsDaytime running lights
 Enforce traffic law, straighten roadsEnforce traffic law, straighten roads
BAC: blood alcohol concentration

26. 11

28. Falls:Falls: the leading c/of ED visitthe leading c/of ED visit
• 47k children die /y47k children die /y
• For every fatal fall 690For every fatal fall 690
children miss schoolchildren miss school
• Falls are the leading c/ofFalls are the leading c/of
long term disabilitylong term disability
c/of: cause of. ED: emergency deptc/of: cause of. ED: emergency dept

29. Falls:Falls: World FactsWorld Facts
 130 die/d: 60% from a height130 die/d: 60% from a height
 Non-fatal falls:Non-fatal falls: significant DALY lostsignificant DALY lost
 50% children ED visits may be for fall50% children ED visits may be for fall
Bangladesh:Bangladesh: fallsfalls are leadingare leading CICI
and 1 of the major c/of permanent disabilityand 1 of the major c/of permanent disability
 770 children are injured/d and770 children are injured/d and 5 die5 die
 Infants have the highest fatal fallsInfants have the highest fatal falls
DALY: Disability-adjusted life year: measure of total
disease burden: number of yrs. lost due to ill-health, disability or early death. It compares
overall health and life expectancy of a country

30. Children playing on roofs is a common sight inChildren playing on roofs is a common sight in
many Asian countriesmany Asian countries

33. Commonest falls:Commonest falls:
– prams, baby walkers, changing tablesprams, baby walkers, changing tables
– cots, beds, bunk bedscots, beds, bunk beds
– trees; sports, roofs, windowstrees; sports, roofs, windows
– stairs, playground equipmentsstairs, playground equipments
– cliffs, buildings, furniturecliffs, buildings, furniture
– jumping/diving into waterjumping/diving into water
 The roads in villages and concrete slabs around tube-wellsThe roads in villages and concrete slabs around tube-wells
become slippery when wetbecome slippery when wet
 Children fall from their beds, or slip from the lap ofChildren fall from their beds, or slip from the lap of
another childanother child
 Young children also fall when they learn how to walkYoung children also fall when they learn how to walk

35. Falls: What works?Falls: What works?
All should be careful about childrenAll should be careful about children
Redesigning nursery furniture and alikeRedesigning nursery furniture and alike
Safe playground: appropriate surface, material, height ofSafe playground: appropriate surface, material, height of
equipment and maintenanceequipment and maintenance
Legislating for stair, window, roof guardsLegislating for stair, window, roof guards
Multifaceted community programs:Multifaceted community programs: ‘Children can't‘Children can't
fly’/they protected by angelsfly’/they protected by angels
Prevent them from climbing and slippery surfacesPrevent them from climbing and slippery surfaces
Hold children on rickshawsHold children on rickshaws
Ensure children’s shoes are not slipperyEnsure children’s shoes are not slippery

36. Burns:Burns: only CI more common in girlsonly CI more common in girls

37. Burns: World FactsBurns: World Facts
 260 die from burn/d260 die from burn/d
– x11 in L&MICsx11 in L&MICs
 Infants are at highest riskInfants are at highest risk
 Smoke inhalation alone can be fatalSmoke inhalation alone can be fatal
 25% from fire, 75% from hot liquids, steam, electricity, etc25% from fire, 75% from hot liquids, steam, electricity, etc
 Many children are disfiguredMany children are disfigured

38. Burns in BangladeshBurns in Bangladesh

39. Risk factors for burn in BangladeshRisk factors for burn in Bangladesh
 Young children are the most vulnerableYoung children are the most vulnerable
 Rural children: >4 times at riskRural children: >4 times at risk
 Homes are the most common placeHomes are the most common place
 The kitchen is the most hazardousThe kitchen is the most hazardous
 KupiBatiKupiBati (kerosene lamp): 10% of the total flame burns(kerosene lamp): 10% of the total flame burns

40. Burns: What works?Burns: What works?
 Laws for smoke alarmsLaws for smoke alarms
 Child-resistant lightersChild-resistant lighters
 Laws for tap water temp.Laws for tap water temp.
 Educating the publicEducating the public
 Caution in transporting hot water, drinksCaution in transporting hot water, drinks
 Rx at a dedicated burns centreRx at a dedicated burns centre

41. Poisoning:Poisoning: World FactsWorld Facts
 >45K die/y or>45K die/y or 125/d.125/d. Highest for U-1y, but peaks again atHighest for U-1y, but peaks again at
15y and older (experiment with substances)15y and older (experiment with substances)
 Fatal poisoning is x4 in L&MICs: commonest are paraffin,Fatal poisoning is x4 in L&MICs: commonest are paraffin,
household products and drugshousehold products and drugs
 In HICs: OTC drugs, householdIn HICs: OTC drugs, household
products, prescription drugsproducts, prescription drugs

42. Substances found in and around the home are mostSubstances found in and around the home are most
commonly involved in childhood poisoningcommonly involved in childhood poisoning
• Many millions of calls are made to poison control centres,Many millions of calls are made to poison control centres,
most resolved over the phonemost resolved over the phone

43. Poisoning: What works?Poisoning: What works?
 Toxin free home.Toxin free home. Removing the toxic agentRemoving the toxic agent
 Child-resistant packaging of drugs and poisonsChild-resistant packaging of drugs and poisons
 Packaging drugs in non-lethal quantityPackaging drugs in non-lethal quantity
 Store out of reach of childrenStore out of reach of children
 Air pollution, smoking, arsenic mitigationAir pollution, smoking, arsenic mitigation
 Poison control centresPoison control centres

44.  U-5 MR from ID is now low:U-5 MR from ID is now low: CICI is ais a major killermajor killer
 CI:CI: 14% of all death: 50/100k (53% among 5-17y)14% of all death: 50/100k (53% among 5-17y)
 CI: U-18y MRCI: U-18y MR:: 30k/y30k/y
– Drowning:Drowning: 17k (46 /d)17k (46 /d)
– RTA 3,400RTA 3,400
– Animal bite 2,600Animal bite 2,600
– SuicideSuicide 2,200 (15-17y; 6/d)2,200 (15-17y; 6/d)
– OthersOthers 4,8004,800

U-18y CI morbidity:U-18y CI morbidity: 9,55,500/y9,55,500/y (30% of all morbidity}:(30% of all morbidity}:
Bangladesh ScenarioBangladesh Scenario

45. U-18y CI morbidity: 9,55,500: 13k permanent
disability
– Fall 2,81,500
– Burn 1,73,000
– Cut 1,22,500
– RTA 1,11,500
– Near drowning 68,800
– Others 1,98,200

46.  CI: oneCI: one/2min. Lack of care/supervision are main reasons/2min. Lack of care/supervision are main reasons
 Caregivers are often preoccupied (poor, both parentsCaregivers are often preoccupied (poor, both parents
working, living in cities)working, living in cities)
 Low awareness of or indifference to risksLow awareness of or indifference to risks
 Harmful practices often make situations worse withHarmful practices often make situations worse with
absence of first-aid knowledgeabsence of first-aid knowledge
Bangladesh …Bangladesh …

47. Impact of CI (BD)Impact of CI (BD)
 38k are orphaned/y38k are orphaned/y
 36/d are disabled36/d are disabled (bleak future, trapped in poverty, denied(bleak future, trapped in poverty, denied
for Rx, education, protection; can’t cope with environ.)for Rx, education, protection; can’t cope with environ.)
 It brings devastation for the poorIt brings devastation for the poor
 Many families are pushed to poverty or even familyMany families are pushed to poverty or even family
dissolution due to Rx and rehab. costdissolution due to Rx and rehab. cost
 RTA loses 2% GDPRTA loses 2% GDP

50. Why must we act now?Why must we act now?
 Burden ofBurden of CICI is on riseis on rise
 We have better/more resources, health knowledgeWe have better/more resources, health knowledge
 We can make our roads safe for children; plan cities,We can make our roads safe for children; plan cities,
caution against flood or mud flows, desertification,caution against flood or mud flows, desertification,
droughts, or rises in sea leveldroughts, or rises in sea level

53. Overall RecommendationsOverall Recommendations
 DevelopDevelop CICI prevention policyprevention policy
 IntegrateIntegrate CICI to all child health programsto all child health programs
 StrengthenStrengthen health systemshealth systems to addressto address CICI
 EnhanceEnhance datadata forfor CICI preventionprevention
 Priorities forPriorities for researchresearch
 InvestInvest forfor CICI preventionprevention

54. CI prevention is cost effectiveCI prevention is cost effective

55. Child injuries are preventableChild injuries are preventable
 12 Proven interventions can save >1000 children/d12 Proven interventions can save >1000 children/d
 Many HICs have been able to reduceMany HICs have been able to reduce CICI deaths by 50%deaths by 50%

57. Challenges in CI Px in BangladeshChallenges in CI Px in Bangladesh
 Perception that CI is a chance!Perception that CI is a chance!
 Lack ofLack of datadata
 Lack ofLack of political willpolitical will
 Poor collaboration and cooperation between agenciesPoor collaboration and cooperation between agencies
 LackLack of fundof fund, human, human resourcesresources
 AppropriateAppropriate technologytechnology

58. WHO
“The cost of doing nothing for CI is
unacceptable”
It would be tragic to achieve significant gains in
child survival only to lose to CI
Make CI top PH policy and practice
PH: public health

59. World Child Health ProjectsWorld Child Health Projects
Convention on Rights of a Child:Convention on Rights of a Child: 19891989
 Protect childrenProtect children. They have the right to the best health. They have the right to the best health
care and a safe environ., free from injury and violencecare and a safe environ., free from injury and violence
WHA resolutionsWHA resolutions
 Children are frequently mentioned in allChildren are frequently mentioned in all resolutionsresolutions
8 MDGs: 48 MDGs: 4thth
 to cut 2/3to cut 2/3rdsrds
U-5MR; not attainable if CI is not controlledU-5MR; not attainable if CI is not controlled

60. UNGA:UNGA: A world fit for childrenA world fit for children (including(including CI)CI)
Child SurvivalChild Survival is an important issue globally. It is “theis an important issue globally. It is “the
most pressing moral dilemma”most pressing moral dilemma”
The Bellagio PapersThe Bellagio Papers
 CI Px should be integrated into all child health initiativesCI Px should be integrated into all child health initiatives
 2/32/3rdsrds
of 11million U-5MR can be reduced by adding 23of 11million U-5MR can be reduced by adding 23
proven cost-effective interventions for CIproven cost-effective interventions for CI

61. DrowningDrowning
andand
Near DrowningNear Drowning

64.  Drowning: death within 24 hrs of
submersion
 Near drowning: survival after 24 hrs
of submersion (may die later)

65. Drowning: World FactsDrowning: World Facts
 480 children die/d.480 children die/d. >98% in L&MICs, usually in open>98% in L&MICs, usually in open
water bodies; most in and around the homewater bodies; most in and around the home
 2-3million/y get into trouble in water (close to drowning)2-3million/y get into trouble in water (close to drowning)
 1111thth
U-5MR; 4U-5MR; 4thth
among 4-14y-age. 1among 4-14y-age. 1stst
in 1-4yin 1-4y
 U-5 children are at greatest risk – infants can drown in aU-5 children are at greatest risk – infants can drown in a
few CM of waterfew CM of water
 In HICs: most drowning happen in swimming poolsIn HICs: most drowning happen in swimming pools

68. Bangladesh ScenarioBangladesh Scenario
 Drowning is number 1 killer in 1-4y ageDrowning is number 1 killer in 1-4y age
 2007 flood: 87% of U-5MR was from drowning2007 flood: 87% of U-5MR was from drowning
 In pre-vax. era, it was equal to measles as killerIn pre-vax. era, it was equal to measles as killer
Most Drowning OccurMost Drowning Occur in pools:in pools:
>75% within 20m of house, in the monsoon>75% within 20m of house, in the monsoon,, during flood;during flood;
between 9am to noon:between 9am to noon: mother is busy!mother is busy!
 46% were <4y:46% were <4y: cant swimcant swim

69. Male Female RatioMale Female Ratio
overalloverall 3:13:1
TeenagersTeenagers 10:110:1
Age of drowningAge of drowning

<1 y<1 y 5%5%
 1-4y1-4y 37%37%
 5-9y5-9y 15%15%
10-14y10-14y 15%15%
15-19y15-19y 28%28%
Age 1-4 y: most D occur in residential poolsAge 1-4 y: most D occur in residential pools

70. PlacesPlaces
 PondsPonds
 Bath tubsBath tubs
 BucketsBuckets
 Swimming poolsSwimming pools  LakesLakes
 StreamsStreams
 FloodFlood
 RiverRiver
 Ocean beachesOcean beaches
Infants mostly drown in bathtubs, buckets, or toiletsInfants mostly drown in bathtubs, buckets, or toilets
Bucket drowning is 24% of all toddler drowningBucket drowning is 24% of all toddler drowning

71. Risks Factors of DrowningRisks Factors of Drowning
 Lack of supervision:Lack of supervision: most drowned childrenmost drowned children
– were last seen in home in care of parents!were last seen in home in care of parents!
– had been out of sight forhad been out of sight for <5 min!<5 min!
 Water recreation, alcohol, illicit drugsWater recreation, alcohol, illicit drugs
 Epilepsy (x13 rise)Epilepsy (x13 rise)
 Child abuseChild abuse
Most pediatric drowning victims drown silentlyMost pediatric drowning victims drown silently

72. Recreation waters:Recreation waters: majority >15y. Boating:majority >15y. Boating:
hypothermia, trauma, CO poisoning, etchypothermia, trauma, CO poisoning, etc..
Alcohol:Alcohol: in 25-50% of teenager and adult drowningin 25-50% of teenager and adult drowning
 affects balance, coordination, judgmentaffects balance, coordination, judgment
 effect iseffect is ⇑⇑ by sun and heatby sun and heat
Epilepsy:Epilepsy: drowning is the greatest c/of death (bathtubdrowning is the greatest c/of death (bathtub
highest risk)highest risk)

73. PathophysiologyPathophysiology
Immediate hypoxiaImmediate hypoxia
– cardiac arrest (? catechol. induced fatal arrhythmia):cardiac arrest (? catechol. induced fatal arrhythmia):
ischemia to all tissuesischemia to all tissues
LaryngospasmLaryngospasm
Pulmonary aspirationPulmonary aspiration (absent in 15%)(absent in 15%)
HypothermiaHypothermia
ComaComa
Terminal apneaTerminal apnea (medullary depression)(medullary depression)

74. HeartHeart
– Cardiac arrestCardiac arrest
– Initial tachycardia, severe hypertensionInitial tachycardia, severe hypertension⇒⇒
bradycardia and arrhythmiasbradycardia and arrhythmias
CNSCNS:: fails in 3min of hypoxiafails in 3min of hypoxia
– Cerebral edemaCerebral edema
– Increased ICPIncreased ICP
LiverLiver:: raised transaminasesraised transaminases

75. LungsLungs
– ARDS; aspiration pn. (gastric, caustic, fluid)ARDS; aspiration pn. (gastric, caustic, fluid)
– Pulmonary edemaPulmonary edema
Kidneys:Kidneys: ATN, cortical necrosisATN, cortical necrosis
CirculationCirculation:: DIC, hemolysis, low plateletDIC, hemolysis, low platelet
GITGIT:: abrasions, bloody stools, infxabrasions, bloody stools, infx..
PancreasPancreas:: raised serum enzymesraised serum enzymes

76. FE ImbalanceFE Imbalance (uncommon)(uncommon)
– Sea waterSea water: hemoconcentration,: hemoconcentration, hypernatremiahypernatremia
– Fresh waterFresh water: water intoxication: water intoxication
 hemodilution, hyponatremiahemodilution, hyponatremia
 hemolysis: ARF, hyperkalemiahemolysis: ARF, hyperkalemia
– SIADHSIADH
Temperature:Temperature: commonly hypothermiacommonly hypothermia
Bradycardia,Bradycardia, ⇓⇓ myocardial contractionmyocardial contraction
loss of vasomotor tone, hypotension, shockloss of vasomotor tone, hypotension, shock

77. ResuscitationResuscitation
 Clear airwaysClear airways
 Don’t press abdomen!Don’t press abdomen! Vomits commonlyVomits commonly
 M2M/M2N breathingM2M/M2N breathing
 IntubationIntubation
 Temp. maintenanceTemp. maintenance
 Venous catheterVenous catheter
 ECGECG
 Correction ofCorrection of hypoglycemiahypoglycemia

81. Prognosis: depends onepends on
– Circumstances of the incidentCircumstances of the incident
– Duration of submersionDuration of submersion
– Speed of rescueSpeed of rescue
– Effectiveness of resuscitationEffectiveness of resuscitation
Cardiac arrest requires aggressive prolongedCardiac arrest requires aggressive prolonged
resuscitationresuscitation

82. A: adult supervisionA: adult supervision
 Must watch children with a distance of an arm’s lengthMust watch children with a distance of an arm’s length
 Look in the pool first if a child is missingLook in the pool first if a child is missing
 Get a lifeguard for social gatheringsGet a lifeguard for social gatherings
Prevention: ABCDPrevention: ABCD

84.  Adult supervision is critical!Adult supervision is critical!
 A lapse of <5min is seen in most drowningA lapse of <5min is seen in most drowning
 May drown in 1-2in. of waterMay drown in 1-2in. of water
 Frequently occurs in bath tubs, buckets, toilets, diaper pailsFrequently occurs in bath tubs, buckets, toilets, diaper pails
and wading poolsand wading pools
 Taking an eye off aTaking an eye off a
child in water forchild in water for
2 sec puts a child at risk!2 sec puts a child at risk!

85. A swimming teacher teaches children to swim

86. B means BarriersB means Barriers
 A non-climbable (4F) fence for pool/spa. No items usableA non-climbable (4F) fence for pool/spa. No items usable
for climbing near fencefor climbing near fence
 Self-closing, -latching gates to pool/spa,Self-closing, -latching gates to pool/spa, (latches above a(latches above a
child's reach)child's reach)
 Secure locks for all openings to pool/spa when not in useSecure locks for all openings to pool/spa when not in use
 Doors and windows could be alarmed when openedDoors and windows could be alarmed when opened
 Power operated pool safety coversPower operated pool safety covers

89. Fence keeps
children
away from
water
Use of waist
bells

90. C means ClassesC means Classes (swimming, CPR)(swimming, CPR)
 Swimming by an instructorSwimming by an instructor
 Teach children toTeach children to
– leave the water if adult leavesleave the water if adult leaves
– enter the water only with a swim suitenter the water only with a swim suit
– first enter the water in the shallow endfirst enter the water in the shallow end
 Teach adults CPR, rescue techniques,Teach adults CPR, rescue techniques, risks ofrisks of
– Bath tubs, buckets, commodes, washing machineBath tubs, buckets, commodes, washing machine
– Close toilet and bath doorsClose toilet and bath doors
– Cover commodeCover commode

92. D means DevicesD means Devices
 Poolside emergency phonePoolside emergency phone
 Install a life saving ring, shepherd's hook and CPR posterInstall a life saving ring, shepherd's hook and CPR poster
by the poolby the pool
 Children must wear Personal Flotation Device (PFD)Children must wear Personal Flotation Device (PFD)
when at water siteswhen at water sites
 Wear PFD while in a boatWear PFD while in a boat

93. Also, never…Also, never…
 leave full bucket/tubs, norleave full bucket/tubs, nor leave a child alone nearleave a child alone near
water or let swim alone, nor use "floaties" or inflatablewater or let swim alone, nor use "floaties" or inflatable
toys as life jackets or substitutes for supervisiontoys as life jackets or substitutes for supervision
 leave toys in or around the pool/spaleave toys in or around the pool/spa
 consider a child asconsider a child as ''drown-proofdrown-proof'' despitedespite
swimming skills, or experienceswimming skills, or experience
 use alcohol or drugsuse alcohol or drugs
 swim in thunder or lightningswim in thunder or lightning
 dive into unfamiliar or shallow bodies of waterdive into unfamiliar or shallow bodies of water

94. MessagesMessages
 Children have the right to a safe environment.Children have the right to a safe environment.
Many lives could be saved byMany lives could be saved by CICI Px measuresPx measures
 Child-friendly ED can reduce consequences ofChild-friendly ED can reduce consequences of CICI
 Enforce safety laws: child-resistant packagingEnforce safety laws: child-resistant packaging
 Modify stairway railings, so children will not try toModify stairway railings, so children will not try to
squeeze through or get stuck in the gapssqueeze through or get stuck in the gaps
 Fence around poolsFence around pools
 Public awareness campaigns aboutPublic awareness campaigns about CICI preventionprevention

95. MCQMCQ
 Drowning is the greatest injury-death among childrenDrowning is the greatest injury-death among children
 Near drowning means there is no aspiration in the lungsNear drowning means there is no aspiration in the lungs
 Drowning in sea water causes water intoxicationDrowning in sea water causes water intoxication
 The brain can tolerate hypoxia up to 9 minThe brain can tolerate hypoxia up to 9 min
 Most children in this country drown in out door poolsMost children in this country drown in out door pools
 Preventing drowning can achieve MDG4Preventing drowning can achieve MDG4

97. NEXT LECTURE

98. THANKTHANK YOUYOU

99. 2015-2030: SDG2015-2030: SDG (Sustainable dev. Goals): to end(Sustainable dev. Goals): to end
poverty, promote prosperity and well-being for all, protectpoverty, promote prosperity and well-being for all, protect
the environment and address climate changethe environment and address climate change
Goal 1. End povertyGoal 1. End poverty
appropriate social protection systems and measures forappropriate social protection systems and measures for
all. by 2030 achieve substantial coverage of the poor andall. by 2030 achieve substantial coverage of the poor and
the vulnerable By 2030, build the resilience of the poor andthe vulnerable By 2030, build the resilience of the poor and
those in vulnerable situations and reduce their exposurethose in vulnerable situations and reduce their exposure
and vulnerability to climate-related extreme events andand vulnerability to climate-related extreme events and
other economic, social and environmental shocks andother economic, social and environmental shocks and
disastersdisasters
Goal 2. End hunger and sustainable agricultureGoal 2. End hunger and sustainable agriculture
Achieve by 2025, targets on stunting and wasting in U5,Achieve by 2025, targets on stunting and wasting in U5,
and meet nutritional needs of adolescent girls, pregnantand meet nutritional needs of adolescent girls, pregnant
and lactating women and older personsand lactating women and older persons

101. Goal 3. Healthy lives and well-being for allGoal 3. Healthy lives and well-being for all
 MMR to <70/100k live births. NMR to 12/1,000 lb andMMR to <70/100k live births. NMR to 12/1,000 lb and
U5MR to 25U5MR to 25
 end the epidemics of AIDS, TB, malaria and NTDs andend the epidemics of AIDS, TB, malaria and NTDs and
combat hepatitis, water-borne and other communicable dcombat hepatitis, water-borne and other communicable d
reduce by 1/3reduce by 1/3rdrd
premature death from NCDs and promotepremature death from NCDs and promote
mental health and well-beingmental health and well-being
 Strengthen the prevention and treatment of substanceStrengthen the prevention and treatment of substance
abuse, including narcotic drug abuse and harmful use ofabuse, including narcotic drug abuse and harmful use of
alcoholalcohol
3.6 By 2020, halve the number of global deaths and injuries3.6 By 2020, halve the number of global deaths and injuries
from road traffic accidentsfrom road traffic accidents
3.7 By 2030, ensure universal access to sexual and3.7 By 2030, ensure universal access to sexual and
reproductive health-care services, including for familyreproductive health-care services, including for family
planning, information and education, and the integrationplanning, information and education, and the integration
of reproductive health into national strategies andof reproductive health into national strategies and
programmesprogrammes

102.  Goal 5. Achieve gender equality and empower all women and girlsGoal 5. Achieve gender equality and empower all women and girls
 5.2 Eliminate all forms of violence against all women and girls in the5.2 Eliminate all forms of violence against all women and girls in the
public and private spheres, including trafficking and sexual and otherpublic and private spheres, including trafficking and sexual and other
types of exploitationtypes of exploitation
5.3 Eliminate all harmful practices, such as child, early and forced5.3 Eliminate all harmful practices, such as child, early and forced
marriage and female genital mutilationmarriage and female genital mutilation
5.6 Ensure universal access to sexual and reproductive health and5.6 Ensure universal access to sexual and reproductive health and
reproductive rights as agreed in accordance with the Programme ofreproductive rights as agreed in accordance with the Programme of
Action of the International Conference on Population andAction of the International Conference on Population and
Development and the Beijing Platform for Action and the outcomeDevelopment and the Beijing Platform for Action and the outcome
documents of their review conferencesdocuments of their review conferences
 Goal 6. Ensure availability and sustainable management of waterGoal 6. Ensure availability and sustainable management of water
and sanitation for alland sanitation for all
 6.1 By 2030, achieve universal and equitable access to safe and6.1 By 2030, achieve universal and equitable access to safe and
affordable drinking water for allaffordable drinking water for all
6.2 By 2030, achieve access to adequate and equitable sanitation and6.2 By 2030, achieve access to adequate and equitable sanitation and
hygiene for all and end open defecation, paying special attention tohygiene for all and end open defecation, paying special attention to