Child school injury in Lebanon: A study to assess injury incidence, severity and risk factors

Objective: School-based injuries represent a sizeable portion of the child injury problem. In this study, we investigated the incidence rate of school-based injuries in Lebanon, and examined injury mechanisms, outcomes and associated risk factors.

Methods: A total of 4,619 injury cases were prospectively collected by intern school nurses at 11 private schools in Lebanon for the 2018–2019 academic year.

Results: The yearly rate for school injuries was 419.1 per 1,000 children per academic year. Boys demonstrated a significantly higher injury rate for most injury mechanisms. Elementary school children had the highest rate of injuries, nearly 2.4 times higher than kindergarten, 2.8 times higher than middle school, and 14.5 times higher than high school children. Injuries to the face and extremities were nearly 3 times more common than injuries to other body parts. Bumps/hits and bruises were most common, almost 3 times more likely than all other injury types. Conclusions: Evidence from this study calls for schools’ compliance with playground safety standards coupled with the implementation of injury prevention strategies and active supervision at school premises to curtail child injuries and ensure a safe and injury-free school environment.

Objective: Road traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5–29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though accurate and reliable RTI data are limited. The aim of this study is to assess the prevalence and the characteristics of child transport injuries and deaths in Lebanon and to determine their outcomes and associated risk factors.

Methods: We conducted a multicentre retrospective study to analyse data on transport injuries and deaths for children aged 0–17 years over a 3-year period (2015–2017). Data were captured from multiple sources, including police reports and the emergency departments of 30 hospitals across the country . We performed logistic regression models to examine the effects and test the association of multiple simultaneous factors on the child injury outcome and severity.

Results: A total of 3,033 cases of child transport injuries and 237 fatalities were collected. The majority of the cases were males (73%) (mean (SD) age=11 (±5) years). Transport victims were Lebanese (66.5%) and Syrian refugees (27.9%). The most commonly reported factor contributing to child’s RTI was a child riding in high-speed vehicles (25%) and the most affected body regions were upper and lower extremities (29.9%), followed by head injuries (26.1%). Pedestrians had higher odds of sustaining fatal injuries compared to four-wheel vehicle occupants (OR=1.6; 95% CI: 1.17 to 2.27). Older age groups of 6–14 years (OR=0.51; 95% CI: 0.79 to 0.69) and 15–17 years (OR=0.41; 95% CI: 0.30 to 0.61) had lower odds of dying from transport injuries compared to the younger age group of 0–5 years. Conclusion: Child transport injury is a major public health problem in Lebanon. Findings from this study urge policy- makers and health professionals to implement evidence- based child transport safety policies and behaviour change programs to reduce child transport injuries and deaths.

Lebanon suffers from a large burden of injury as a consequence of conflict and war, political instability, and the lack of policies and safety regulations. We systematically mapped and comprehensively described the injury research literature in Lebanon (1945-2017). We retrieved and analyzed 467 from major databases including MEDLINE, Embase, Eric and SafetyLit, and the grey literature. Our review identified war-related injuries as the most prevalent type of injury (31.9%) in Lebanon, followed by homicide (18.2%) and occupational injury (16.2%). Existing efforts have focused on reporting the prevalence of various mechanisms of injuries and making safety recommendations, with a considerable gap in the implementation and evaluation of interventions and programs to inform policies. Future injury-related work should prioritize intervention strategies, prevention programs and safety policies.

Objectives: Unintentional injuries constitute the leading causes of death and long-term disabilities among children aged 5 to 15 years. We aimed to systematically review published literature on interventions designed to prevent unintentional injuries among school-aged children.

Methods: We searched MEDLINE, PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO and screened the reference lists of included studies and relevant reviews. We included randomized controlled trials, controlled before-and-after studies, and interrupted time series studies. The focus of included studies was on primary prevention measures. Two reviewers collected data on type of study design, setting, population, intervention, types of injuries, outcomes assessed, and statistical results.

Results: Of 30 179 identified studies, 117 were included in this review. Most of these studies were conducted in high-income countries and addressed traffic-related injuries. Evidence from included studies reveals that multicomponent educational interventions may be effective in improving safety knowledge, attitudes, and behaviors in school-aged children mainly when coupled with other approaches. Laws/legislation were shown to be effective in increasing cycle helmet use and reducing traffic-related injury rates. Findings reveal the relevance of infrastructure modification in reducing falls and improving pedestrian safety among children.

Conclusion: Additional studies are needed to evaluate the impact of unintentional injury prevention interventions on injury, hospitalizations, and mortality rates and the impact of laws and legislation and infrastructure modification on preventing unintentional injuries among school-aged children

Lebanon and further identifies factors associated with hospital admission. Materials and methods: A retrospective cross-sectional study was conducted on adult patients (aged≥16) who presented with an injury to one of the five participating EDs from June 2017 to May 2018. Pan-Asia Trauma Outcomes Study (PATOS) variables were adopted for data collection. A descriptive analysis was performed, followed by bivariate and multivariate logistic regression to identify injury risk factors for hospital admission. Results: A total of 3,716 patients’ records were included. Most injuries were sustained by males (62.7%), patients aged between 16 and 35 years (16–25: 28%; 26–35: 22.7%), and above 65 years (15.6%). Most injuries were unintentional (94.9%). Falls were highly prevalent across all age groups (38.8%), more proclaimed among the older adults’ population (56–65:52.8%; ≥66:73.7%), followed by struck-by object (23.6%) and transport injuries (10.1%). Upper and lower extremity injuries were common across all ages. Most patients (80.9%) were treated and discharged at the ED, 11.4% were admitted to the hospital, 4.3% were transferred to other trauma care facilities, and 2 patients died in the ED. Factors positively associated with hospital admission included: older age (≥56 years); private insurance; spine and lower extremity injuries; fractures, cuts/open wounds, concussion, and organ injuries (p-value≤0.05; OR>1). Conclusion: Injury is a neglected public health problem in many LMICs, including Lebanon. While youth and the elderly are most affected, injuries occur across all age groups. This study lays the foundation for establishing a population-based injury surveillance system, crucial for designing tailored injury prevention programs to reduce injury-related deaths and disabilities.

Objective This study aims to assess the epidemiology of paediatric injury in Beirut, giving insights into their characteristics, contributing risk factors and outcomes.

Methods: A retrospective study was conducted to review medical charts for children aged 0–15 years presented to five hospital emergency departments (ED) located in Beirut over a 1-year period (June 2017–May 2018). A total of 1142 trauma-related visits for children under 15 years of age were included. A descriptive analysis and a bivariate analysis were performed to investigate admitted and treated/discharged patients. A logistic regression was conducted to identify factors associated with hospital admission among injured children.

Results: A total of 1142 cases of paediatric injury ED cases were sampled, mean age was 7.7±4.35 years. Children aged 0–5 years accounted for more than one- third of the total cases, 40.0% (206/516) of the fall injuries and 60.1% (220/366) of home injuries. The leading cause of paediatric injury was fall (45.2%), nearly 4.1% of the cases were admitted to hospitals. Factors associated with admission included injury to abdomen (OR=8.25 (CI 1.11 to 61.24)), to upper extremity (OR=5.79 (CI 2.04 to 16.49)), to lower extremity (OR=5.55 (95% CI 2.02 to 15.20) and other insurance type (OR=8.33 (CI 2.19 to 31.67)). The three types of injuries mostly associated with hospital admission were fracture (OR=13.55 (CI 4.77 to 38.44)), concussion (OR=13.60 (CI 2.83 to 65.41)) and organ system injury (OR=31.63 (CI 3.45 to 290.11)).

Conclusions: Injury remains a major health problem among the paediatric population in Lebanon. Parental child safety educational programmes and age-targeted injury prevention strategies should be initiated and implemented to mitigate the burden of child injuries and improve child safety and well-being.

Objective: Childhood injury is a neglected public health problem with a sizeable burden on children’s well‐being and their families. This study aims to describe the pattern and types of childhood injuries and to determine the level of mothers’ Knowledge, Attitude, and Practices (KAP) towards childhood injury prevention in Lebanon. The study further examines the association between childhood injury occurrence and mothers’ supervision.

Methods: This cross‐sectional study recruited mothers of children aged up to 10 years from multiple sites (i.e., a medical center, a private clinic, a healthcare facility, and a refugee camp clinic). Data were collected on mothers’ KAP toward childhood injuries using self‐administrated questionnaires. A summation score for KAP correct answers was calculated and descriptive and statistical analyses were performed to measure the association between the outcomes.

Results: A total of 264 mothers were surveyed and injury data were collected on their 464 children. The prevalence of childhood injury was 20% in the past 12 months, mostly sustained by males (53.8%) and children aged 5–10 years (38.7%). The most common type of injury was fall (48.4%), followed by burns (%7.5), and sports injuries (7.5%). Hospi‐ talized children were more likely to be males and older than 5 years (p < 0.001). More than one‐third of the mothers demonstrated poor knowledge, while the majority showed poor practice (54.4%), and fair attitude (45.6%) towards child injury prevention. Children of working mothers have three times higher odds of sustaining injuries (OR: 2.95, 95% CI: 1.60;5.47) compared to those of non‐working mothers, accounting for possible confounders (p = 0.001).

Conclusion: Childhood injuries represent a major health problem in Lebanon. Findings from this study showed that mothers are less knowledgeable and unprepared to prevent their children from getting injured. Educational programs are much needed to address the gap in the mothers’ KAP toward child injury prevention. Further studies are recom‐ mended to understand the cultural context and examine its key determinants to identify effective strategies and develop tailored interventions for preventing childhood injuries.