Community-based programs to promote care seat restraints in children 0-16 years - A systematic review

Study Objective: Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0-16 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study: target population was children aged 0-16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33-55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1-5 year aged children by up to 11%; child booster seat use in 4-8 year aged children by up to 13%; rear restraint use in children aged 0-15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5-11 years. Conclusion: While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base. (C) 2004 Elsevier Ltd. All rights reserved.

The spatial pattern of child growth in Papua New Guinea

Child growth in PNG shows strong regional differences, with highlands children being generally shorter but stockier than those from lowland areas. Differences in diet, socioeconomic status and local subsistence agriculture were found to be important predictors of child growth. All variables indicating higher socioeconomic status were correlated with better growth, as was a high consumption of imported and local high quality foods such as cereals, legumes, tinned fish or meat and fresh fish. Differences in subsistence explained between 25% and 50% of the geographical variation in growth. Child growth was better in systems based on cassava and sweet potato, and worse in those where banana, sago and taro are staples. The cultivation of all major cash crops and sales of fish and food crops improved child growth. Birth weights show similar patterns to those observed in child growth. The implications of these findings for possible interventions are discussed.