# Effectiveness of enhanced supervision, health education and environmental improvement interventions for injuries among children aged 6–17 in Shijiazhuang

## TL;DR

A comprehensive intervention combining supervision, education, and environmental improvements reduced childhood injuries in Shijiazhuang.

## Contribution

Demonstrates the effectiveness of a combined 5E strategy in reducing injury incidence among children.

## Key findings

- The intervention reduced injury incidence by 2.13% compared to the control group.
- Children's injury-related knowledge and protective behaviors significantly improved.
- Parents also showed improved knowledge and protective behaviors.

## Abstract

Injuries represent a significant public health concern, ranking as the primary cause of mortality among children in China. The 5E strategy is one of the most frequently employed strategies for injury prevention, yet the efficacy of a single prevention strategy is often eclipsed by that of a comprehensive intervention strategy. The present study employed a comprehensive intervention approach, encompassing enhanced supervision, health education and environmental improvement, to evaluate the efficacy of such interventions in preventing injuries among children aged 6–17.

The study population consisted of children aged 6–17 years. A stratified cluster sampling method was adopted to select 6 primary schools, 6 junior schools, and 4 senior high schools from Yuanshi County and Lingshou County respectively, which were then randomly assigned to the intervention group and the control group. The intervention group received a one-year comprehensive injury prevention intervention (January to December 2019), included team-based efforts to strengthen child supervision, with daily visits during school days and weekly visits during holidays; monthly health education sessions on injury prevention; and biannual home-school-community environmental inspections and improvements. The control group received no intervention.

The intervention group showed a 0.13% decrease in injury incidence following the intervention, while the control group exhibited a 2.00% increase in injury incidence during follow-up compared to baseline. Analysis using the difference-in-differences method indicated that the intervention reduced injury incidence by 2.13% (95% CI: [0.506, 0.809], p < 0.001). Specifically, children’s injury-related knowledge scores increased by 2.830 points (95% CI: [2.659, 3.001], p < 0.001), and their injury-related protective behavior scores improved by 4.573 points (95% CI: [4.308, 4.839], p < 0.001). For parents, injury-related knowledge scores rose by 3.076 points (95% CI:[2.804, 3.347], p < 0.001), and their injury-related protective behavior scores increased by 1.358 points (95% CI: [0.543, 2.174], p = 0.001). No significant changes were observed in injury-related belief scores (children: p = 0.354; parents: p = 0.576) or injury-related risky behavior scores (children: p = 0.961; parents: p = 0.426) among either children or parents.

Interventions that integrate childcare, health education and environmental improvements shown a positive impact on the reduction of childhood injuries, the enhancement of injury prevention knowledge, and the promotion of injury prevention behaviors.