A systematic review and meta-analysis of school based programmes to prevent childhood injuries

Problem

Unintentional injuries are the leading cause of death in children aged 5-19 and are a major cause of ill health. They place extra demand on the healthcare system, including primary care, and are largely preventable. The school setting offers the opportunity to deliver preventative interventions to a large number of children and has been used to address a range of public health problems. The aim of this Cochrane systematic review was to evaluate the effectiveness and cost-effectiveness of school-based education programmes to prevent unintentional injuries in children and young people.

Approach

A total of 28 electronic databases and websites were searched up to June 2015. We included randomised and non-randomised controlled trials and controlled before-and-after studies of primary and secondary prevention interventions, delivered in the school setting, aimed at a range of injury mechanisms. The primary outcome was self-reported or medically-attended unintentional (or unspecified) injuries and secondary outcomes were observed safety skills, observed behaviour, self-reported behaviour and safety practices, safety knowledge and health economic outcomes. Pairs of review authors identified potentially relevant trials from title and abstracts of studies identified in searches and pairs of review authors extracted data from full text reports of included studies and assessed risk of bias. We grouped different types of interventions according to the outcome assessed and the health topic targeted. Where data permitted, we performed random effects meta-analyses to provide a summary of results across studies.

Findings

We included 27 studies reported in 29 articles. Interventions comprised information giving, peer education or were multi-component. Seven studies reported the primary outcome of injury occurrence and only 3 of these were similar enough to combine in a meta-analysis with a pooled incidence rate ratio of 0.76 (95% CI 0.49, 1.17) and significant heterogeneity between effect sizes (Chi² = 10.38, df = 2, P = 0.006; I² = 81%). The three studies included the provision of information for parents, mass media campaigns, peer-led education classes, injury themed games and safety campaign weeks. Safety skills reported in 2 studies showed significant improvement, as did all 4 studies reporting observed safety behaviours and 13 out of 19 studies describing self-reported behaviour. Nineteen of 21 studies reporting changes in safety knowledge found an improvement in at least some question domains in the intervention compared to the control group. Only one study reported intervention costs but the authors did not undertake a full economic evaluation.

Consequences

There is good evidence that school-based injury prevention programmes improve safety knowledge, skills, and behavior and should be considered therefore as part of a whole-school approach to health and well being. We found insufficient economic studies to assess cost-effectiveness.