The objective of this cross-sectional study was to examine the relationship of provincial economic development indices with incidences of child injury mortality in Thailand from 1999 - 2001. All injury deaths among children age 1-14 years were included. The independent variables included gross provincial product per capita (GPP/c), poverty and inequality indices, material and social deprivation indices, population in rural/ urban areas, and migration. Due to multicollinearity of such variables, the 76 provinces were categorized by GPP/c quartile, and means of overall injury, drowning, and transport-related mortality rates were compared among quartile groups. Spearman’s rho correlation between GPP/c and injury mortality rates was also performed. Finally, factor analysis was employed to create a set of factors to be treated as uncorrelated variables and stepwise multiple regression was carried out for the effects of the factors on injury mortality rates. A significant direct relationship was observed between GPP/c and overall injury mortality among children age 1-4 years, and 10-14 year-olds of both genders. Drowning was the main cause of this relationship among children age 1-4 years, and transport-related injury was the principle cause among children age 10-14 years. Conversely, provinces with lower GPP/c experienced higher injury mortality rates among school-age children 5-9 years old for both genders, mostly due to drowning. Factor analysis, and multiple regression results confirmed the relationships between economic development and injury mortality rates. These findings revealed that economic development had an adverse impact on injury-related mortality among children 1 to 4 and 10 to14 in Thailand.

Key Take Away Points

  • One proximal determinant which public health strategies need to more strongly target is environmental hazards for the urban poor. This would not only reduce child deaths caused by drowning, but also decrease the risk of other types of injuries among young children associated with poverty and inequality.

  • Another target is to identify consumption and production activities that are deleterious to health, such as the harmful effects of motorcycle marketing to child and adolescent riders.

  • Apart from raising safety literacy, responsible governmental agencies need to address and control inappropriate marketing practices which induce unhealthy lifestyles among children and adolescents.

Author Biography

As the director of the Child Safety Promotion and Injury Prevention Research Center, Department of Pedaitrics, Ramathibodi Hospital, Mahidol University, Associate Professor Adisak Plitponkarnpim, MD, MPH has over ten years of experience working in research, community empowerment and policy advocacy for child safety promotion. He has initiated the intervention programs of child helmet, child seat, drowning prevention, safe toy, safe home, safe community and child death review in Thailand. His interests also focus on the social determinants of injury among children within the rapid socioeconomic transition. He has worked with several organizations in child safety network. Currently Dr. Adisak is: Chairman of Toy Safety Standard Committee, Thai Industrial Standard Institute, Ministry of Industry; Secretary of Community Empowerment for Injury-Disaster Prevention Committee, National Safety Council Board; Deputy Chairman of Child Death Review Committee, National Child Protection Board. Ragnar Andersson has a combined background in engineering and public health. After serving for fifteen years for the Swedish National Board of Occupational Safety and Health, he took his PhD in social medicine at Karolinska Institutet, Sweden, in 1991 on occupational injury prevention. Since 2001, Dr. Andersson has held a position as Professor of Risk Management at Karlstad University, Sweden. His research is focused on accident and injury analysis and prevention, injury surveillance, and macro-level determinants of risk and safety. He is also an experienced teacher and supervisor, and publishes regularly with his students and colleagues. Huiyun Xiang, MD, MH, PhD, is a pediatric trauma researcher and injury epidemiologist. He is an Associate of Professor of Pediatrics at The Ohio State University College of Medicine. He holds a joint appointment as an Associate Professor at the Division of Epidemiology, The Ohio State University College of Public Health. An internationally recognized expert in injury epidemiology and pediatric trauma research, Dr. Xiang is also the Director for Research Core of the Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital. He has a M.D. in Preventive Medicine and a master degree in biostatistics from the Tongji Medical University, China. He earned a Ph.D. in injury epidemiology from Colorado State University. Dr. Xiang currently serves on the Research Committee of US Pediatric Trauma Society, and is the deputy-section-editor of BMC Public Health – Global Section, a board member of Injury Prevention, Co-Chair of the 1st Global Summit on Child Injury Prevention: Progress since World Report on Children Injury Prevention. His primary research interests include injury and safety research in individuals with disabilities, pediatric trauma outcomes research, and injury research training in the developing world. Dr. Xiang has published more than 120 peer-reviewed journals articles, 2 book chapters, and has presented his research findings at a variety of conferences around the world.


Acknowledgements The author would like to thank Bureau of Registration Administration, Department of Local Administration, Ministry of Interior, and Ministry of Public Health for providing mortality data to use under the Civil Registration Act B.E. 2534, Section 17, and the Office of the National Economic and Social Development Board (NESDB) for providing the economic data.

This study was approved by the ethical committee related to the Institutional Review Board, Nationwide Children’s Hospital, Columbus, Ohio (study number IRB08-00166).