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"Prevention of childhood injuries- LMIC perspective" by Dr Abelbasit Ali, a Paediatric Surgeon, in Sudan and Saudia

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Summary

Join us for an on-demand teaching session led by Dr. Abdelbaset Ali, consultant and chairman of pediatric surgery at King Saud Medical City, on the crucial topic of "Prevention of Childhood Injuries in Lower and Middle-Income Countries." Despite childhood trauma being a universal and indiscriminate disease, it’s unfortunate that 95% of these injuries occur in low and middle-income countries. Explore the basics of injury prevention in children, the risk, causes, and mechanisms of injuries, and how to develop educated plans for trauma prevention. With at least 30% of serious pediatric trauma avoidable by implementing preventative measures, your participation can help save lives, avoid disabilities, and preserve the psychosocial and socio-economic integrity of communities. It's not just about saving lives, but also about saving on the estimated cost of preventable trauma that exceeds $1,33 billion a year. This session is not just for medical professionals, but also for all stakeholders including authorities and community leaders.
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Description

This is an invited talk on the "Prevention of childhood injuries- LMIC perspective" by Dr Abelbasit Ali, a Paediatric Surgeon, in Sudan and Saudia, as a part of the Zoom academic meeting of the Department of Paediatric Surgery in East London, South Africa. This video is for health care professionals ONLY and NOT for the general public.

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Learning objectives

1. Understand the importance and urgency of preventing pediatric trauma, particularly in low and middle income countries. 2. Acquire knowledge about the statistical data related to pediatric trauma and the need for reliable data collection systems, particularly in low and middle income countries. 3. Gain insight into the risk factors, causes, and mechanisms of pediatric trauma. 4. Analyze the recommendations made by WHO for pediatric trauma prevention and the role of integrating childhood injury into a broader approach to health services. 5. Formulate strategies for reducing pediatric trauma in their communities and healthcare systems, including the creation of preventive policies, strengthening health services, enhancing data quality, setting research priorities, and increasing awareness.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello. Hi, Mary. Hello, ABD. How are you? Hi, how are you? I'm well, thank you. How are you? I'm I'm good, good, thank you. I'm fine. Good, good. Yeah, good to see you. Good to see you in person just on time. Yeah. Can I try to uh share my screen? Yes, please. Yes, please. Yes, I just would like you to, I'm just keeping my video off because I am conducting the meeting from home, my home office, right? Ok. So please. Uh so II II should uh Yes. No, I didn't see that you, you you can uh uh feel free to keep it on. If the internet bandwidth gives problem, then maybe you can switch off the video but feel free. Yes, I can see your first line nicely. Um If you just want to go forward and backward a little bit just to check. Yeah, let's see. Is that moving? Well, that's perfect. That's moving very nicely moving. Perfect. Ok. Yeah. Ok. So I forgot to ask you how much time do you have for the meeting? You know, this is about usually an hour or so. The total meeting is for an hour or hour, five minutes. Ok. And uh, so I think we would like your talk to be finished in 35 minutes maximum 40 minutes because then we remaining 20 minutes for, for discussions. Comments, right? I'll try. It may go, may go up to 45 minutes or so. But, uh, yeah. Ok. I think 4545 is fine but uh then we at least need to have 15 to 20 minutes for, for discussion, questions and comments. OK. OK. Good, good then. Then I think you can stop sharing now because I will uh just before I start the meeting, I will share my slides of introduction for you. And uh after that, I will stop sharing and you can share again, right? So there is no way that we can just minimize or uh OK. Yeah. No, you can share again. OK. So you, you have already stopped sharing. So that's perfect. Yeah. So, yeah, I know. But uh yes. Yeah. Ok. Yeah. And I don't know. Yeah. And uh there's still uh five minutes so you can also meet yourself and uh we will start just exactly at five o'clock, our time, six o'clock your time. Ok. So all looks good, isn't it? Sound looks uh oh, sound is perfect. Uh We could get the slide moving forward and backward and uh so yeah, yeah. So we'll, we'll keep logged on, right? Don't we keep locked on, keep logged on? But we'll just let uh people time, uh, give time to join because it's five minutes to five here. Uh, so in another 5 to 6 minutes we will start. Ok. Fair enough. Ok. Yeah. Apple. Yeah. Shoulder. Can you see my first light? Yes, you can see it. Ok, thank you. Ok, good afternoon. Good evening. Good morning from wherever you are joining. Welcome to the Zoom Academic Meeting of the Department of pediatric Surgery in East London, South Africa. And today we are really very happy and honored to have a talk on the prevention of childhood injuries in lower and middle income country or LM perspective by Doctor Abdelbaset Ali. And Doctor Abdelbaset Ali is currently consultant and chairman of pediatric surgery at King South Medical City and Riyadh in the Kingdom of Kingdom of Saudi Arabia or Saudi, as he likes to call it. He is a founding member of the pediatric Surgery Specialty Council at Sudan Medical Specialization Board, also academic Secretary of the Sudanese Association of pediatric Surgeons. He is a board member and leader of the pediatric trauma group at the Global Initiative for Children Surgery. And currently, I'm honored to be assisting him in developing the pediatric trauma course and also a, a hand book for the course for the L. He is a member of the International Pediatric Endosy Group IP and he is the president elect of the Pan African Pediatric Surgical Association. But over and about all these academic and, and uh the duty affiliations. He is a very dear family friend. He is actually my brother in, from Sudan, working in Serbia. So Abdelbaset, I'm very happy that you could spare time. Um And, and, and share your experience and, and knowledge with us. I will stop sharing and you can share and start your talk. Thank you. Thank you very much, me. Um uh Thank you very much indeed for this introduction. Um It's my pleasure actually to talk today uh about this very important topic. So, hello everybody. Uh Good morning, good afternoon, good evening, wherever you are. Um I would starting. Can you see the slides? Yes, we can see your slide. You can just start the slide show. Ok. Yeah, here we are. Um thanks again me. Um So, um pediatric trauma prevention. Uh This is a topic for today. Um It's a very important topic as you are all, uh you're all aware that uh pediatric trauma is uh and remains a global health set. Um And a leading cause of this in, in Children. As such, there are about a million Children who die annually because of trauma and that number actually exceeds the major diseases such as tuberculosis HIV and malaria combined uh as the causes of of mortality in, in Children. Uh Although it's universal and indiscriminating disease, it's unfortunate that 95% of these um uh let injuries take place in the low and middle income countries. Uh And you can see this in, in this um figure here, irrespective of the um uh the predisposing factor of the the cause, uh the vast majority take place in NMYC S. So the question is, is trauma preventable in Children? Well, at least 30% of um serious pediatric trauma can be avoided. And this is simply by implementing uh necessary preventative and mitigating measures uh as we will see later on during this uh presentation. So the question is uh why prevention, why should we care about uh trauma prevention Children? Uh because it saves lives, it avoids disabilities, it preserves psychosocial and uh socioeconomic integrity uh of the society and of the community and of, of the, the um uh uh and, and nationwide and it saves money. Um Many people spend a lot of money um uh on treatment of trauma. Um Many family members may um uh have to stop work and stop earning money because of looking after injured Children. Uh It also disrupts the socio economic status and their growth and nationally it stretches the health services and leads also to loss of manpower. So as such and financially um preventable trauma in Children costs. Um the places in H I CS, like in America and Europe, a staggering number or figure of about $1.33 million a year. Um And just a reduction of 10% uh in the prevalence of childhood trauma would equate to an annual saving of uh over a billion um dollar. So, um what are the basics of injury prevention in Children? Uh First, we need to agree that injuries are not sheer accidents, they are often understandable, predictable and preventable. Uh specific injuries share similar characteristics of uh person who place and, and, and, and many um uh injuries actually are more or less replicated. So, by understanding the injuries interventions can be developed and implemented to prevent or limit the extent of, of the uh injury. So what do we need um to achieve um uh the uh trauma prevention. Um there are um few things that we need to consider. Um First, we need statistical data about injuries, we need to understand the risks, the causes and the mechanisms of injuries. And then we will be able to draw um uh educated plans for uh throop prevention. So for uh statistics, um data on the extent and characteristics of injuries need to be corrected uh collected in every country, especially in LM I CS to allow better targeting of interventions and assessment of this, of their success. The problem is in most of these LM is the data collection system. Uh reliability is really questionable and uh many, many of these events uh go under re underreported. So uh understanding the risks, the causes and mechanisms of injuries. Um far, what are these risks in, in Children, Children in general uh are more vulnerable to um uh being subject to, to trauma because they are usually distracted from danger, they are attracted to some harmful objects. Um, and here we are talking about, um, not just, uh, um, mechanical injuries, uh, due to, to, uh, direct, uh, trauma, car accidents. So now we're talking about injuries at, at large including, um, uh, exposure to, uh, um, uh, harmful, um, objects in including ingestion of foreign material, um, including, um, uh, uh, sub uh, of injuries that could be, be avoided. Actually that and they uh they can be um abused and Children, unfortunately, many times are unwatched and that what makes them vulnerable because of, of lack of awareness to the uh the the risks surrounding them, these causes of injuries if we take them and, and try to see how these can be um uh avoided. Um road traffic accidents as fatal causes of injuries represent the majority of, of causes actually. Um and not only that, but 50% of them or more of that are, are um um are occurring to uh pedestrians. It has been observed that in the last few decades, uh that LM is weakness, increased motorization. Um and this is associated unfortunately with poor infrastructure, sub optimal road construction and inadequate road safety measures. And so that resulted in increase in road traffic accident, but as I mentioned, mostly uh affecting pedestrians rather than um uh uh vehicle ex uh occupants. Um We, we have seen that in, in the recent, in the last two decades or so, there were many studies uh, from the African continent, um, which were showing the, the incidence of, uh, road traffic accidents in Children. Um, and the vast majority of them are between 60%. Up to 100% were, um, the, the ones involved were pedestrian Children and there are the other causes. Of course, there are the, uh, the falls from heights. Um, and, uh, generally speaking, infants and toddlers have more falls at home while all the Children um uh have um uh injurious falls uh in the playgrounds on the playgrounds at sports or when they are climbing trees or uh when they are going to incomplete buildings where there is open access uh construction sites and in uh in places where there are unprotected windows. And of course, there are the, the drowning, the vas majority of which occurs in, in, in LM I CS compared to H I CS, the burns, the chemicals. So knowing the um the, the, the risk factors and, and the, the causes. Yes, we, we need to consider how can we draw um plans and combat those or avoid those uh types of injuries. The um wh O recommendations uh for pediatric trauma prevention uh were listed uh as on this slide that uh integrating um childhood injury into an all inclusive approach to uh the health uh services and uh developing preventative policies for Children and developing according to that specific actions and strengthening of health systems addressing childhood injuries and enhancement of quality and quantity of data for children's injury prevention and defining uh research priorities and also increasing awareness um of uh uh and and and target uh investment towards childhood uh trauma prevention awareness to stake all stakeholders um including the um authorities and and community uh uh equally. So to summarize this injury prevention in Children is best achieved by blending education legislation, law enforcement, environmental modifications, use of safer products and uh safety devices. And of course, we cannot talk about um uh trauma prevention without referring to uh the work by William Hudon, uh whose famous um hiden matrix uh about uh phase and factor and, and decision making. Um was the first conceptual framework for studying injuries and the uh and their causes and prevention. Because by studying a specific injury with these matrix, one can identify modifiable risk factors and identify points of intervention uh in the cause of sequence. This is an illustration of the uh uh hidden uh matrix uh where you can see the um on the one arm here there, the preevent event and postevent that's the face and then the factors uh that uh contribute to uh influencing the uh incidence of of the trauma and the decision making uh uh factors here. So if we apply this to the uh road traffic injury or road traffic accidents or uh some people like to call it a a motor vehicle accidents. Um So if you take the prerash uh as a face and this is what we are talking about the prevention part. Um The the factors involved here are the, the human, the information, the attitudes um impairment, uh police enforcement and we're not talking about Children here. Also the lack of awareness and uh as, as the family members or, or uh caretakers um also either lack of awareness or not being um like good role models for their Children um and subjecting them to, to trauma uh vehicle and equipment and for Children, we can consider also bikes. So the vehicles should be um roadworthy. Um They should be hit uh with lighting, braking, handling and bikes also with their, their tires and they should be um the suitable size for the Children and the the environment. And that involves the road, the, the design of the roads, the speed limits uh and the pedestrian facilities, as you mentioned that the vast majority of injuries in Children are due to road traffic accident are um for, for pedestrians. So there is a need for a political will in order to enforce that uh uh road safety cause you need to have safe road infrastructure. You need, as I mentioned to uh enforce the speed limits and you need to enforce um the uh restrain of, of Children in the cars um by um using the, the uh car seats um for Children and, and the seatbelts and for um bike users. Uh the the helmets are, are necessary. And II it is important to realize that these behaviors are very commonly noticed in, in LM I CS that Children may not be restrained on, on their labs when they uh driving cars. And so, uh it's important for the, the caretakers also to obey the traffic safety regulations and to be withdrawn mo models for, for, for their Children. And of course, uh i it's necessary to use the ree uh mobile phones during um driving to protect the uh passenger Children or to, to, to focus on the road. So as to uh avoid um uh injuring uh or, or uh car, uh R is affecting Children who pedestrians due to uh car drivers um using their mobile phones while driving um in Sub Saharan Africans. Um it is important more important there to uh to promote pedestrian and safety. So the importance of legislations is being increasingly um recognized by um by governments in LM I CS. Uh for instance, in, in, in places where motorbikes are commonly used um uh for transportation for traveling. The uh such as Vietnam, the legislations are mandating the use of, of helmets and this should be actually across the board for, for Children um on, on the bikes. Um There is um an experience which is worth even sharing uh that of culture related trauma um in, in, in uh Sudan um where these types of uh barrel carry, uh water, barrel carry um animal pulled carts, uh, which run on two wheels and they are uh horizontal when they are linked or, or hooked to the animal. But when they are left, um, when they are released, they are falling, um, at the front, um, in that, uh way and Children like to play with it by swinging on the back or on the rear end of the frame. And by so doing these barrels fall on, on Children. And that had actually resulted in severe multiple severe injuries. And, and uh at least one of um the Children in, in that series of 54 Children died of such an injury due to um severe head injury. And uh as a result, the authorities decided to, to make changes. And many of those animal pulled carts actually had been replaced with uh motorbike, uh driven uh tents like that to deliver uh water to remote areas and, and uh some uh rural areas. And that study highlighted the morbidity and mortality of culture related trauma in central Sudan. But it also showed the usefulness of institutional trauma database in identifying common trauma uh injuries in pediatrics required for identifying um uh public health measures and directing measures towards the prevention and management of trauma. So same applies to uh folks. Uh and the the, the uh Children should be advised to avoid climbing trees and uh when harvesting fruits, they should um try different measures and um um Children should be supervised especially on Children and toddlers, um especially when they are uh playing on, on uh hard courts or, or playgrounds. The equipment in playgrounds should be safe and the, the flooring should be um soft as much as possible. Many places in low and middle income countries have uh anyway and the um uh soil and, and, and that may reduce the risk of, of uh of injury due to falls. Um, but uh uh o overall, um Children should be um uh supervised and not allowed to uh uh climb um trees without being um um uh supervised or uh without uh necessary protection. Um Example of the importance of legislation uh was that um campaign, uh which is stated that Children can't fly and that in the seventies, um was the case because Children were falling through from windows which were not guarded, um because there were no uh drills and from that time, um, windows, bars were um by law uh were enforced um in, in all constructions and the rates of falls from those windows fell by, um, by 50% burns. On the other hand, are common, um domestic uh causes of, of uh injuries and um to prevent this. Uh it's important to make sure that Children stay away from uh flammable uh products, um especially in the kitchen where they tend to um stretch out for pulling, pulling uh hot objects from the um, from the, the stove and, and that, and, and and, and that can, um, can cause severe, uh, um, burns. Um, also, uh, Children should not, in many places by law, it is preventable to, to use, uh, flammable, um, clothes and long time, uh, people stopped using the, the, uh, flammable types of, of, uh, clothes, uh, for Children. Um, yet still Children can, um, get, um, subject to, to be un unfortunately drowning again. It's, it's very common in low and middle income countries. Um And um Children should always be supervised when they are close to uh water areas. Um uh rivers and, and seizures, they should be um supervised and, and they should be um uh taught actually how to, to swim from, from early on. But uh still, um there are places for legislations and environmental barriers to prevent um to a drowning among Children. Um There are projects such as the Swima Project in Thailand, Bangladesh and Vietnam and another one in Bangladesh. Uh the saving of lives for uh from drowning solid. Uh And that aim to reduce the risk of, of drowning. Another legislative advocacy which was also helpful in reducing risks of ingestion of uh chemicals uh was introduced early on with the aspirin packaging and that resulted in reduction in to 50%. But now nowadays, this is universally applicable that most of these um drugs uh have uh covers and leads that are difficult for, for Children to um open. And so actually parents should make sure that all um, corrosives and, and uh, and such harmful material should be out of the reach of Children. And, uh, one of, one of the, um, the problem that was noticed frequently here in our area was that of swelling of um foreign bodies, uh particularly the harmful ones such as the uh button batteries and the magnets. Um, these pets of magnets which result in um, uh attachment of two pieces of magnets across bowel loops and resulting in multiple perforations may lead to peritonitis uh or fistula formation. This can be very serious and we need surgical intervention to removing them um um batteries by their action mechanically, chemically and electrically can be also very, very erosive uh to the uh gastro intestinal tract. Um So we uh here in our place, uh we, we ran a campaign um last year about uh keeping these objects away from reach of Children. So it was uh called Keep the Keep It Away, keep them safe. And since that time, actually, there was uh a noticeable reduction in the incidence of foreign bodies ingestion there. Uh there is actually an inspiring experience about an overall approach to prevention of uh the most of the types of, of uh injuries in Children. That was the experience from Brazil um by safe kids. Brazil um uh is to work with child and adolescent uh trauma prevention through the pillars of mobilization, communication, and policy, um and public policy and through their um na nationwide actions um and uh uh through campaigns, education, material um uh community uh e events um and addressing um uh the, the uh wide uh area of the, the sector of the public. Uh they managed to reduce the incidence of um trauma um and fatal trauma to uh by 53%. And that decrease uh to 53 3% actually took place over um 20 years. And that strategy contributed to um building of culture of prevention um in the country. So that was the graph of the, the drop of uh the injuries from 6656 in 2000 down to uh the um 3000 figure, which is about 53% reduction in the incidence of fatal injuries, talking about injuries, especially in low and middle income countries. Um We should not forget about the seriousness of um wars and, and the vast um um devastating injuries uh that uh take place in, in, in those war zones. And given the increasing numbers of Children who are injured uh in these armed conflicts, it's imperative to the governments uh that all governments um especially those in AIC S um and, and the organizations in such as the United Nations, uh they should make every effort to uh stop these um um conflicts and minimize their impact on Children. And um my home country is now um one of those areas which are badly affected by um uh war and many Children have been, have been actually victims of that war. So, if not, that many of the strategies uh that have been successful are based on high income countries, uh experiences. Some of these may be of use in African context and, and LM I CS um with some modifications and some actually require total new strategies to uh com uh avoid the injuries. I'm sure every one of, of, of you would have uh an idea about um how he can make uh a change. Uh Each 1 may have a story to share and uh may at least you can know in your near surrounding area which risks are there for Children that you can and see and can make, uh make a change and, and public listen. Actually, even if we just uh focus on uh advocacy on, on, on education at the global initiative for children's surgery, which um believes in that each and every child has uh, should have uh a right for uh an access, um safe quality and timely and affordable surgical anesthetic and nursing care, including of course, trauma and through our um uh trauma working group at the global Initiative for Children Surgery, we have produced um prevention um information such as these are like uh leaflets uh with summarized information and advices about how to uh avoid trauma. Um If you are interested, you can find these available on the website of the global initiative for children's surgery. And here is the address. So uh to take home message from this talk, uh beware of local epidemiology, re reliable data collection is necessary is of essence to guide your actions. And uh we should work and invest on the vaccine prevention rather than um treatment and, and cure because many of times these um results of this trauma uh are not completely curable. They may result in devastating long term um disabilities uh educate the community, Children learn from their parents and from their role model. Um we should involve the governmental a authorities. They, they should be involved actually in um um the uh uh the the capacity to prevent trauma to Children by producing the necessary legislations. Um And we should remember that prevention involves not only the governments or the parents but all the um society, schools, teachers, um uh healthcare workers. So, in conclusion, uh ladies and gentlemen, there is often a misconception that injuries uh are, are just uh a random chance um events and little can be done about them. Uh In fact, um it's important to intensify the public awareness campaigns and prevention efforts should tackle the the various mechanisms of injury in Children, including um uh road traffic accidents, falls, events, drowning, et cetera. So much can be done by using the same scientific approach by better understanding of the extent and nature of the problem through surveillance and research. Uh Are you good data collection as well? Identifying the risk factors and then designing the preventative programs and measures that targets these factors and after that vigorously assessing the results and auditing those. And uh at the end, just to remind, you don't gamble with green fields. Thank you very much. Thank, thank you very much uh Abdelbaset. That was so very nice, scientific methodical um uh logical um with lots of um uh examples of safe kids or child, safe prevention of accident uh interventions uh from NM I CS. Um And I think it was highly enjoyable talk and, and absolutely worth learning from, I just have a very few comments uh Before um before I invite uh comments from experts who are attending the talk. Um We, we uh you mentioned about the safety of Brazil. Uh And I'm glad that you introduced uh that that concept and what they have achieved over 20 years. And I am happy and proud to tell you that um uh first weekend of May next year, we will be hosting the National Pediatric Surgical Conference in East London and Doctor Simon Abib with whom both of us work at Giggs level and who has been a major player in safe skills. Brazil is one of the invited faculty for our congress and we are also planning to conduct actually a session on pediatric trauma prevention. Uh so that uh that uh we are on track. And the second uh contribution I would like to make is that there has been very little progress in pockets about prevention of childhood injuries in South Africa. And um one of them is child safe sa and uh this is just an NGO which is run from the premises of Red Cross Children's Hospital. They're not related to Red Cross Children's Hospital, but they have been active for the last 1015 years. And mainly they have worked with prevention of burn injuries and prevention of road traffic accidents. So it has always been my dream to um start a child safe is a uh branch you can say in in our province and that is slowly going to happen because child safe, South Africa is going to work with two young doctors and we are going to start with the clinics in our small metro municipality. So that's something just to report to you and just a corollary to that. Um I'm happy that doctor Nira Patel is able to join us despite our family responsibilities. He is a young uh dynamic active pediatric surgeon who works at the Baragwanath Hospital in Johannesburg in Gauteng province in South Africa. And um and he has done um some work in uh spreading the message and and actively trying to prevent injuries, mainly burns. So I would like to share him to share his experience mea please, you can unmute yourself and and briefly tell your experience. So thank you so much. Um So sorry that there might be a bit of background noise, I had to travel unexpectedly. So I'm a consultant at hospital in Johannesburg in South Africa. And trauma makes up about 50% of the burden of care that we have to deliver at our particular hospital. Um And obviously we know that uh most trauma is absolutely preventable amongst the trauma patients that we treat. Um, uh, burns makes up a significant proportion. So uh burns makes up about 20% or 25% of all the surgical cases that we have to do per year. So we do about 2500 cases per year at our facility and about uh 500 of those are, are are burns cases. Um So when I started as a consultant, I started thinking about things that we can do to try and decrease the burden of disease because I think we all know that um there are never going to be enough pediatric surgeons. Um uh uh and there are never going to be enough resources to actually meet the demand for nonpreventable disease. So, um it was uh sort of um a straightforward thing for us to think that burns was the first place to start because they sap so many of our resources or so much of our resources are dedicated towards the management of absolutely preventable injury. So we looked at the data and we noticed that uh burns in our hospital were mainly affecting male Children under the age of five, who were burnt with hot water um in their home environment. So, about uh 75% of the Children that we admit are burnt with hot water. About uh 70 70% are under the age of five. The majority of burns occur at home. And uh using this information, we came up with a, a prevention campaign and the prevention campaign is based on three pillars, general awareness, risk reduction and action. So general awareness is a few simple messages. Uh burns occur at home. Burns occur while bathing, playing or cooking burns are preventable and most burns will be caused by hot water. Risk reduction is what to do in your home in case, uh in, in order to decrease the risk of a burn occurring. So simple things like what uh prof Abdula it has already uh mentioned. Um keep all hazardous equipment out of reach of Children, create a child safe zone in your home. Don't hold your child while cooking uh your food. Make sure that you test the bath water in your home before bathing your child because many of the patients uh don't have geezers, they boil water in kettle and then because we know that accidents will occur, uh don't do the wrong thing because uh out of uh out of the patient population that we have, we noticed that 60% don't get any first aid at all, which is fundamental to uh the management of any burn and decreasing the severity of illness and uh, 40% out of the remaining 40% 25% got the wrong first aid. So their, their burns got covered by things that would make the injury worse, something like toothpaste or sunlight or Colgate or, or pup or whatever it is. So the last, uh, message that we wanted to deliver was don't make anything that don't do anything that can make the burn worse. So, um, uh, uh wash the burnt area and tip the tap water for 20 minutes and uh seek early attention at a medical facility. So what we've done is we've um created this uh messaging with, we, we think is relatively simple and we are delivering it to the community uh using a variety of different media because we, we just pamphlets um that maybe the message won't translate into behavior change. So what we do is we use social media, we use uh pamphlets, we use radio adverts. Um uh We use shows on radio in, in, in local radio stations and we employ community healthcare workers to go to local clinics to give this very simple message. And, and what we're hoping is that by giving the message repetitively in a local language to the correct target audience. So because our, our, our uh target or I mean, our, our, our patient population is Children under the age of five, we've targeted um the caregivers of those Children. Um So what we want to do is give them a simple message in a local language, repetitively using a variety of media to the correct audience. And we hope that it will translate into behavior change. So, I mean, the, the challenge is then, and I think this uh draws on uh Prof's work or Prof's talk. How do you turn common sense into behavioral change that will result in um in a decreased burden of disease. So, we're not uh at the stage where we've completely assessed the impact of our intervention yet, but we are in the process of that final step. Um Seeing whether our messaging is actually resulting in behavior change. I'm not sure that we'll ever be able to assess whether it's actually resulted in a decrease in the number of burns. But I think that's also just because of epidemiological reasons. I mean, we live in a, in a, in a, in or we live and work in a place where the level of uh data collection at a, at a mass basic level is, is just not there. So we won't really be able to tell um from, from just broad numbers, whether whether we are making a change or not. But II think we will be able to tell if we, if we test uh caregivers knowledge of uh what we've taught and whether they've used that knowledge to um impact uh preventative measures in their own homes. Yeah. Thank you, Brooke. Th th thank you ne uh and, and uh in, in um around East London in Ss Congress, we will hear uh probably follow up of what work al has already happened in Johannesburg. And we'll probably be able to see um um scientifically proven improvement in the outcomes. And next, I would like to invite Doctor Bip Nandi. Uh Doctor B Nandi is a senior pediatric surgeon in Blan Malawi. Uh PIP. I know you joined a bit late but uh any, any initiatives in Malawi for prevention of childhood injuries? I um to be honest, I'm not sure. Um we're quite fortunate in the l long way, but we don't look after the burns. Uh that would be a huge amount of work. Um But uh I mean, there have been some initiatives from um I wrote safety for uh improving um life vests and I'm really not sure uh specifically amongst the pediatric population if there is anything. Ok, be. Thank you. Um I see Doctor Aa Obasi uh pediatric surgeon in private practice in, in Lagos, Nigeria is here aa any experience of uh different from Nigeria? Yeah, thank you so much for your presentation and um the talk. So um in, in my experience, the uh childhood um trauma, trauma here is of various degrees and um the most common that you have experienced is burns um in Children, especially like um uh prof was talking about, you know, uh when your, when your child is with you in the kitchen and you are, you know, using cooking hot, you know, things, those are the common injuries I've actually experienced and um they present in the emergency with several degrees of, of uh bones injury, usually scout injury from uh hot liquids, especially oil and water. So, um also, um, I it, it be one of the also accidental ine of crosis. I don't know if that's um, is also part of it but it, it's something that is quite a bit common in our environment because people try to make local um detergents and uh they store um uh or uh or um alkaline in very unsafe places and these alkaline actually look like water. So these Children goes and inject this uh alkaline and they come down with a corrosive um esophagitis and later on stricture. Um So these are our experience and uh that's what I want to put out. Thank you, sir. Thank you aa I see there is Doctor Pfizer, he who is joining for Barra uh Doctor Pfizer. Anything to contribute from bare. Hello. Good evening everybody. I'm doctor. Hi there. I'm pediatric surgeon in Bahrain. Um, trauma is not very common in the pediatric population and uh the burn is common. Yes. Um but trauma is like all other uh that uh professor and then uh uh he, he described about the road traffic accidents and most of them, the pediatric car passengers and we lately have the trauma with the uh three wheelers and the latest, uh, vehicles that the Children are, uh, obsessed with lately, but it's not that common like we see one every two or three weeks regarding the road traffic accidents. Otherwise we are stable from that time. Thank you very much. Oh, thank you. You are very lucky and the Children in Bahrain are very lucky. Uh, we would really sort of pray and aspire for such, uh, statistics of trauma. But thank you for sharing your experience. Next, I would like to, I see doctor um uh uh sorry, I see uh doctor um uh Mohmed Aza Azar is here. Uh He's from Pakistan if I'm correct from Peshawar. So doctor Mohmed, uh any experience from Pakistan, just unmute yourself, please? Doctor Moma. If not, then I'll ask Doctor Ti mcguire uh to comment. Uh Doctor Maguire I believe is uh is, is in Pretoria uh foot any comments? Ok. Uh um uh Good afternoon uh pro yeah, lovely talk. Um Thanks pro pro. Um I think um sort of like um a lot has been shared by my seniors. I really have nothing to add. I really enjoyed um um listening to the talk and also hearing all the other people's uh experience things for. Thank you very much. Next, I would like to ask uh to comment. Doctor Nicola Mohave is our young consultant, pediatric surgeon. She trained with Doctor Patel at Baragwanath Hospital and she has been with us for last two plus years. And I can say that both of us are honor that we were part of the recent publication uh December issue of the seminars in periodic surgery about prevention of childhood injuries. Uh which Doctor Abdelbaset was one of the lead authors. So, Knox uh any comments. Um Yeah, thank you. Thank you, Prof um um prof Ab uh Abdelbaset. I just want to um thank you for your role in advocating for pediatric trauma and global surgery and the role that you play in gigs and PSA um my comments, um just firstly, I would like to commend um the joburg team for um all the work that they are doing currently um in prevention of uh pediatric burns, especially bringing the information um to caregivers and families in a language that they understand and um to actually make the information accessible um especially in um new age of social media. Um Just um interestingly because I've worked in um three provinces as a pediatric surgeon and I've noticed that um the pediatric trauma is actually regional in terms of um the, the patterns of injury. Um for instance, in Joburg, um like Nira said that burns and road traffic accidents were quite common. Um whereas um in Limpopo, um we hardly got um trauma from road traffic accidents um and burns um but it was more of falls than anything else. Um And um if you look at the Eastern Cape have been uh more prevalent and if you look at the Western Cape, you find that road traffic accidents um as as well as gunshot injuries are more prevalent. Um So for me, that is um quite notable and also the fact that um we are sitting on a gold mine of information um especially um in, in regards to the pattern of injuries like um prof was in his presentation. Um It did tell us about car injuries. Um The one interesting um pattern of injury that I noted when I was working in Joburg was um traumatic brain injuries due to collapsing gates. Like um you know, the the gates in the household. Um the main entrance gates, um Children would usually play on those gates and then because they were poorly installed or they were old, then those gates would fall and then because they are so heavy, um they would end up falling on the Children and causing significant trauma and over a five-year period, um We noted that 71 Children had actually come into the trauma unit with traumatic brain injury due to um collapsing gates. So, um yeah, I thought that was um quite interesting. Um And also I just wanted to find out from prof um how far out we with um establishing trauma registries um within um the the low middle income countries. Um just so that we can use those trauma registries to advocate for um intervention at higher levels of, of government. Um Would you know that by any chance pro Yeah. Um If you around me. Yes. Um Yeah, thanks. Uh Can you hear me? Yes. Uh Thanks doctor so I can hear you. Thank you. Yes. Yes. And, and uh I would like to thank you again for your role in uh repairing that uh manuscript that uh we published in uh the seminars in pediatric surgery uh recently. Um Yes, regarding the um data registry. Um There are 22 issues here. One the uh there is a generic uh data collection form um issued by the WO uh and you can access that through the wh O website and um you can use it a anyway, it's generic. Uh but it is so so detailed. Uh II don't think many people, especially L I CS would be able to uh fill that all for every uh individual who comes in with, with the trauma. But uh a few years back, we launched a, a survey um through the PAP PSA um and actually that was published recently in the African General P surgery, a survey about trauma. The response from Africa came from a few countries. Um But overall, um it gave a uh a broad idea about the the incidence of, of trauma. Uh they were like 531 entries and it showed that the vast majority of injuries were due to road traffic accidents and falls uh in the African continent. And there are a few interesting things such as bear trauma in, in some of the West African uh countries and, and uh so this, uh as you said, um these findings raise the flag that there are locoregional uh types of injuries. And so that's our responsibility as a healthcare uh uh professionals uh is to advocate for uh looking into any of these uh repeated types of, of injuries and patterns of, of injuries and try to, to pick the risk factors for those and raise um the issue to the awareness uh to the, to the uh um authorities and, and raise the awareness of the public about these uh incidents because that will certainly help in reducing. Sometimes people think everything is, is, is obvious and self-explanatory and that's not always true. There are times when people may not be not, for instance, you may be walking every day on the road and you will see that there is a hole on one side of that road and nobody cares about it. And it causes many, many, many uh trauma, many injuries to Children and even to adults or, or even to animals. But the issue is that because people think that it's not happening to me and it's not going to happen to me. And sur as surgeons, we may be thinking more of um operating rather than preventing uh incidents of, of traumas while these very simple things, observations, raising awareness, education and, and trying to um uh attract the attention of the uh uh the uh decision maker. It's very important to have that political will in helping you. I if you allow me, II can just mention that there was, there was a time when we, we in, in, in Sudan. Um at the time uh I was working in a place where there was no such facilities to um to treat uh a traumatized patient uh properly. So as a group there, uh in, in our department, we just decided to get a few things, collect them and make a special shelf on a uh on a drawer. On one side of that emergency department, ask the hospital administration to provide us with a suction machine. Few items, drips, IV cannula, uh and the tracheal tubes and uh uh blood disc of such things. And then we noticed a remarkable difference in the way how we treated patients who came in this trauma. But more important than treatment I think is uh advocacy for, for prevention. And thanks for everyone who commented, there are comments I've seen. Um Yes. Um yes about that. Uh I want to read, read one comment. Uh There was obviously comment for doctor Ho Bilal. Um and I think, um, uh Abdel Basit, you're already working on the pediatric trauma course and handbook. But I think we will think at peps level how we can encourage different uh member countries to including South Africa to try and work towards a pediatric Trauma registry because I think the next comment is linked to that and that's from Doctor Yoda man who is a senior consultant, pediatric surgeon. Unfortunately, she had to leave the meeting but her, her comment is also the same that message to us. Uh boils down to data collection and advocacy and uh I think we in East London will certainly try and work towards it. Um We will learn from from uh Johannesburg Group, Cape Town Group and obviously uh inspired by what you have told us. Now, I just want to ask for one final comment before I ask your concluding remarks. Uh Professor Arturo Delgado is here. He works in uh in the same province for last many years, but he originally comes from Cuba and he has worked for years together in Cuba. So Arturo, um any experience from Cuba you would like to share because I'm sure things are different in Cuba, please unmute yourself. Arturo. Ok. Thank you very much. Mainly. Good evening to everyone and thank you to the presenter. So actually in Cuba, it's not very different but we can find here in a so in general, we could say that no, most of the injuring Children are avoidable. You know, the all of them are avoidable. Yeah. Does it depend on us to avoid, that's injury that is not very different? That's depend in a house at home that's very frequent. Like here the pedestrians, a child of the pedestrian and the traumatized. And, uh, but then like, uh, here there a motor vehicle accident, the Children, they are not there to. Sorry. I, yeah. Ok. Go ahead. And, uh, so Arturo, I think there is some problem, uh, your internet connection. It's on and off. Yeah, I think there is some problem with his internet connection. So I'll just, uh, request, uh, you're back. Can you talk? Can you finish your remind? Yeah, just finish your remark. No, sorry. There is, there's some problem with his communication. Um What I would like to sort of uh ask and uh uh ask all of us to introspect because some of us as parents may not be religiously wearing seatbelts and putting our young Children in car seats and the older ones with seat belts. So I think just retrospect and, and make sure that we follow the rules because as of uh uh sorry, pro pro aba told us that Children follow their parents. So, so we must follow the rules and automatically Children will do that. Uh So I think it has been very inspiring talk, interesting discussion and a lot of um uh you can say um we, we, we are inspired and we are enthusiastic about uh working towards this cause. So, Abdelbaset, your final concluding remarks. Yeah, thanks very much. Thanks again, uh me and thanks to everyone who attended, I hope it had been uh useful. Um just uh uh two things uh to remind everyone that yes, uh trauma can be avoided uh when it comes to the registry, um, that you just mentioned, uh I think we need to work on that uh me um through PSA yeah, and we need to make it as simple as possible. Um So as to allow people to um uh respond to it and, and uh keep filling the forms properly so that we can have a reliable uh uh trauma registry. And uh at the end, I would like to thank you very much and wish you all the best with the endeavor and with your uh um preparation for the meeting that it would be great uh when you have uh Simone to come and, and address um that uh meeting because she, she's uh uh an authority in the uh the uh program of uh prevention in, in Brazil. And uh thanks very much everyone and have a good evening. Thank you. Yes. Uh Thank you, Bill. And what I will work is I will recruit uh my young colleagues like Nero and Knox and, and uh definitely few others uh including Arua in Nigeria um uh as a, as a young group. And then we will probably recruit some trainees and our medical students who will work under your guidance for us to develop a very simple form, uh a, a as a basic trauma pediatric trauma registry, which we can roll out in English and French uh in the next year or so. Uh So that at least we will start collecting data of patients who present themselves to the hospital. Uh So uh we, we will uh work on that and just a reminder that uh second Tuesday of May next month, uh we will have have a talk by Doctor Linda Remer, who is a pediatric intensivist at our hospital here. And she will be talking to us about um i intravenous fluids. So basically fluid um administration for uh pediatric surgical patients. So that's also going to be an interesting talk and today's uh recording um in a couple of hours, I will upload it on youtube and also on the Med All platform and I will share the recordings extensively. Just one last request to you Abdelbaset. I wasn't aware of the publication in African Journal of pediatric surgery. So if you don't mind, uh when you get a chance to just share it with me uh by whatsapp or by email, then I will uh circulate it widely so that colleagues in Africa and also in the Middle East are aware of that recent publication. Sure. Yeah, sure. OK. Will do so so. Thank you very much. Um uh I hope to meet you in person in the near future, definitely in Abidjan uh for PAP Sar 2025 at the end of May next year. OK. Thank you very much. OK. Thank you all. Um and, and have a good evening or a Good afternoon. Bye-bye.