Countries Who Have Killed the Most Handicapped Babies

• Original contribution
• Open Access
• Published: 12 July 2016

Baby walker injury, disability, and expiry in a high-income heart eastern country, as reported by siblings

• Michal Grivna ORCID: orcid.org/0000-0003-2349-0922 ⁱⁱ,
• Amna Al-Hanaee²,
• Ayesha Al-Dhahab²,
• Fatima Al-Kaabi² &
• Shamma Al-Muhairiⁱⁱ

Injury Epidemiology book 3, Article number:17 (2016) Cite this article

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Abstract

Background

Baby walkers (BWs) are frequent causes of infant injuries. Little inquiry is reported from the Middle East and few population-based studies anywhere.

Methods

Using multistage random sampling in a city of the United Arab Emirates, 4 of 8 female Arab government high schools and 3 last-twelvemonth classes each from science and arts tracks were selected. Structured self-administered questionnaires assessed prevalence, frequency, severity, and external causes of BW incidents and injuries, and residential hazards.

Results

Response was 100 %, 696 students, 55 % (north = 385) Emirati citizens. 87 % (northward = 605) of families used/had used BWs. Among 646 injuries were 118 ER (emergency) visits, 42 hospitalizations, xi disabilities, and iii deaths. Boilerplate risk was 1 incident/user, ane injury/iv users, 1 ER visit/20, ane hospitalization/55, one disability/200, 1 death/1000. Odds ratios for >1:ane flooring levels were ii.3 (95 % confidence interval: one.2, 4.three) for hospitalization, xvi.8 (95 % CI: 2.ane, 132.5) disability. Incidents included hitting objects 48 % (n = 1322), overturning 23 % (northward = 632), accessing hazardous objects 17 % (northward = 473), and falling down stairs 11 % (n = 300); one % (n = 32) brutal into swimming pools. In 49 % (north = 297/605) of user families, ≥1 kid had been injured.

Conclusions

Despite causing many injuries including disabilities and fatalities, BWs were used by nearly all families. Governments should consider Canada's lead in prohibiting importation, sales, and advertising of BWs.

Groundwork

Babe walkers (BWs) were described in one of the earliest textbooks of paediatrics in Arabic over a millennium ago (Al-Baladi 1980). Prevalence studies in various countries bespeak that this product is used by between xx and 90 % of parents, mainly for children about 5 to 14 months old (Al-Nouri and Al-Isami 2006; Health Canada 2007; Rodgers and Leland 2005; Santos Serrano et al. 1996). Due to the frequency and severity of BW injuries, the Canadian authorities has banned import, advertising and auction since 2004 under the Hazardous Products Act, and resisted a subsequent manufacture challenge (Health Canada 2007). Other countries have no interventions or less effective measures such as warning labels, pattern modification, or public instruction (American Academy of Pediatrics 2001; Taylor 2002; Shields and Smith 2006). Despite existing voluntary standards in the Us to forestall falls downwards stairs, such equally presence of brakes and minimum width, non all manufacturers are members of the Juvenile Products Manufacturers Association (JPMA) and receive a rubber product certification from JPMA (American Academy of Pediatrics 2001). Furthermore, speeds can exist loftier plenty to overcome brakes and incidents such as reaching dangerous objects are non affected by the standards (Health Canada 2002; Ridenour 1997).

Since early clarification of BWs, piffling has been published in the Centre E. In an earlier habitation safety survey in the United Arab Emirates (UAE), a rapidly developing oil-rich state, BWs were used by 32 % of families (Al-Saridi et al. 2005). A larger study was therefore adult focusing specifically on BWs. In a first article we reported the noesis and attitudes of future mothers on perceived safe, reasons for initiating and stopping use, and support for legislation banning BWs (Grivna et al. 2015). This newspaper assesses the epidemiology of BW injuries, including prevalence, frequency and severity of associated injuries, external causes, and environmental risks at homes. Due to local Arab culture making information technology difficult to sample and interview at homes, another method was needed. We chose to interview high school girls equally future mothers and as siblings of injured babies. This provided a rapid large multistage random sample.

Methods

Design, target population, sampling

A cross-sectional survey was conducted during September 2005 in Al Ain, a desert urban center of population 460,000, which is one of the iv largest cities in the UAE. Using multistage random sampling, 4 of 8 regime female Arab loftier schools were selected, then grade-12 classes in each, including 3 from science and 3 from art tracks. All students in selected classes were included, on boilerplate xxx each. Previous research in such schools showed a adequately fifty-fifty distribution of income groups among families (Al-Saridi et al. 2005); 43 % of fathers and 26 % of mothers had at to the lowest degree university didactics. Children of departer workers with very low income would not have been included in sampling since such workers were not allowed to bring families. Because the study was in Arab schools, Indian or European families were not included.

Nowadays many mothers piece of work, delegating oversight and intendance of young children to older siblings and/or housemaids. Hence, siblings are potentially more enlightened of home injury incidents than their working mothers. Sample size requirements to detect uncommon events such as deaths and disabilities together with challenges of household surveys of women in the Islamic cultural context indicated that a population-based school survey of youth in generally large families was the most feasible study design.

Data collection musical instrument

The self-administered questionnaire included 32 structured questions. It was developed in English and translated into Arabic. BW prevalence and injury incidence for each young woman'south family unit were reported as far dorsum equally they could recall, including simply persons living in their home; extended families were excluded. The questionnaire included: socio-demographic variables such as age, nationality, number of children in the family <15 years-old; frequency, external causes and outcome of potentially injurious BW incidents; and environmental risk factors such equally number of floor levels, stairs, and pond pools. Incidents mainly involve external causes of hitting objects, flipping over on flat surfaces, accessing dangerous items, falling down stairs, and falling into pools. Severity was categorized every bit a potentially injurious incident, emergency room (ER) visit, hospitalization, long-term disability, and death. For long-term disability, the respondent was asked to specify information technology, i.east., provide details. Conspicuously where the patient was not taken for clinical assessment or even if they were, the sibling would not exist by and large exist expected to provide a diagnosis, only the external cause. For falls down stairs, it would be surprising if at that place were no injury at all as such incidents tend to be severe. The questionnaire was improved after a pilot among grade 12 students in a randomly selected grade. It was explained and distributed by the Arab medical pupil investigators and completed in grade.

Information processing and analysis

Questionnaires were pre-coded for data entry, verified later on completion, double- entered and compared to prevent keystroke, range, and consistency errors, and and then transferred to SPSS. Analysis included regrouping, frequencies, and cross-tabulations. For incidence density calculation, boilerplate exposure per babe was assumed to be half dozen months, based upon an Irish study where median duration of use was 26 weeks, starting at 26 and finishing at 54 weeks (Garrett et al 2002). In Canada, range of apply was estimated at v–14 months by Health Canada (Health Canada 2007). Conviction intervals were calculated using the method recommended by Newcombe and Altman (2000). For comparisons of injury rate ratios betwixt families living on one versus more than than one level, odds ratios were computed; since more national families lived in multi-level homes, these data were as well stratified into national and non-national families to assess potential confounding past nationality.

Results

Incidents, injuries, and external causes

A total of 696 students completed the survey, 55 % (due north = 385) of whom were Emirati citizens. Response was 100 %. Prevalence of BWs in families was 87 % (north = 605/696), with a total of 2376 children exposed to BW use (Tabular array 1). In 49 % of families (due north = 297/605) where a BW had been used, at least ane child was reported injured, with a full of 646 injuries (Tabular array 2); 52 % (due north = 180) of victims were Emiratis and 42 % (n = 117) other Arabs. Of the 646 injuries, 118 were treated in emergency rooms (ER), 42 hospitalized, eleven long-term disabled, and 3 died (Table ii). Although the nature of almost injuries was unknown, 23 ER visits were for head injury, 12 for lacerations, three for fractures, and three for drug ingestion or other poisoning. 1 infant in a BW was killed by a car, while external causes of the 2 other deaths were unspecified.

Table i Number of users of baby walkers and of injured babies per family and total number of injuries, families of female person Class-12 students, Al Own, United Arab Emirates, 2005 (due north = 696 families; 2466 children)

Total size table

Table 2 Number and charge per unit of events related to baby walker employ, families of female person Grade-12 students, Al Ain, United Arab Emirates, 2005 (n = 2376 BW users in 695 families)

Total size table

With 2376 children in the students' families exposed to employ of a BW for an estimated average of six months, information technology was possible to estimate incidence densities for 1188 infant-years of exposure (Table 2). BW-related events could then be expressed per 1000 babe-years (double the rate per g babies), besides as the predictable probability of each issue, ranging from a gamble of i potentially injurious incident per user, to ane long-term disability per 200 users and i decease per 1000 users.

The most frequent external cause of a potentially injurious BW incident was hitting a hard object, bookkeeping for nearly half of all 2759 incidents (Tabular array 3). Next were flipping over, accessing dangerous items, and falling down stairs. The potentially near dangerous incidents included 300 falls down stairs and 32 into swimming pools. Stair-related injuries were more frequent in two-story homes while in 1-story homes, overturning on apartment surfaces and accessing dangerous items.

Table iii Number of infant walker incidents by external cause, number of floors in the home, and nationality, families of female person Grade-12 students, Al Ain, United Arab Emirates, 2005 (n = 696)^a

Full size table

Home environmental determinants for BW injury

84 % (n = 573) of students' families lived in houses and 16 % (n = 109) in apartments. 64 % (northward = 440) of houses and apartments had i story and 36 % (n = 253) ≥two; 48 % (n = 186) of UAE nationals and 22 % (n = 67) of non-nationals lived in a residence with ≥2storys. External stairways are by and large much lower than internal; however, falls occurred on both. x % (n = 69) of residences had a sunken room and 21 % (due north = 142) 1 or two steps betwixt or within rooms, while 7 % (n = 45) had an elevated room. 82 % (n = 517) of families used BWs downstairs inside the habitation, xv % (n = 92) upstairs and downstairs, and three % (northward = 21) only upstairs. 36 % (n = 235) used a BW outside in yards, half-dozen % (n = 38) on verandas, and four % (due north = 26) in driveways.

BW hospitalizations were more than than double in frequency among families in residences with ≥ii storeys compared with one, while long-term disabilities were 17 times greater (Tabular array four). After stratification of UAE nationals and non-nationals, results were similar for all categories except hospitalizations, where odds ratios were not-significant for nationals, but 14.half-dozen (95 % CI 4.7, 45.7) for non-nationals.

Table four Number and odds ratio of events related to baby walker employ by number of stories in home, families of female Course-12 students, Al Own, United Arab Emirates, 2005 (northward = 2376 BW users in 605 families)

Total size table

12 % (north = 83) of families had a abode swimming pool. Merely 12 % (due north = 10) of pools had complete automatic passive protection past a self-closing and self-latching gate, while threescore % (northward = 49) had no gate, 21 % (n = 17) manually closing gates, six % (due north = v) self-closing, and 1 % (n = 1) other.

Give-and-take

Incidence

Despite potential limitations of lifetime recollect for students, severe and pocket-sized non-fatal BW injuries as well equally deaths were frequent. In about half of UAE families using BWs, at to the lowest degree one child sustained injury, averaging two injuries per family. At that place were l ER visits, 18 hospitalizations, five disabilities and 1 decease per 1000 infant years. As a comparison, in the United States, almanac incidence of BW emergency section visits was estimated at 8.ix injuries per 1000 infants, astringent i.7 per m (Chiaviello et al. 1994). During 1973–1998, 34 BW-related deaths were reported (American Academy of Pediatrics 2001). With an average population of about 4 1000000 infants (births) at hazard over 25 years, i.east., 100 million babe years, U.s. data at 0.034 BW deaths per 100,000 baby (births) years may be incomplete or the risk far less, since our UAE written report institute 3 deaths in a urban center of less than 0.5 million, virtually 9000 infants (births) per year with a recall period of perhaps equally much as 18 years, say almost 1.9 deaths per 100,000 infant years. The ratio would be about 55 to one for UAE to The states. These are judge estimates based on small UAE numbers, but provide some possibilities every bit to differences in BW mortality risk for infants in the two countries. For two of the UAE BW deaths, the external cause was not specified by the sibling, maybe considering the term "specify" was unclear in translation or because the sibling was crying at that point, as all three were.

Built environs factors

Homes are the primary site for severe BW injuries (Ozanne-Smith and Brumen 1993; Thein et al. 2005; Shields and Smith 2006). Although hit a hard object and flipping over on a flat surface were the nearly frequent BW injury incidents in the UAE, most dangerous were falls down stairs and into pools. BW injuries were frequent due to the combination of high prevalence of BWs and of home stairs. Many families, especially citizens, live in multi-story residences with inside and exterior stairs. For multi-story residences, hazard of BW hospitalization was more doubled and long-term inability was 17 times greater. Other frequent hazards include more 1 floor level on the aforementioned story, in-ground pools, and play areas contiguous with parking and/or traffic. Most floors and outside play areas are hard finished surfaces (Al-Saridi et al. 2005). Basements are uncommon in desert homes in the UAE, whereas in the United States about 40 % of BW injuries occur on basement stairs (Consumer Production Safety Commission every bit cited in American University of Pediatrics 2001).

In Australia, 65 % of households using BWs had stairs (Ozanne-Smith and Brumen 1993). 77 % of BW injuries involved a autumn, and stair falls accounted for 47 % of BW hospitalizations. This and our UAE results contrast with the city of Baghdad, where most families reportedly lived in unmarried-story homes and simply ii of 148 injuries involved stairs (Al-Nouri and Al-Isami 2006). In the US, 96 % of BW injuries treated in ERs were stair falls (Smith et al. 1997). Among BW injuries at a trauma centre, 95 % were stair falls (Partington et al. 1991). In Commonwealth of australia, only thirty % of households had protection such as gates at acme and bottom of stairs; touch with physical or other fabricated surfaces was the direct cause of injury in 50 % of BW incidents (Ozanne-Smith and Brumen 1993). Unfortunately, non all stair gates fairly foreclose BW injuries (Smith et al. 1997).

Habitation pools are another hazardous built environment, and in our study 31 incidents involved infants in BWs falling into pools. Exposure is loftier, with 12 % of families having pools in this written report. In other unpublished population-based studies in v UAE cities, 9 to 29 % of families had home pools, fewer than x % with automatic cocky-closing and self-latching gates (Al-Saridi et al. 2005; Mussab et al. 2006). Although other medical students described at least one BW family pool death, in our study infants survived pool incidents, suggesting presence of a caregiver(s). In a US report of 11 BW deaths, 4 were drownings, at least 3 in pools (US Consumer Product Safety Commission 1994).

Although niggling is published on BW injuries in yard play areas contiguous with parking, one death in our written report resulted from a vehicle. Nigh homes with yard play areas accept smooth surfaces continuous with parking areas, oft opening into a street. Hence, risk for infants in quickly moving BWs is potentially high. In New Zealand fewer child injuries past family vehicles occurred with barriers between home play areas and parking (Roberts et al. 1995).

Anatomical site of injury

Among UAE children with BW injuries taken to ER, the head was the most frequent anatomical location of injury, xx % of the total including unknowns. Level of energy transfer to a child's trunk in falls is determined past distance fallen and free energy-absorbing chapters of the impacted surface (Smith et al. 1997). The number of steps fallen in a BW is associated with infirmary admission and head injury such equally skull fracture (Smith et al. 1997; Al-Nouri and Al-Isami 2006). While many injuries are minor, concussion, intracranial haemorrhage, and fractures of the skull and cervical spine do occur with stair falls (Al-Nouri and Al-Isami 2006; Health Canada 2007; American University of Pediatrics 2001; Taylor 2002). Elsewhere, in Iraq 94 % of 83 children using BWs sustained one or more injuries (n = 148) between 6–10 months of age; with 82 % involving the caput (Al-Nouri and Al-Isami 2006). Amid U.s. emergency room BW injuries, 91 % involved the head and 62 % of fractures the skull (Shields and Smith 2006; Casell et al. 1997). In Sweden, BWs were the childcare product nearly frequently associated with concussion or "balmy" traumatic brain injury for the entire 0–4-year-old population in 1998–99 (Emanuelson 2003).

Limitations of study population

Although inquiry was confined to final year classes, duplicate reporting by siblings or other relatives could take occurred, and sampling was cluster-based at the level of class. However, student respondents provided the optimal possibility for a population-based sample representative of all prospective future Arab mothers in the study urban center. Furthermore, once students leave home for matrimony, work, or advanced study, their exposure to and awareness of babe injuries in the family dwelling would decline. In non-school populations, 100 % response is unusual; even so, 98–100 % response is frequent in our medical student school surveys. High schoolhouse students are enthused to meet medical students and enjoy a break from school routines.

Many Emirati and other Arab mothers are nowadays highly educated and work, with childcare provided past departer housemaids. Older siblings are frequently delegated by parents to keep an eye on younger children and care by housemaids. Siblings can be more than aware of incidents than parents since paid caregivers may fright reporting incidents. In local Islamic cultural contexts, home surveys of women are challenging and it can too be difficult to obtain not-biased samples of mothers in other settings. Finally, large sample sizes are necessary to detect sufficient uncommon fatal or disabling incidents, which would not exist viable if studies involved interviewing individual mothers, some with only a single child.

Population surveys are useful for estimating injury frequency. Victims or their families are allowed to speak for themselves when the health system is unable to do so (Fingerhut and McLoughlin 2001). For BWs, lack of a specific ICD-10 code for such product-related injuries complicates cess of brunt of injury. BW injuries may be counted nether falls, motor vehicle injuries, immersions, or other external cause codes (Earth Health Organization 2007a).

Limitations of think menses

Our grade-12 potential rather than actual mothers had long recall periods for all BW injuries during their childhood and youth. Less severe incidents could have been forgotten, leading to recall bias with underreporting or misreporting of frequency, nature, severity, and external causes of non-fatal and non-disabling injuries, so-chosen loss of memory (Harel et al. 1994) or memory decay (Mock et al. 1999; Moshiro et al. 2005). Alternatively, recall bias tin lead to reporting of incidents outside the recollect period, known as telescoping; however, this seems unlikely in the current context.

Loss of memory reportedly is minimal for "severe injuries", defined in the US as "injuries resulting in at least i bed day, 1 schoolhouse loss 24-hour interval, surgery, or hospitalization" (Harel et al. 1994). The frequency per BW user of our three more severe categories, deaths, disabilities, and hospitalizations, should exist if anything bourgeois if undercounting occurred. ER visits, injuries, and incidents could exist expected to be undercounted, with study data representing lower limits in a sensitivity analysis based on scaled retrieve assumptions. This could explain ER visit and decease ratios betwixt UAE and the The states of 5 and 55 respectively. Reporting practices and employ of ER versus clinics and definitions of severity tin differ among countries. In Greece, to classify injuries every bit "major" required only contact with a health institution (Petridou et al. 2004).

Although reports validating recall periods greater than a year for injury are uncommon, fatal injury in a BW would not more often than not be forgotten in a lifetime, and indeed iii students with loss of a sibling began crying during the questionnaire. A child with permanent disability would be a daily reminder of BW injury even decades before. Elsewhere, reported trauma deaths were highly accurate (Claude et al. 1984; Snow et al. 1992; Snowfall et al. 1993), and call up by relatives of a family member'due south death was unaffected past recall period (Claude et al. 1984). In evaluating maternal remember of child deaths from all causes in Bangladesh, no departure was found between i and v years post-incident (Halder et al. 2009).

Other potential limitations

Since some families move, bodily built environments for some BW injuries may have differed from reported. Withal, families do not relocate often equally in some countries and due to regime subsidies many citizens build homes in their community shortly after spousal relationship. Some are assigned a house or apartment elsewhere by employers but return home to families on weekends. For expatriates, information technology is non easy to relocate or change employers or housing due to piece of work permit requirements, rules on switching employers, and the fact that houses are generally assigned for the elapsing of work contracts. Nonetheless, research was conducted in i of four master UAE cities and the situation could differ elsewhere. Abu Dhabi and Dubai accept more high-rise apartments and mayhap less exposure to stairs, pools, and play areas contiguous with parking, than Al Ain, where near buildings greater than four storeys have been prohibited for aesthetics.

Our incidence data were based upon an estimated exposure denominator of six months per babe, similar to enquiry elsewhere. However, if exposure were doubled to 12 months per infant, unlikely considering when an boilerplate baby stands and walks, then sensitivity analysis would halve adventure to one death per 2000 users, 1 disability per 400, ane hospitalization per 110, 1 ER visit per xl, and 1 injury per 8.

Another exposure issue is the number of hours per mean solar day infants are left in a walker. There could exist major differences among families and even among siblings and we are not aware of studies documenting this and our survey could not have readily addressed it.

With no published data on ER visits, hospitalizations, and deaths from BWs in the UAE, validation of student retrieve was challenging. However, information from a subsequent intervention for BW injuries amid new mothers back up injury frequency and severity in this study and indirectly students as rapporteurs of BW injury of siblings. Among 339 respondents, pre-intervention information for equally far back every bit could be recalled found 259 children injured, 57 taken to ER, 13 hospitalized, 15 left disabled, and 0 deaths. During a single mail-intervention twelvemonth, 110 available respondents reported 9 children treated for BW injury at main health care centres, 17 in ER, 3 hospitalizations, 1 disability, and 2 deaths. This suggests that in environments with hard access, interview, and prospective follow-up of sufficient mothers, interview of high-schoolhouse girls using long remember periods is a valid option to judge incidence of severe BW injuries.

Decision

BW injuries are serious contributors to UAE infant mortality and morbidity. High incidence and severity are due to loftier prevalence of BWs, built environment hazards, and other factors. These are a issue of a lack of product safe regulations to ban BWs. Other cities in the UAE and countries elsewhere besides merit study of variables such every bit prevalence of BWs, exposure to stairs and differences in floor levels, besides every bit automatically closing and latching kid barriers between play areas and pools, family parking, and streets.

In an before paper associated with this study (Grivna et al. 2015), nosotros reported on why families used BWs and perceptions regarding causes of injuries. 84 % reported that BWs are used to keep babies safe and 92 % to aid them walk earlier. lxx % attributed BW injuries to carelessness of parents, 43 % carelessness of babe, 42 % fate or destiny, 14 % evil heart, and 3 % jinns. In contrast, but 16 % perceived the BW and twoscore % dangerous environments as causal.

Clearly, in the brusque term, active protection by health promotion is warranted to right misperceptions almost safety and efficacy of BWs and causality of incidents and injuries. Until countries have been cleared of BWs, families demand frequent warnings to avoid and dispose of them (Emanuelson 2003). Concurrently, automatically endmost and latching childproof barriers should be mandatory to separate play areas from stairs, pools, and vehicles, and fifty-fifty helmets might be considered if stairs are easily accessible in a home. However, since such measures require repeated intervention at household and sales levels, none are adequate substitutes for legislation blocking import and sales. Supervision by parents, older siblings or others cannot exist relied upon, since an baby in a BW can move at 90cm/s (3ft/south), so there is frequently not fourth dimension to react (American Academy of Pediatrics 2001). Supporting this are reports that many incidents occur with parents in the room (American University of Pediatrics 2001; The states Consumer Production Safety Commission 1994; Millar et al. 1975).

Since a substantial proportion of BW injuries result from access to hazards other than stairways, stationary play centres are considered safer, more comprehensive, and more practical alternatives for caregivers than mobile BWs designed non to roll downwards a stairway (Thompson 2002). Modified mobile devices as well large to pass through a standard door and with brakes were a compromise solution adopted in the USA, and provide incomplete protection compared to banning all BWs. It is a voluntary standard and compliance has been limited (American Academy of Pediatrics 2001). Furthermore, such devices do not change the negative touch of BWs on physical development of infants, especially the risks for infants with neuromuscular disorders. Infants in mobile BWs can still achieve unsafe items such as poisons, hot objects, and knives, while burns have been frequent in some studies (Ozanne-Smith and Brumen 1993; Liao and Rossignol 2000; Martin 2003).

To provide long lasting passive or automatic protection, governments worldwide, including the Centre Due east, should review the good testimony and prove given to the Canadian regime'southward Board of Review and results of on-going surveillance (Public Health Agency of Canada 2009), and prohibit BW imports and sales. An initial voluntary industry ban was constructive in Canada while regulations were implemented. A ban on industry and sales is supported by the American Academy of Pediatrics (2001). In the UAE, if there are no manufacturers, then a ban could be focused mainly on importation and sales. While diligent enforcement is essential, this is required for all hazardous toys and should not excuse inaction. The BW issue deserves urgent add-on to priority lists for advising governments on injury interventions (World Health Organisation 2007b) of the Division of Injuries and Violence at the Globe Health Arrangement and for the agenda of the European Commission'due south Advisers Full general for "Health and Consumers".

Lobbying by relevant national groups can be key to encouraging governments to human action. In Canada, the Canadian Paediatric Society'south Injury Prevention Committee led a long term bear witness-based campaign. In the UAE, paediatric and other medical and health societies could place and collaborate with various condom oriented groups such as health authorities, Cherry Crescent, and other organizations.

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Acknowledgements

Cheers to Al Ain school district students, teachers, principals, and administrators for helping with the survey, Hussein Al Agab for technical back up, Dr Mohamed El-Sadig for authoritative arrangements and support, Dr Chris Frampton for statistical support of students during their projection, and Terri Everest, English lecturer for review of the document.

Funding

The authors received no fiscal support for the research, authorship, and publication of this commodity.

Authors' contributions

AH, AD, FK and SM (final-yr medical students) adult the idea and PB and MG helped with methods during a Customs Medicine field inquiry project. Lead and MG worked with the medical student researchers to better and adapt a questionnaire. MG provided overall supervision of the group. AH, AD, FK and SM entered and analysed their team's data, and prepared a study, which was helpful in preparing the final newspaper. MG and PB did farther statistical analysis. Pb and MG prepared the final draft of the paper. All authors read and approved the concluding manuscript.

Competing interests

The authors declare that they have no competing interests.

Ideals blessing and consent to participate

Ethical approval was obtained from the UAE University Faculty of Medicine & Health Sciences Research Ideals Committee. Approval for conducting the study at schools was obtained from the Ministry of Education. Participation was voluntary and questionnaires anonymous.

Author information

Affiliations

1. Schoolhouse of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

   Peter Barss

2. Institute of Public Wellness, College of Medicine & Health Sciences, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates

   Michal Grivna, Amna Al-Hanaee, Ayesha Al-Dhahab, Fatima Al-Kaabi & Shamma Al-Muhairi

Corresponding author

Correspondence to Michal Grivna.

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Barss, P., Grivna, M., Al-Hanaee, A. et al. Baby walker injury, disability, and expiry in a loftier-income eye eastern country, every bit reported past siblings. Inj. Epidemiol. 3, 17 (2016). https://doi.org/10.1186/s40621-016-0082-vii

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• Received: 08 April 2016

• Accustomed: 06 July 2016

• Published: 12 July 2016

• DOI : https://doi.org/ten.1186/s40621-016-0082-vii

Keywords

• Babywalker
• Baby walker
• Baby walker
• Child injury
• Disability
• Bloodshed
• Falls
• Epidemiology
• Prevention

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