CI Kuok, WKY Chan

Dear Editor,

Paediatric trauma is a major public health concern, which leads to significant mortalities and morbidities globally. Among these, unintentional fall injuries, especially in domestic settings, constituted a major burden in this locality.^{1, 2} In particular, accidental fall from home, which mostly occurs in the toddler group, often leads to grievous outcome to the child, and guilt in the family. Over the past eight years, we managed four patients (age range: 2.5 to 4.5 years old) who had sustained injuries due to unintentional fall from home in our paediatric intensive care unit, which resulted in two deaths. All patients were from ethnic minority families, which included three Nepalese and one Indonesian.

The observed preponderance in ethnic minority in our experience may partly be explained by the geographical location of our centre. Nearly one-tenth of ethnic minorities resides in the Yau Tsim Mong district, which shares the largest proportion among the 18 District Council districts in Hong Kong.³ Besides, around 60% of Nepalese lives in Kowloon,³ which is mostly within the catchment area of our hospital under the trauma system.

Nonetheless, the phenomenon should not be ascribed solely to that. Other contributing factors should be sought to prevent the future occurrence of the tragedies, especially in some underprivileged families. A survey conducted by Against Child Abuse in 2012 revealed that 37.3% of the ethnic minority families had previously left their children unattended, with a duration more than eight hours in around 20% of these, highlighting the lack of vigilance in child protection.⁴ Currently, parental education on home safety is conducted in multiple platforms, such as in Mother

& Child Health Centres, schools and community centres. However, factors like education level and language barrier may impede the dissemination of information to the target audience. Furthermore, working parents, inadequate social support, suboptimal home environments, among others, are some more predisposing factors for childhood injuries in this population. There is a pressing need to proactively reach out to these ethnic minority families, to understand their concerns and connect them with community and welfare services, and to empower the families in injury prevention and child protection. Prompt action is needed to mitigate the threat to these vulnerable children.

References

1. Hon KL, Leung TF, Cheung KL, et al. Severe childhood injuries and poisoning in a densely populated city: where do they occur and what type? J Crit Care 2010;25:175.e7-12.

2. Kuok CI, Chan WKY, Kwok AWL. What and who should we focus in pediatric injury prevention - An analysis of critical pediatric trauma in a major trauma center in Hong Kong. Pediatr Neonatol 2021;62:620-7.

3. Census and Statistics Department, Hong Kong SAR. 2016 Population By-census - Thematic Report: Ethnic Minorities. Available from https://www.statistics.gov.hk/pub/B11201002016XXXXB0100.pdf. Accessed 3 Oct 2021.

4. "Creating Harmony for Families of Ethnic Minorities" - Enhancing Parent-child Relationship and Social Integration with Local Community [press release]. Against Child Abuse, 2012. Available from https://www.aca.org.hk/top-a/press-news/20120317-CreatHarmonyEthnicMinorities-eng.pdf. Accessed 3 Oct 2021.