It is well know that risk of injury is influenced by factors such as temperament, personality, psychopathology, and cognitive development of the children, as well as by the quality and style of parenting supervision (11). Boys are more prone to risky behavior (especially boys without parents’ supervision) compared to girls and usually have a higher level of activity (12,13). So mortality due to external causes of death was twice as high for boys compared to girls (3, 14).
During the study period, mortality rate from external causes among children aged 1-14 years in Serbia dropped 3-5 times. Similar results were seen in the study by Kyu et al. (2018) when mortality rate from injury among children aged 5-14 years in WHO European Region dropped almost 3 times in 2016 compared to 1990 (7.5 vs. 22.5 per 100 000 children). There are some possible explanations for these decreasing trends (15).
Firstly, this decline may be the result of application of injury prevention policies and strategies around the world (3, 7) including national policies of European countries (16).
Secondly, children in Serbia (17), as in many other European countries (18), have a low level of physical activity (far below WHO recommendations), sedentary lifestyle, and spend most of their free time at home in front of TV or computer (19,20). It is also known that increased physical activity increases the possibility of injury and this actually may be the cause of the reduction of injury related deaths among children. Nevertheless, the promotion of the healthy lifestyle, including physical activity must be accompanied by education of children in ways of injury prevention (21).
For example, some authors report that the deaths of children as pedestrians is decreasing because children walk less often (22,23). Pedestrian injuries among children mostly occur when school children walk home from school unaccompanied by adults (24) or children running into the street outside a marked pedestrian crossing or running out into the street from unsecured playgrounds and yards during a game (25). In Europe and Serbia there is an increasing number of parents driving their children to school. Experience for EU countries shows that this is not good a solution for children. Walking or cycling to school will help the children to develop road safety skills and also improve their ability to anticipate other road users (26).
Road safety education of children is very important because traffic accidents are the leading cause of death in children in all age groups in our study, which is also true for many other countries (2,3,27).
In Europe, nearly half (48%) of all traffic accident related deaths in children aged 0 – 14 years were vehicle occupants, 30% were pedestrians, 13% cyclists while transport mod in case of 9% of child deaths on the roads were listed as other or unknown (26). We can assume that the number of children aged 1- 14 years dying as pedestrians (22.8%), and car occupants (14.7%) in Serbia is actually far greater than reported in our study, taking into account that the cause of death in more than half of the children (52.3%) dying in traffic accidents was listed as other or unknown. About 64% of all children deaths occur on urban roads in Serbia (26). Therefore, road infrastructure throughout the country needs to be improved.


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