|Year : 2018 | Volume
| Issue : 1 | Page : 4-9
An epidemiological study on home injuries among children of 0–14 years in South Delhi
N Bhuvaneswari1, JG Prasuna2, MK Goel3, SK Rasania4
1 Junior Resident, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
2 Director Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
3 Associate Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
4 Director Professor and Head, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
|Date of Web Publication||6-Mar-2018|
Dr. N Bhuvaneswari
Department of Community Medicine, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Injuries are an important public health problem worldwide, accounting for 5 million deaths, of which unintentional injuries account for 0.8 million deaths in children. Though there are many factors responsible for injury in the home, the environment plays an important role. Objectives: The objectives were to study the magnitude and pattern of home injuries in children aged 0–14 years and to assess the environmental risk associated with home injuries. Methods: A community-based, cross-sectional study was conducted in 2015 in a ward of Mehrauli containing 20,800 households, and the total sample of children was selected from 400 households by systematic random sampling, with sampling interval being 52. Information was taken using a predesigned, semi-structured, pretested proforma from both the parents and children. The data collected were analyzed using SPSS version 12. Results: The prevalence of home injury was found to be 39.7% in the last 1 year, significantly higher in the age group of 1–3 years (54.3%) followed by 5–10 years (45.1%) (P = 0.000). The total number of injuries and the average number of injuries in girls were significantly higher than those of boys. The most common type of home injury was falls (59.5%) followed by injury with sharps and burn injury. The environmental risk was assessed using standard and working definitions and found unsafe electrical points (95.3%), unsafe stairs (100%), unsafe kitchen with access to sharps (29.3%), access to active fire (19.3%), and unsafe furniture and objects (22.8%). Conclusion: Though home injury did not occur in 60% of the children during the study period, the risk of injury in the future is high. Educating the parents and the children at schools and environmental modification are important strategies for prevention of home injury.
Keywords: Child, environment, home, injury
|How to cite this article:|
Bhuvaneswari N, Prasuna J G, Goel M K, Rasania S K. An epidemiological study on home injuries among children of 0–14 years in South Delhi. Indian J Public Health 2018;62:4-9
|How to cite this URL:|
Bhuvaneswari N, Prasuna J G, Goel M K, Rasania S K. An epidemiological study on home injuries among children of 0–14 years in South Delhi. Indian J Public Health [serial online] 2018 [cited 2018 Oct 18];62:4-9. Available from: http://www.ijph.in/text.asp?2018/62/1/4/226627
| Introduction|| |
Injuries are an important public health problem in the world, causing 5 million deaths every year. Among those, unintentional injury accounts for nearly 80% of the injury deaths (3.9 million deaths) (WHO Global Burden of Disease 2004).
Nearly 1/4th of the total unintentional injury deaths (0.8 million) occurred in children aged ≤18 years, mostly in the low- and middle-income countries.,
It is seen that most of the childhood unintentional injuries take place in and around the home as children spend most of their time at home. The type, the cause, and the outcome of injury vary within populations and across countries. Though everyone is at risk of injuries, children are more susceptible because of their age, gender, curiosity, and risk-taking behavior.
The hazards responsible for injuries at home include unsafe building designs (stairs and windows without safety grills), unsafe furnishings, unsafe packaging and storage of toxic materials (access to poisonous substances and pesticides and medicines), open water containers, and unsafe kitchen (access to stoves and knives). Home injuries are underreported and have not been recognized to the same extent as road traffic injuries. The present study was done to study the profile of home injuries and assess the environmental risk associated with home injuries.
| Materials and Methods|| |
This was a community-based, cross-sectional study.
The study was carried out in the field practice area, Mehrauli, Delhi, India.
The study was conducted from January 1 to December 31, 2015.
The study population comprised of children aged 0–14 years, of both sexes residing in the area.
The sample size was calculated using the formula: n = 4pq/l2, where n = 4 × 15 × 85/16 = 5100/16 = 318, design effect = 1.25 (as systematic random sampling was used), total sample size = 1.25 × 318 = 397 ~400, the prevalence P = 15% and q = 85%, (100−p), allowable error (l) =4%, confidence interval: 95%, power: 80%.
Hence, the sample size was calculated to be 400.
There are eight wards in Mehrauli area with 94,475 households. One ward (ward 2) having 20,800 households was selected by lottery method considering the feasibility of the study. The sample number of children was selected by visiting 400 households using systematic random sampling, the sampling interval being 52. Sampling unit was household and study units were children aged 0–14 completed years in the selected houses.
Ethical clearance was obtained from the Institutional Ethical Committee. A house-to-house survey was conducted in the 400 households and the population surveyed was 2024, of which 622 (32.5%) were children of 0–14 years. When there was more than one child in a household, all were included in the study. Both the parents (mother/father/caretaker) and the child (wherever possible) were interviewed after taking written informed consent from the parents and assent from the children. Information was taken using a predesigned, semi-structured pro forma which was pretested in 10% of the sample in another location.
History of home injury (only unintentional) or death of any child in the family following injury in the last 1 year was taken to include all major childhood injuries/hospitalizations/deaths.
Intentional injuries and road traffic injuries were excluded. The following locations were examined and observed for risk area assessment in the home environment of the child using working and standard definition [Table 1].
The primary outcome was the proportion of children with home injuries and type of home injuries.
The secondary outcome included environmental risk factors for injuries as follows: living area, overcrowding, kitchen, bathroom, stairs, pets and stray animals, electric circuits, and drain.
Information collected in the pro forma was coded and entered in Stastistical package for the Social Sciences (SPSS Inc. SPSS for Windows, Version 12.0. Chicago). The qualitative variables were expressed in proportion and quantitative variables were summarized by mean and standard deviation. The difference in proportion was analyzed by applying Chi-square test and Fisher’s exact test and P < 0.05 was taken as the cutoff for commenting statistically significant association. The difference in mean was analyzed statistically by applying unpaired Student’s t-test and P < 0.05 was taken as the cutoff for commenting statistically significant association.
| Results|| |
[Table 2] shows that out of the 622 children of 0–14 years studied, 53.7% were male and 46.3% were female. The highest proportion of the study participants belonged to the age group of 5–10 years (40.7%) followed by <5 years (35.8%) and 10–14 years (23.5%) (not shown in table). Nearly 40% had suffered injury in the last 1 year, with the highest proportion of children injured in the age group of 1–3 years (54.3%) followed by 5–10 years (45.1%), which was statistically significant (P = 0.000). The average number of injuries among female children was significantly (P = 0.026) higher than male children and so is the total number of injuries in both the groups (P = 0.025).
|Table 2: Magnitude of home injury in children according to age and sex (n=622)|
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[Table 3] shows that the most common injury was falls followed by injury with sharps, burns/scalds, animal bite/human bite, and other injury (crush injury, foreign body ingestion, and injury with heavy objects). The most common injury in both groups was falls with 63.4% and 56%, respectively. The order of type of injuries was found to be significantly different in both the groups (P = 0.004).
The most common place of home injury was inside home for both sexes and the most common place inside home was in the living room (53.6%), followed by stairs (20.1%). The most common place of injury outside home was play area (67.8%), followed by compound/courtyard (32.2%). Most of the injuries occurred in summer (129 [42.9%]) followed by winter (100 [33.3%]), and monsoon and postmonsoon (72 [23.9%]) (not shown in table).
[Table 4] shows that the majority of the households had unsafe electric points (95.3%), and in nearly half, overcrowding was seen. Majority (98%) of them used liquefied petroleum gas and electric stove (2%) as a source of fuel for cooking (not shown in table). Majority, i.e., 79.5% used electric rod, 8.5% used electric heater, 6.5% used firewood, and 5.5% used stove as water warming system (not shown in table). Majority, i.e.,69.8% of the households had wooden doors and 30.2% had iron doors and 61.8% of the households did not have the height and width as per recommendations. Stairs were present in 80.8% of the households, and all the stairs were not safe as they were either steep or narrow and did not have width and height as per the recommended measures. Ninety percentage of the balconies were not appropriate as they did not have the recommended height of parapet wall. Terrace was not safe in 15.1% of the households as injury-causing items were present. Presence of stairs, balcony, and terrace was considered unsafe.
|Table 4: Risk profile of home environment of children (domestic) (n=400)|
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[Table 5] shows that there was a significant association of falls and slippery floor (P = 0.002), injury with sharps and access to sharps (P = 0.000), burns/scalds with unsafe kitchen (P = 0.000), and access to fuel (P = 0.007).
| Discussion|| |
Every day around the world, more than 2000 families are suffering by the loss of a child to an unintentional injury or the so-called “accident” that could have been prevented. Child injuries have been neglected for many years and are largely absent from child survival initiatives presently on the global agenda. In this study, male children were more than female children, which is similar to other studies.,, The highest proportion of children was in the age group of 5–10 years (40.7%), which was similar to other studies., In this study, the magnitude of injury in children was 40%. In a study done in periurban area, the magnitude was 64.4%, and in a study done in rural area, it was 13%, showing varying prevalence in different parts of the country. The reason may be because the measurement of magnitude is different in most of the studies. In the present study, females were injured more than males, a similar finding in other studies.,,, This could be due to the amount of time the girl child spends at home in doing domestic work. In some studies,, males were injured more.
In this study, the most common age group injured was 1–3 years, followed by 5–10 years and similar findings were reported by other studies.,,,, This could be because the toddler starts walking during this period and is usually not aware of the risk of injury and the schoolgoing age group play actively and usually have a experimenting behavior.
In the present study, the most common injury found was falls, which is consistent with most of the other studies,,,,,,,,,, whereas in few studies,, cuts was the most common injury. The variations could be due to variation in sociodemographic and environmental differences of risk exposure.
In our study, the most common place of home injury was inside home compared to outside home, which was similar to other studies;, this could be because the children spend most of the time at home, whereas some studies,,, reported that the most common place of accident was outside home. Few studies, reported that accidents took place in the afternoon, which was similar to our study. Other studies,,, reported that most accidents took place in the morning hours. Some studies,,, reported that accidents were more in the winter and summer months, which was consistent with the findings of our study.
Our study reported unsafe home environment for children and a similar finding was reported in few studies.,,
Recommendations and way forward
From the observations made and considering the results and discussion of the present study, it was found that the environmental factors put the children at risk for injury at home. There are a number of interventions that can be done to tackle these problems. Policies and programs to reduce child injuries should incorporate several effective approaches including the following:
- Legislation requiring the use of protective equipment such as safe (closed) plug points and child-resistant containers (chemical/syrups/lotions)
- Modification of products such as (noninflammable) cooking stoves, lamps, furniture, and furnishings (e.g., with rails, cribs, and stairway railings), and baby walkers without wheels
- Environmental modification is an especially important strategy for home injuries. Improvements to the home include completion of house construction, appropriate staircases and windows, type of flooring – non slippery, locked cupboards for storage of hazardous materials (such as cleaning agents/tablets, medicines, and matches), separate kitchen away from the reach of children, sharp equipment out of the reach of children’s hands, and use of safe systems such as electric heater for warming water
- Health-promoting initiatives – Education, skills’ development, and behavioral change programs for children (at schools) and parents should be incorporated as one component of a multifaceted child injury prevention strategy. Health information systems should monitor child injuries as an indicator of child health at national and local levels. The findings of the study give an in-depth knowledge of the causes of the accidents. Thus, these findings will be helpful not only to the people of home management but also to the nongovernmental organizations, voluntary organizations, doctors, nurses, social workers, and common man to develop a proper understanding of the factors that will be helpful in preventing the accidents.
The study does not reflect the burden of injuries in the community as the study focused on unintentional home injuries alone. There could be underreporting of not severe or life-threatening episodes. The generalizability of the results could be compromised owing to the setting and a random selection of the ward. Injuries in the school and violence-related injuries could not have been elicited.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]