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ORIGINAL ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 1  |  Page : 39-43  

Prevalence and pattern of childhood injuries in Siliguri City, West Bengal, India


1 Divisional Medical Officer, NJP Railway Hospital, Coochbehar, West Bengal, India
2 Professor and Head, Department of Community Medicine, Coochbehar Government Medical College and Hospital, Coochbehar, West Bengal, India
3 Associate Professor, Department of Community Medicine, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India
4 Professor and Head, Department of Community Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
5 Specialist Medical Officer, Birpara State General Hospital, Alipurduar, West Bengal, India

Date of Submission08-Nov-2018
Date of Decision03-May-2019
Date of Acceptance27-Jan-2020
Date of Web Publication16-Mar-2020

Correspondence Address:
Romy Biswas
Department of Community Medicine, Coochbehar Government Medical College and Hospital, Coochbehar, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_401_18

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   Abstract 


Background: Children are vulnerable to injuries, and childhood injury is a complex phenomenon precipitated by a set of factors. In India, the magnitude and nature of childhood injury are not clearly known owing to the absence of a proper injury surveillance system. However, in recent days few studies demonstrated a substantially high burden of childhood injury. Objectives: To find out the prevalence, pattern, and the factors associated with injury among children of 0–14 years in the Siliguri city of West Bengal. Methods: A cross-sectional study was conducted among 780 children aged 0–14 years residing in the Siliguri Municipal Corporation area selected through cluster sampling technique (30 clusters [wards] with a cluster size of 26). Relevant data were collected by interviewing the mothers of children as respondents and was analyzed using SPSS software, binary logistic regression was applied to test the association between injury and other risk factors. Results: Of total 780 children, 165 had reported a total of 220 injury events with an overall period prevalence of 21.2% and a mean of 0.28 injury events per child. Majority of injuries were superficial in nature (53.2%); due to fall (56.4%), extremities were mostly involved (62.3%), and 12.8% cases were moderate-to-severe grade. Under-five children were most vulnerable. Injury was significantly related to socioeconomic status, presence of siblings, outdoor activities, and the presence of supervising person during travelling. Conclusions: Childhood injury is still highly prevalent in the area with its unique pattern and few preventable risk factors requiring a multifaceted comprehensive approach.

Keywords: Childhood injury, pattern of injury, prevalence, risk factors


How to cite this article:
Basak M, Biswas R, Bhattacherjee S, Das DK, Mitra S. Prevalence and pattern of childhood injuries in Siliguri City, West Bengal, India. Indian J Public Health 2020;64:39-43

How to cite this URL:
Basak M, Biswas R, Bhattacherjee S, Das DK, Mitra S. Prevalence and pattern of childhood injuries in Siliguri City, West Bengal, India. Indian J Public Health [serial online] 2020 [cited 2020 Dec 1];64:39-43. Available from: https://www.ijph.in/text.asp?2020/64/1/39/280776




   Introduction Top


Globally, childhood injuries have been documented as a major noncommunicable epidemic in this era of technological development, demographic transition, and modernization.[1] An emerging trend is observed in childhood mortality and morbidity related to injury in Asia.[2] After infancy, that proportion rises with increasing age to replace infectious diseases.[2],[3] Injuries share 13% of the total burden of morbidity among children ≤15 years of age in low-and middle-income countries, and the fatality is 3.4 times higher than in high-income countries.[1],[4] Global school-based student health survey reported 42% annual incidence of injuries among school adolescents in four Southeast Asian countries.[5]

An injury is a bodily lesion, resulting from acute exposure to energy such as mechanical, thermal, electrical, chemical, or radiant in amounts and rates that exceed the threshold of physiological tolerance.[6] Children are vulnerable to injuries which are vastly unintentional. Road traffic accidents, falls, poisoning, burns, and drowning are common unintentional or accidental injury.[4] A small proportion also attributes to abuse or interpersonal injuries. Besides geographical differences, cause and types of injuries also differ by age and gender.[1],[4]

Paucity of accurate information on childhood injury regarding prevalence, cause, type, and the outcome has thwarted their recognition in India. However, few hospital and population-based studies with a widely varying figures demonstrated a substantially high burden of childhood injury in recent days. A national review stated that overall 20%–25% of hospital admission with 8.2% case fatality rates were due to injuries among children in India.[7]

The lack of adequate evidence and understanding about the problem and poor injury surveillance are the challenges for tangible reductions in injury rates in our country. Many injuries are also epidemiologically linked to various social, environmental, cultural, and biological factors. Hence, studies contributing toward the magnitude of the problem, understanding of relationships of risk factors with the events, and the outcomes of childhood injury is crucial for developing the intervention, allocating resources for control, and reducing the burden of injuries in the coming years. Under this perspective, this community-based study was conducted with the objectives to find out the prevalence, pattern, and risk factors of injury among children of 0–14 years in Siliguricity, West Bengal.


   Materials and Methods Top


This was a descriptive cross-sectional study conducted over 1 year period (May 2016–April 2017) among children aged 0–14 years old residing in the Siliguri Municipal Corporation (SMC) area. SMC is the heart of Siliguri urban agglomeration comprising 47 wards of Darjeeling and Jalpaiguri district situated in the northern part of West Bengal. This city is not only of vital importance to West Bengal, it is also the gateway to the whole of Northeast India.

The sample size was determined considering the assumed prevalence of injury as 50% to get the maximum sample size with 95% of confidence level, 5% absolute precision, and a design effect of two for cluster sampling design. Thus, the minimum required sample was 768.

Based on the principle of population proportion to size, 30 wards among 47 wards were selected as clusters. An equal number of study participants were recruited from each cluster, i e., 26 children (cluster size); thus, the final sample size was 780 children. A list of households with eligible children in each identified cluster (ward) was prepared. Twenty-six from each household only one eligible child was chosen(randomly from households with more than one child).

Data were collected by home visit taking prior consent from the participants informed. The mothers of the children were the respondents for data collection and were interviewed through a semi-structured schedule, which sought information on the sociodemographic and injury-related variables. “Injury” was operationally defined as any kind of damage to any part of the body following sudden exposure to any physical or chemical impact. The injury classification and codes were taken from the World Health Organization injury surveillance guidelines.[6] Injury events occurring during a reference period of the past 1 month before interview were only considered to minimize recall bias.

Data were analyzed by IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp). Binary logistic regression analysis was used to test the association between injury and related factors. P < 0.05 were considered statistically significant. The predictor variables used for the analysis were gender, age <5 years, socioeconomic status, working mother, and outdoor activity. Ethical approval was obtained from the Institutional Ethics Committee of North Bengal Medical College.


   Results Top


Background characteristics

Of 780 study children, 52.3% were girls; 65.1% were >5 years of age, with the mean age of 6.7 ± 4.1 years; 42.3% had at least one sibling, and 33.8% belonged to the lower socioeconomic class. Most of the children (64.4%) were accompanied while traveing, and 56.4% of children were involved in outdoor activities such as play, sports, or recreational activities [Table 1].
Table 1: Prevalence and risk factors of injury among the study participants (n=780)

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Pattern and profile of injury

[Table 2] describes the profile of 220 injury events encountered by the study of children. The extremities were the most common site (62.3%) of the injury events, followed by head-and-neck involvement (31.8%). A large majority of injury occurred due to fall (56.4%) and hit by objects (27.7%). More than half of the injury events (53.2%) were superficial in nature followed by open/cut injury (34.5%), sprain, and fracture (6.8%). The 80% of injuries occurred during daytime; majority events took place at home and school (68.6%) and while playing and sports (8.6%). Among the 220 injury events, 12.8% cases were moderate-to-severe grade requiring professional intervention such as surgery, plaster of paris casting, and/or hospitalization with school days loss following 15.5% of events. The mean days of school absenteeism were 4.65 ± 3.2.
Table 2: Pattern of childhood injury among study population (n=220)

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Prevalence of injury and risk factors

Of a total of 780 children, 165 reported a total of 220 injury events during the reference period of the past 1 month. The study revealed an overall period prevalence of childhood injury as 21.2% (165/780) and a mean of 0.28 (220/780) injury events per child. Further analysis showed, among 165 children with injury, 119 (72.1%) had a single injury event, and the rest 46 (27.9%) had multiple injury events.

The risk of injury was higher among those who were not accompanied by adults during travelling (AOR 2.23,95%CI). Children who did not have any outdoor activities had less, injuries (AOR 1.76, 95% CI) and whose mothers were working had more injuries (AOR 1.06, 95% CI). The occurrence of injury was not related to the gender of the child or age as depicted in [Table 1]. After controlling for the predictors, the model explained between 5.4% (Cox and Snell R2) and 8.4% (Nagelkerke R2) of the variance of injury in the studyparticipants. Although there was a good fit of the model as evident from nonsignificant P value (0.417) from Hosmer and Lemeshow statistic, the contribution of the independent variables was not significant when adjusted with other variables.


   Discussion Top


Childhood injury is a major killer of children throughout the world, responsible for about 950 000 deaths in children and young people under the age of 18 years each year, 90% of which are unintentional.[1]

Prevalence of injury

The present community-based study revealed a substantially high prevalence of childhood injury as 21.2% which was very similar to what had been reported by Mahalakshmy et al.[8] in Pudduchery. A study by Hemalatha and Prabhakar Reported a 12.9% prevalence of unintentional childhood injuries among the rural population of Tamil Nadu.[9] However, widely variable prevalence, both much higher and lower than the present study, was reported by other researchers as 58.9%, 11%, 15.6%, 30.7%, and 6.3% in different studies.[10],[11],[12],[13],[14]

In this study, the risk of injury was more among under-five children, may be due to their increasing restlessness, inquisitive nature, and inability to anticipate the danger. Studies in Puduchery[8] and China[12] revealed similar findings, whereas studies in Aligarh,[11] Delhi[15] found 6–12 years old were more vulnerable to injury than preschooler. The developmental stage of the child partially determines the type of injuries that are most likely to occur at a specific age. The toddler with the highest curiosity to explore, investigate, and with the ability to run and walk are more prone to variety of injuries such as burns and scalds.

In the present study, the gender of the child was not found to be related with occurrence of injury differed from previous studies.[8],[13],[16] Evidence suggests that across all ages, males engage in more behavior that exposes them to the risk of injury, and thus experience more injuries compared to females.[17],[18] As a generalization, females spend much more time at home and do not go outside the home with the same frequency as males, which may account for the lower prevalence of injuries in them.

Pattern of injury

The superficial injuries were the most common variety in the present study as was also reported by other studies[11],[19] but Ray et al.[10] and Nirgude et al.[13] found an open wound as the most common. Nath and Nai[19] demonstrated abrasions accounted for majority of the injuries (72.6%), followed by cuts and lacerated wounds (11.8%), avulsions (6.6%), contusions (4.4%), burns (3.8%), and bite wounds (0.8%) in rural South India.

This study revealed that the extremities were the most common site of the injury, followed by head-and-neck (31.8%) involvement and findings were similar with other studies.[10],[16] In contrast, a study in Delhi[14] revealed head-and-neck injury followed by extremities as major sites of injury for admission. Whereas, Zaidi et al. in Aligarh[11] found extremities and head-neck having almost equal involvement. According to the world report 2008, the head injuries are the most common type of injury. The causes of injury were observed to be fairly constant in various studies[3],[10],[12],[15],[16] with a preponderance to falls, and this also corroborates with the present study. The children spend maximum time at their home. Home and school are ideally should be the safest place for children because of direct supervision by guardians and teachers, but the findings of the present and various studies worldwide[8],[12],[20],[21] consistent about that the injury was more common at home and its surrounding areas. This implies that safety precautions at home and school play a vital role in the causation of injury, which has so far been ignored.

Global childhood unintentional injury surveillance[4],(2009) reported that most of the time injuries occurred during play and sports. The findings of the present study emphasize the need for full-time supervision by an adult, because 59.5% injury occurred in the absence of supervising person, as also earlier reported in West Bengal by Ray et al.and in Pakistan by Lasi et al.[21] Although a study in Damascus[20] noted the majority of the child had a companion at the time of injury.

We found 12.8% of children had moderate-to-severe injury requiring interventions; whereas Zaidi et al.[11] in Aligarh stated 10.2% as major injury which restricted activity of the children >30 days. In the present study, 15.5% injury events accounted for school absenteeism (mean 4.65 ± 3.2 days) in contrast to a study in Pakistan[21] (53.4%) with mean absenteeism of 9 ± 10 days.

Poor living conditions, overcrowding were the likely causes of injury events in poor people. The present study also revealed that children having siblings were more vulnerable to injury, and this was concordant with other studies;[10],[14],[16] indicating more number of children in a family as an associated factor for childhood injury.

Working status of mothers had a significant association with the occurrence of childhood injury, but older mothers had reduced risk of injury than younger. Studies by Shriyan et al. In Karnataka[16] and Bashour and Kharouf in Damascus[20] had observed that childhood injury neither had any corelation with age and working status of the mother.

Societal influences on parents have been cited as important drivers of changes in children's outdoor play opportunities. Increased societal concerns about child safety have heightened parental concerns, especially with regard to traffic dangers and child abduction by strangers. Guardians provide as much protection as possible—potentially more as they personally perceive necessary. There is evidence to support concerns that the absence of opportunities for outdoor risky play will result in children disengaging from physical activity.[22] The prevalence of injury was derived based on self-reported injury data. Some of the events perceived to be minor by the caregiver, and as such, medical care might not have been sought after following the occurrence of injuries. Hence, the extent and nature reported by the caregivers could be an underestimation which was the limitation.


   Conclusions Top


The present study highlighted the epidemiological features of childhood injuries in an urban area, with still a considerable high overall prevalence and few associated risk factors which could be addressed. There is a clear need for public health educational programs for parents regarding the prevention of unintentional injuries in children, including safety measures and education of the children and parents for the prevention of childhood injuries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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