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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 266-271

Safe home toolkit for under-five children: An intervention for prevention of domestic accidents


1 Department of Child Health Nursing, Kasturba Nursing College, Sevagram, Maharashtra, India
2 Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed To be University), Wardha, Maharashtra, India
3 Deparment of Child Health Nursing, SRMM College of Nursing, Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission27-Jan-2020
Date of Decision20-Feb-2020
Date of Acceptance15-Mar-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Prof. Usha Shende
Department of Child Health Nursing, Kasturba Nursing College, Sevagram, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_24_20

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  Abstract 


Background: Domestic accidents in and around home are a leading cause and preventable death of children under 5 years and are the major cause of ill health and serious disability. Creating awareness among parents of under-five children is a cost-effective strategy to prevent domestic accidents among children. Objectives: (1) The aim of this study is to assess the baseline knowledge and practices regarding the prevention of domestic accidents among parents of under-five children and (2) To evaluate the effectiveness of safe home toolkit among parents of under-five children. Research Design: Randomized control trial. Setting: Community setting in the Wardha district. Population: Parents of under-five children. Sample Size: The sample size was 20. Sampling: Simple Random Sampling. Materials and Methods: Demographic datasheet, Knowledge Questionnaire – developed by researcher and Standardized Home safety checklist. Intervention: Standard Safe home toolkit comprises Information handouts regarding home safety, which include Engineering measures, Environmental measures, Legislation, and standard. Education material and skills, Videos on home safety, and Safe home model demonstration. Results: The difference in means in pre-test and post-test of experimental group and posttest of the experimental and control group for knowledge and practices regarding the prevention of domestic accidents was statistically significant as P = 0.000 for all comparisons. Conclusion: Safe home toolkit for under-five children, the 2 day intervention for creating awareness regarding the prevention of domestic accidents, is found effective in improving the knowledge and practices of parents of under-five children.

Keywords: Domestic accidents, knowledge, practice, prevention of accident, safe home tool kit


How to cite this article:
Shende U, Vagha J, Maurya A. Safe home toolkit for under-five children: An intervention for prevention of domestic accidents. J Datta Meghe Inst Med Sci Univ 2020;15:266-71

How to cite this URL:
Shende U, Vagha J, Maurya A. Safe home toolkit for under-five children: An intervention for prevention of domestic accidents. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 19];15:266-71. Available from: http://www.journaldmims.com/text.asp?2020/15/2/266/304251




  Introduction Top


Domestic accidents in and around home are a leading cause and preventable deaths for children under 5 years and are a major cause of ill health and serious disability. The reduction in the incidences of domestic accidents in childhood remains an important public health priority.[1],[2]

Unintentional injuries are a major health inequality. There is a persistent social gradient for unintentional injuries. The analysis shows that the emergency hospital admission rate for unintentional injuries among the under-fives is 38% higher for children from the most deprived areas compared with children from the least deprived, and previous research indicates that for some injury types, this inequality may be much larger.[1]

Approximately 830,000 children under 18 years die every year due to an unintentional injury. It is the leading cause of death for children over 9 years. Ten millions children require hospital care every year for nonfatal injuries. About 95% of child injuries observed in low-income and middle-income countries (LMICs). In high-income countries (HIC), child injuries account for 40% of all child deaths.[2]

Nearly 47,000 children and teenagers die from falls each year. For every fatal fall, there are about 690 children absent in school. Falls are the leading cause of long term disability.[2]

Preventing domestic accidents cuts across a range of stakeholders working with children and their families; much can be achieved by mobilizing existing services to develop a local child unintentional injury strategy that builds on strengths and develops capacity.[1],[3]

Five causes account for 90% of unintentional injury hospital admissions of this age group and are a significant cause and preventable death and serious long-term harm-these are choking, suffocation and strangulation; falls; poisoning; burns and scalds; and drowning; therefore, taking action in these areas would make a significant difference.[2]

The most important reason for reducing these injuries is the benefits to children and their families. Personal costs of an injury can be devastating. For example, a young child's severe bath water scald will require years of painful skin grafts. Fall in the home can result in permanent brain damage. Due to injuries, major effects on education, employment, emotional well-being, and family relationships. In addition, injuries also impact psychologically on those caring for children. Parents also face substantial costs when their children are injured.[3]

There are also significant costs to local authorities and to society as a whole. For example, a traumatic brain injury to a child under five from a serious fall may cause acquired disabilities, which lead to high education and social care costs as well as the loss of earnings to families and benefit costs to the state.[4]

Unintentional injuries in and around the home are a leading preventable cause and death for children under 5 years and accounted for 7% of all deaths of all children aged 1–4 years in 2015.[4]

Background of the study

A report of 1960 from the World Health Organization Regional Office for Europe reported that, in HIC, injury had become the leading cause of death in children older than 1 year. However, the acknowledgment that childhood injuries are a significant problem in developing countries. With improvements in other areas of child health and better methods of collecting data, is that injury is a leading cause of child death and ill-health in LMICs. Recent large-scale community-based surveys in five countries in South and East Asia (Bangladesh, China, the Philippines, Thailand and VietNam) of overall child mortality, have found much higher levels of death from injury – both before as well as after the age of 5 years – than had been previously thought. This approach has complemented hospital-based and clinic-based health information systems, which often miss many injury deaths. Drowning, although unrecognized as a major cause of child death in earlier estimates, accounted for around half of all child injuries and deaths in each of the countries surveyed.[5]

Children are not just little adults. They live in a world built for adults. Studies have reported a strong association between injuries and a child's age, developmental stage, how the child interacts with the world, and activities undertaken.[5]

In the world, 480 children die from drowning every day. Over 98% of child deaths from drowning occur in low-income or middle-income countries, usually in open bodies of water such as lakes, and streams. In HIC, most drowning events happen in swimming pools. Each year 2–3 million children and teenagers get into trouble in the water and come close to drowning. Covering water bodies, isolation fencing (four-sided) around (four-sided) around swimming pools and other water bodies, wearing personal flotation devices, and ensuring immediate resuscitation, would probably work to save lives. However, the best intervention would be smart parents/carers well educated and alert to keep a watchful eye while children are around water or playing with water.[6]

The studies report that 260 children die from a fire-related burn every day. The death rate from burns is 11 times higher in LMICs than in LMICs than in HIC. Infants are at the highest risk of death from burns. Nearly 75% of nonfatal burns are from hot liquids, hot tap water, or steam. Many children are disfigured for life from burns. The strategies such as setting (and enforcing) laws on smoke alarms, developing and implementing a standard for child-resistant lighters, setting (and enforcing) laws on hot tap water temperature, and educating the public and treating patients at a dedicated burns center are possible.[7] However, the education of the public and parents, in particular, would be a sure-shot remedy to this problem.

World-wide, 130 children die from a fall every day. About 60% of these fatal falls are from a height. In some countries, nearly half of the children taken to emergency clinics are from falling. Nonfatal falls result in significant disability-adjusted life years lost. The interventions of redesigning nursery furniture and other products, establishing playground standards for the depth of appropriate surface material, the height of equipment and maintenance, legislating for window guards and implementing multifaceted community programs such as “Children can't fly” would work in countries with high literacy rate.[7] However, in countries like India, the parents' education in this regard would be more effective.

Neglect resulting in poisoning is very common in many countries. One hundred and twenty-five children die from poisoning every day. Fatal poisoning rates are four times higher in LMICs than HICs. The most common poisoning agents in LMICs are paraffin, household products, and pharmaceuticals. In HICs, the most common poisons are over-the-counter medications, household products, and prescription drugs. Removing the toxic agent, legislating for (and enforcing) child-resistant packaging of medicines packaging of medicines and poisons, packaging drugs in nonlethal quantities, and establishing poison control centers are some of the strategies that the government can enforce.[7] However at grass root level again, a simple measure of parent education and conscious efforts of storing poisonous items beyond the reach of children would do much of the task of prevention.

Aim of the study

The study aims at assessing the utility of a safe home toolkit for under-five children (SHT-UFC) in improving the awareness regarding the prevention of domestic accidents among parents of under-five children.

Objectives of the study

  1. To assess the baseline knowledge and practices regarding the prevention of domestic accidents among parents of under-five children
  2. To evaluate the effectiveness of safe home toolkit among parents of under-five children.



  Materials and Methods Top


Research approach

Pilot study.

Research design

Randomized control trial.

Setting

Community setting in Wardha district.

Population

Parents of under-five children.

Sample size

20 (Control 10 and Experimental 10).

Sampling technique

Simple random sampling.

Material for data collection

  1. Demographic datasheet
  2. Knowledge questionnaire– developed by the researcher and validated in the pilot study
  3. Standardized home safety checklist.


Intervention

Standard safe home toolkit comprises of:

  1. Information handouts regarding home safety which includes Engineering measures, Environmental measures, Legislation and standards, and developing educational material and skills
  2. Videos on home safety
  3. Safe home model demonstration.


Method of data collection

The data were collected on one-to-one basis. The investigator prepared the sampling frame of families having children under-5 years of age in the selected community area of Wardha district. Twenty families were randomly selected for recruiting in the study. Ten of them were again randomly assigned to the control group, and the remaining ten were assigned to the experimental group. Informed consent was taken from the participants. Only one parent from each family was included in the study, although, the intervention was given to both parents. The baseline data was collected through self-reports (Knowledge) and observations (Practices). The intervention was given in groups of five parents at a time. Overall, data were collected for knowledge and practices two times (pre-intervention and 1 month after intervention). Period of Implementation was 2 days On Day, information handouts were given, and on Day 2, the video was shown along with the demonstration of safe home model. The model prepared by the investigator includes Engineering measures, Environmental measures, and Legislation and standards for buildings used for residence in India with the help of experts in the field of architecture and civil engineering, and fire engineering. This model was shown and explained to the parents. Their queries regarding material to be used and why it should be used were answered satisfactorily.

Data analysis

Descriptive statistics with percentage, mean, mode and standard deviation are used to describe the population. Inferential statistics with Paired t-test used for studying the effectiveness of intervention.

Ethical Clearance

Ethical approval for this study (DMIMS(DU)/IEC/2018-19/7281) was provided by the Ethical Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University) on 28/06/2018.


  Observations and Results Top


The analysis of the collection data was performed based on the objectives of the study.

The demographic description of both groups showed that they match most of the demographic characteristics. Most participants had one to two children, most of them lived in pakka own house and had nuclear families. Most of them had three to five members in their families, and none of the participants were illiterate. All of them were in the age group of 20–45 years [Table 1].
Table 1: Demographic distribution of the study participants

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The distribution of both experimental and control groups on the level of knowledge regarding the prevention of domestic accidents showed that they matched in this regard. The study participants in both groups had poor to average knowledge regarding the prevention of domestic accidents before the intervention [Table 2].
Table 2: Level of knowledge about the prevention of domestic accidents among participants before intervention

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The comparison of the experimental and control groups on the level of knowledge regarding the prevention of domestic accidents after intervention showed that the frequency of experimental group participants had increased in the levels of satisfactory and good knowledge as compared to their counterparts in the control group [Table 3].
Table 3: Level of knowledge about the prevention of domestic accidents among participants after intervention

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The distribution of both experimental and control groups on the level of practices regarding the prevention of domestic accidents showed that they matched in this regard. The study participants in both groups had poor-to-average knowledge regarding the prevention of domestic accidents before the intervention [Table 4].
Table 4: Level of practices related to the prevention of domestic accidents among participants before intervention

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The comparison of the experimental and control groups on the level of practices regarding the prevention of domestic accidents after intervention showed that the frequency of experimental group participants had increased in the levels of average and satisfactory practices as compared to their counterparts in the control group [Table 5].
Table 5: Level of practices related to the prevention of domestic accidents among participants after intervention

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The level of significance between experimental and control group for the level of knowledge regarding the prevention of domestic accidents showed that the difference in means in pre–test and posttest of experimental group and posttest of the experimental and control group is statistically significant as P = 0.000 for both comparisons [Table 6].
Table 6: Effectiveness of safe home toolkit for under-five children on knowledge in the experimental group

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The level of significance between experimental and control group for the level of practices regarding the prevention of domestic accidents showed that the difference in means in pre–test and posttest of experimental group and posttest of the experimental and control group is statistically significant as P = 0.000 for both comparisons [Table 7].
Table 7: Effectiveness of safe home toolkit for under-five children on practices in the experimental group

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These results indicate that the 2-day intervention of creating awareness among parents of under-five children with the use of SHT-UFC was effective significantly.


  Discussion Top


The study aimed at evaluating the effectiveness of SHT-UFC in creating awareness regarding the prevention of domestic accidents among parents of under-five children. The findings of the study suggest that before the 2-day intervention of handouts, video and demonstration of safe house model, the knowledge and practices of the participants were poor to average in both control and experimental group. Most of the participants had one to two children in the under-five age group, belonged nuclear family, and lived in their own pakka house. They all were young (<45 years of age) and educated.

Comparison of means before and after the intervention and between control and experimental groups for knowledge and practices showed that the intervention was effective as the difference in means was statistically significant (P < 0.05).

The investigator did not find exactly a similar study to compare the findings. However, the need to create awareness among the parents/public to prevent domestic accidents is stressed in similar studies conducted earlier.

Barcelos et al. (2018) in their systematic review on Interventions to reduce accidents in childhood reported that Family counseling, changes in the home environment, and identification of risk factors, according to the stage of the child development and behavioral habits common to the age period, were important factors for devising effective interventions in the prevention of childhood accidents.[7]

Royal Society for the Prevention of Accidents (2018) reported on reducing unintentional injuries in and around the home among children under 5 years that, the transformation of services for under-fives is needed with local authorities to develop a more integrated, systems approach that is essential for reducing unintentional injuries.[8]

World Health Organization's report on child injury prevention (2016) stressed the importance of transferring knowledge in a sensitive and context-specific manner.[9]

Jian et al. in their article Epidemiology of Injury-Related Death in Children Under 5 Years of Age in Hunan Province, China during 2009–2014 reported that injury-related fatalities in children <5 years of age followed time trends that were different in rural and urban areas. Effective childhood injury prevention may require different prevention policies combination depending on epidemiological characteristics such as the development of injury surveillance and public education on injury knowledge.[10]


  Conclusion Top


A multi-sectoral partnership working across the public, social enterprise, private, voluntary, and community sectors is essential to devise strategies for preventing domestic accidents. A wide range of services including health, education, social care, housing, and fire and rescue needs to be integrated for better outcomes of domestic accidents. Parents must be made aware of this multi-agency linkage for the prevention of domestic accidents among their children. Simply reproducing injury prevention strategies for adults will not work in children. Parents should be aware and equipped for using the available services effectively in times of need.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Public Health England Reducing Unintentional Injuries in and Around the Home among Children Under Five Years; 2014. Available from: https://www.gov.uk/government/publications/reducing-unintentionalinjuries-among-children-and-young-people. [Last accesed on 2019 Nov 27].  Back to cited text no. 1
    
2.
Davies SC. Annual report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays; 2013.  Back to cited text no. 2
    
3.
Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, et al. Keeping Children Safe: A Multicentre Programme of Research to Increase the Evidence base for Preventing Unintentional Injuries in the Home in the Under-Fives; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK447053. [Last accesed on 2019 Nov 27].  Back to cited text no. 3
    
4.
Audit Commission. Better Safe than Sorry. Preventing Unintentional Injury to Children. National Report (Health). London: Audit Commission; 2007.  Back to cited text no. 4
    
5.
Morrongiello BA, Ondejko L, Littlejohn A. Understanding toddlers' in-home injuries: I. Context, correlates, and determinants. J Pediatr Psychol 2004;29:415-31.  Back to cited text no. 5
    
6.
Morrongiello BA. Caregiver supervision and child-injury risk: I. Issues in defining and measuring supervision; II. Findings and directions for future research. J Pediatr Psychol 2005;30:536-52.  Back to cited text no. 6
    
7.
Barcelos RS, Del-Ponte B, Santos IS. Interventions to reduce accidents in childhood: A systematic review. J Pediatr (Rio J) 2018;94:351-67.  Back to cited text no. 7
    
8.
2018. Available from: http://www.facebook.com/PublicHealthEngland [Last accesed on 2019 Nov 27].  Back to cited text no. 8
    
9.
Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AKM, et al. World report on child injury prevention, WHO, Unicef, 2018.  Back to cited text no. 9
    
10.
Lili X, Jian H, Liping L, Zhiyu L, Hua W. Epidemiology of injury-related death in children under 5 years of age in Hunan province, China, 2009-2014. PLoS One 2017;12:e0168524.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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