Risk factors for burns at home in Kurdish preschool children: a case-control study

Logistic regression analysis of risk factors for pediatric burns: a case-control study in underdeveloped minority areas in China

Background

Pediatric burns are common, especially in underdeveloped countries, and these can physically affect the children involved and have an impact on their mental health. The aim of the present study was to assess the effect of pediatric burns in underdeveloped minority areas of China.

Methods

Case information from 192 children was collected from outpatient and inpatient clinics using a survey questionnaire. These included 90 pediatric burn cases and 102 controls who were children without burns. A stepwise logistic regression analysis was used to determine the risk factors for pediatric burns in order to establish a model. The goodness-of-fit for the model was assessed using the Hosmer and Lemeshow test as well as receiver operating characteristic and internal calibration curves. A nomogram was then used to analyze the contribution of each influencing factor to the pediatric burns model.

Results

Seven variables, including gender, age, ethnic minority, the household register, mother's employment status, mother's education and number of children, were analyzed for both groups of children. Of these, age, ethnic minority, mother's employment status and number of children in a household were found to be related to the occurrence of pediatric burns using univariate logistic regression analysis (p < 0.05). After a collinearity diagnosis, a multivariate logistic regression analysis of variables with tolerances of >0.2 and variance inflation factor <5 showed that age was a protective factor for pediatric burns [odds ratio (OR) = 0.725; 95% confidence interval (CI): 0.665-0.801]. Compared with single-child parents, those with two children were at greater risk of pediatric burns (OR = 0.389; 95% CI: 0.158-0.959). The ethnic minority of the child and the mother's employment status were also risk factors (OR = 6.793; 95% CI: 2.203-20.946 and OR = 2.266; 95% CI: 1.025-5.012, respectively). Evaluation of the model used was found to be stable. A nomogram showed that the contribution in the children burns model was age > mother's employment status > number of children > ethnic minority.

Conclusions

This study showed that there are several risk factors strongly correlated to pediatric burns, including age, ethnic minority, the number of children in a household and mother's employment status. Government officials should direct their preventive approach to tackling the problem of pediatric burns by promoting awareness of these findings.

Dark side of customs: scalding burns in childhood due to use of traditional teacup and teapot, in Turkey

The most common type of burn among children is scalding burn. This study aims to reveal child abuse and neglect as a specific etiological factor that specific to our country, traditional teapot- and teacup-related scalding burns. Burn cases that admitted to our Burn Center were investigated, and among these, 72 cases suffering from scalding burns were included in the study. The interview forms issued upon admission of these cases were evaluated in detail. Out of 148 scalding burn cases, 48.6% were related to the use of traditional teapots and teacups. After a detailed assessment, all cases were considered neglect-related burns. As a result of considering the role of traditional teapots and teacups in pediatric injuries in our country, parents and caregivers should be warned about these types of injuries. Also, physicians must determine the possibility of child abuse or neglect in all pediatric burn cases.

The epidemiology of self-immolation in Iraq: A systematic review

BACKGROUND

Self-immolation is one of the most brutal suicide methods and is a significant social and medical problem throughout the world. Self-immolation is more common in low-income countries than in high-income countries.

AIM

The aim is to evaluate the trends in self-immolation and examine its frequency in Iraq.

METHODS

The PRISMA guideline was used to conduct this systematic review study. We searched for publications in English, Arabic and Kurdish in PubMed and Google Scholar. A total of 105 publications were identified through the search; however, 92 were eliminated due to duplication and irrelevant content. Finally, 13 full articles were included for data extraction. The inclusion criteria were articles that investigated self-immolation. However, letters to editors and media reports on self-immolation were excluded. The retrieved studies were selected, reviewed and then quality assessed.

RESULTS

This study included 13 articles. According to the findings, self-immolation accounted for 26.38% of all burn admissions in the Iraqi provinces and the Kurdistan region, with 16.02% of those occurring in the middle and southern provinces of Iraq and 36.75% in the Kurdistan region. It is more common in women than in men, especially among young, married, illiterate, or poorly educated people. Sulaymaniyah had a higher percentage of self-immolation than other governorates in Iraq, accounting for 38.3% of burn admissions. Cultural and social norms, domestic violence, mental health problems, family conflicts and financial problems were identified as the most common causes of self-immolation.

CONCLUSION

The prevalence of self-immolation is high among the Iraqi population, compared to other countries, particularly among the Kurdish population and in Sulaymaniyah. Self-immolation is relatively common among women. There are sociocultural factors that could contribute to this problem. Families must be restricted from having easy access to kerosene, and high-risk individuals should have access to psychological consultation to reduce the risk of self-immolation.

Aetiology of severe burn incidents in children under 5 years of age in the Netherlands: A prospective cohort study

BACKGROUND

Risk factors and mechanisms of injury may change over time. Since knowledge on aetiology of severe burn incidents in children under 5 years of age in the Netherlands is outdated, this study aimed to identify current risk factors and mechanisms of severe burn injury in children under 5 years of age in the Netherlands to direct future prevention campaigns.

METHODS

Information on personal-, environmental- and behavioural circumstances as well as the mechanism of burn injury was prospectively collected in all burn centres during one year from patient records and structured interviews with parents.

RESULTS

Boys around 18 months of age, who, while in upright position, pulled down a cup of hot tea over themselves, were overrepresented. Children in families with more children, having a migration background, living in urbanised neighborhoods or with a low socioeconomic status (SES) are at increased risk for severe burn injury. Most incidents happened in their own home with the parents in close proximity to the child.

CONCLUSION

Outcomes of this prospective cohort study provide up-to-date and extensive knowledge on the aetiology of severe burn incidents in children under 5 years of age in the Netherlands, and provide directions for prevention policy and campaigns.

Burn injuries in primary care in the Netherlands: Risk factors and trends

BACKGROUND

Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention.

METHODS

Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010-2015. We studied risk factors and trends.

RESULTS

The average burn injury prevalence rate was 4.40 (95% CI 4.27-4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46-1.49) per 1000 inhabitants in out-of-hours care. Children of 0-4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year's Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods.

CONCLUSION

Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year's Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.

Evaluating Burn Recovery Outcomes in Children with Neurodevelopmental Symptoms

Neurodevelopmental symptoms (NS) including attention and behavioral problems, developmental delays, intellectual disabilities and learning problems are prevalent in children with burn injuries. The presence of NS may predispose children to poorer burn injury recovery outcomes compared to children without these symptoms (non-NS). The Multi-Center Benchmarking Study (MCBS) monitored recovery outcomes in children with burn injuries in real time utilizing the Burn Outcomes Questionnaire (BOQ). The objective of this study was to retrospectively assess the long term burn recovery outcomes in NS patients versus non-NS patients from the MCBS population. This study assessed parent-reported BOQ outcomes in a sample of 563 patients aged 5 to 18 years who were admitted for burn injuries to a pediatric burn center. A subsample of patients had reported NS (n=181). Analyses compared BOQ outcomes within the NS subsample and the non-NS subsample (n=382) across three longitudinal points post-discharge. The prevalence rate of NS was 32.1% in the full sample. Findings revealed statistically significant improvement in the recovery curves in all five BOQ subscales for the non-NS group and all subscales except for Compliance for the NS group across all longitudinal points. When compared to non-NS patients, NS patients had significantly poorer burn recovery outcomes on the Satisfaction and Compliance subscales. Although it is important to educate all clinicians, parents, and children on burn prevention efforts, targeted education is necessary for children with NS since they may be at greater risk for burn injury as well as worse recovery outcomes.

Factors Related to Pediatric Unintentional Burns: The Comparison of Logistic Regression and Data Mining Algorithms

Burn injuries are one of the traumas seen in all parts of the world and children are usually one of the vulnerable groups. The aim of this study was to determine the factors related to unintentional burns in children, using data mining algorithms. In this hospital-based case-control study conducted in Kermanshah province, Iran, data were collected over a period of 15 months. Children under the age of 15 years old who were referred to the burn ward of Imam Khomeini Hospital, the only burn referral in Kermanshah province, were included as cases. For the control group, children who were admitted to Dr. Mohammad Kermanshahi Hospital, the only specialist and subspecialist pediatric center in this province, were included. Frequency matching was performed for age and sex. Support vector machine, artificial neural network (ANN), random forest, and logistic regression were employed to determine the factors related to burns in children. The mean age of children with burn injuries was 4.29 ± 3.51 years and 58% of them were boys. The ANN algorithm had better performance than other algorithms. Body mass index (BMI), socioeconomic status, hours without a watchful, mother's age, mother's education, household size, father's job, father's age, having more than one watchful, and petroleum storage were the most important factors related to pediatric burns. The majority of the burn-related variables were related to individuals' social welfare status and their environments. Lessening the effects of these factors could reduce the incidence of pediatric burns.

Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review

Social complexity in health outcomes has been attributed to greater risk of injury, adverse health consequences, and early death in a variety of populations. To determine what social complexity factors associated with burn injury in children, a systematic review of the literature was performed. Two different databases (PubMed and SCOPUS) were searched for articles related to environmental and social determinants of burn injury. Selected literature examined social complexity factors to establish the strength of evidence in relation to incidence of burn injury in children. The extent of factors and the most common social complexities were reviewed. The 641 manuscripts found in PubMed and 327 from SCOPUS were initially reviewed for duplication and English language. Subsequently, manuscripts were selected for relevance based on titles followed by abstracts. Forty-seven manuscripts were reviewed in their entirety. The literature supports a relationship between an increased incidence of pediatric burns in lower income families, children with behavioral disorders, fewer years of parental education and children residing in a rural setting. The majority of reports came from Europe followed by Australia, and scattered information from other countries. Social complexity factors in the environment of the child are associated with an increased risk of burn injury in children. The literature supports the influence of lower income, lower parental education, behavioral disorders and living rurally with an increased incidence of injury. By identifying children at increased risk, it is possible to develop targeted burn prevention and education programs to mitigate burn injury.

Risk factors for burn injuries and fire safety awareness among patients hospitalized at a public hospital in Nairobi, Kenya: A case control study

INTRODUCTION

Burn injuries are some of the most physically and psychologically devastating forms of trauma and most common injuries affecting children, especially in the home environment. They are more prevalent and are a public health problem in developing countries mainly because of poor socio-economic conditions. Effective prevention programs should be guided by the results of well-designed studies aimed at investigating risk factors for burns.

STUDY OBJECTIVE

To establish the risk factors for burn injuries among patients hospitalized at the Kenyatta National Hospital (KNH).

METHODOLOGY

This was an age and gender matched case-control study comprising 202 patients admitted with burns (cases) and 202 non-surgical patients (controls) admitted into the pediatric and medical wards. The study site was KNH, a 1800-bed national referral and teaching hospital in Kenya.

DATA ANALYTICAL METHODS

SPSS version 17 was used for data analysis, with descriptive statistics used for demographic data, whereas in the analysis for risk factors chi square test and odds ratio (OR) were used to determine the relationship between the predictive (risk factors) and outcome variables (burn injury). Logistic regression was used to determine the strength of association between risk factors and burn injury.

RESULTS

The risk factors found to be significant for burn injuries were: low level of education (p=0.043), use of kerosene as fuel for cooking (OR=2.027; 95% CI: 1.361-3.019, p=0.000) and lack of knowledge of burn injury prevention and fire safety (OR=4.009; CI: 2.603-6.172, p=0.000).

CONCLUSION

Low level of education, use of kerosene for cooking and lack of knowledge of burn injury prevention and fire safety were identified as risk factors for burn injury among patients hospitalized at KNH. These risk factors should be addressed in burn injury prevention programs for Kenya.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Background

Unintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking.

Aim

To increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives.

Methods

Six work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning.

Results

Modifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care.

Limitations

Our case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours.

Conclusions

Our studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours.

Future work

Further randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model.

Trial registration

Current Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191.

Funding

The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information.

Epidemiologic characteristics, knowledge and risk factors of unintentional burns in rural children in Zunyi, Southwest China

We investigated the knowledge level and risk factors for pediatric unintentional burns in rural Southwest China with an aim to provide basic evidence for the prevention strategies. A stratified sampling method was used to recruit 1842 rural children from 9 schools. Self-reported burns during the past 12 months and relevant risk factors were collected by questionnaires. The burn incidence of all surveyed children was 12.7% (95% confidence interval [95% CI] 11.2–14.2%). We found that burn incidence had a trend to increase with the increasing school grade level and a trend to decrease with increasing knowledge scores on burns. The top two causes of burns were hot liquids (36.3%) and hot object (29.5%). More than 30% of children had little knowledge about preventive measures and how to give first-aid after burns. The main risk factors for burns included female gender, left-behind children by parents who were working in cities, and poor mother school education level. As the incidence of pediatric unintentional burns was high in rural southwest China, schools, families, and local public health agencies should put efforts into health education targeting burn prevention and first-aid measures after burns, particularly in “left-behind” children and those with mothers with poor education.

Modifiable risk factors for scald injury in children under 5 years of age: A Multi-centre Case-Control Study

OBJECTIVE

To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years.

METHODS

Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, gender, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression.

RESULTS

Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63 to 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12 to 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33 to 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30 to 2.75; PAF 26%).

CONCLUSIONS

Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.

Individual-level predictors of inpatient childhood burn injuries: a case-control study

Background

Burn injuries are considered one of the most preventable public health issue among children; however, are a cause of significant morbidity and mortality in Iran. The aim of this study was to assess individual-level predictors of severe burn injuries among children leading to hospitalization, in East Azerbaijan Province, in North-West of Iran.

Methods

The study was conducted through a hospital based case–control design involving 281 burn victims and 273 hospital-based controls who were frequency matched on age, gender and urbanity. Both bivariate and multivariate methods were used to analyze the data.

Results

Mean age of the participants was 40.5 months (95 % CI: 37–44) with the majority of burns occurring at ages between 2 months-13.9 years. It was demonstrated that with increase in the caregiver’s age there was a decrease in the odds of burn injuries (OR = 0.94, 95 % CI: 0.92-0.97). According to the multivariate logistic regression there were independent factors associated with burn injuries including childhood ADHD (OR = 2.82, 95 % CI: 1.68 - 4.76), child’s age (OR = 0.73, 95%CI: 0.67 - 0.80), flammability of clothing (OR = 1.60, 95 % CI: 1.12 - 2.28), daily length of watching television (OR = 1.31, 95 % CI: 1.06 - 1.61), playing outdoors (OR = 1.32, 95 % CI: 1.16 - 1.50) and increment in the economic status (OR = 1.37, 95 % CI: 1.18 - 1.60).

Conclusion

Major risk predictors of burn injuries among the Iranian population included childhood ADHD, child’s age, watching television, playing outdoors, high economic status and flammable clothing.

Unintentional injuries in children with disabilities: a systematic review and meta-analysis

Children with disabilities are thought to have an increased risk of unintentional injuries, but quantitative syntheses of findings from previous studies have not been done. We conducted a systematic review and meta-analysis to assess whether pre-existing disability can increase the risk of unintentional injuries among children when they are compared to children without disability. We searched 13 electronic databases to identify original research published between 1 January 1990 and 28 February 2013. We included those studies that reported on unintentional injuries among children with pre-existing disabilities compared with children without disabilities. We conducted quality assessments and then calculated pooled odds ratios of injury using random-effects models. Fifteen eligible studies were included from 24,898 references initially identified, and there was a total sample of 83,286 children with disabilities drawn from the eligible studies. When compared with children without disabilities, the pooled OR of injury was 1.86 (95 % CI 1.65–2.10) in children with disabilities. The pooled ORs of injury were 1.28, 1.75, and 1.86 in the 0–4 years, 5–9 years, and ≥10 years of age subgroups, respectively. Compared with children without disabilities, the pooled OR was 1.75 (95 % CI 1.26–2.43) among those with International Classification of Functioning (ICF) limitations. When disability was defined as physical disabilities, the pooled OR was 2.39 (95 % CI 1.43–4.00), and among those with cognitive disabilities, the pooled OR was 1.77 (95 % CI 1.49–2.11). There was significant heterogeneity in the included studies. Compared with peers without disabilities, children with disabilities are at a significantly higher risk of injury. Teens with disabilities may be an important subgroup for future injury prevention efforts. More data are needed from low- and middle-income countries.

Keeping children safe at home: protocol for a case-control study of modifiable risk factors for scalds

Background

Scalds are one of the most common forms of thermal injury in young children worldwide. Childhood scald injuries, which mostly occur in the home, result in substantial health service use and considerable morbidity and mortality. There is little research on effective interventions to prevent scald injuries in young children.

Objectives

To determine the relationship between a range of modifiable risk factors for medically attended scalds in children under the age of 5 years.

Design

A multicentre case-control study in UK hospitals and minor injury units with parallel home observation to validate parental reported exposures. Cases will be 0–4 years old with a medically attended scald injury which occurred in their home or garden, matched on gender and age with community controls. An additional control group will comprise unmatched hospital controls drawn from children aged 0–4 years attending the same hospitals and minor injury units for other types of injury. Conditional logistic regression will be used for the analysis of cases and matched controls, and unconditional logistic regression for the analysis of cases and unmatched controls to estimate ORs and 95% CI, adjusted and unadjusted for confounding variables.

Main exposure measures

Use of safety equipment and safety practices for scald prevention and scald hazards.

Discussion

This large case-control study will investigate modifiable risk factors for scalds injuries, adjust for potential confounders and validate measures of exposure. Its findings will enhance the evidence base for prevention of scalds injuries in young children.