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Ali AE, Sharma S, Elebute OA, Ademuyiwa A, Mashavave NZ, Chitnis M, Abib S, Wahid FN. Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries. Semin Pediatr Surg 2023; 32:151356. [PMID: 38041908 DOI: 10.1016/j.sempedsurg.2023.151356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.
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Affiliation(s)
- Abdelbasit E Ali
- Department of Pediatric Surgery, King Saud Medical City, KSA, Associate Professor of Surgery, Faculty of Medicine, University of Khartoum, Sudan
| | - Shilpa Sharma
- MCh, PhD, ATLS Faculty, ISTPF(UK), FIAPS, MNAMS, FAMS. Professor of Pediatric Surgery, Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Olumide A Elebute
- College of Medicine, University of Lagos and Lagos University Teaching Hospital Idi Araba, Lagos, Nigeria
| | - Adesoji Ademuyiwa
- Department of Surgery, College of Medicine, University of Lagos & Honorary Consultant and Chief Pediatric Surgery Unit, Lagos University Teaching Hospital. Lagos, Nigeria
| | - Noxolo Z Mashavave
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | - Milind Chitnis
- Department of Pediatric Surgery, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
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Khan UR, Ali A, Khudadad U, Raheem Buksh A, Zia N, Azam I, Chandran A, Razzak JA, Hyder AA. Follow-up household assessment for child unintentional injuries two years after the intervention: A community-based study from Karachi, Pakistan. Injury 2023; 54 Suppl 4:110519. [PMID: 36481051 DOI: 10.1016/j.injury.2022.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions. METHODS This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age. RESULTS A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]). CONCLUSION An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Ahmed Raheem Buksh
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Iqbal Azam
- Community Health Sciences, Medical College, Aga Khan University, Karachi, Pakistan
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Junaid Abdul Razzak
- Centre of Excellence for Trauma and Emergencies, Aga Khans University, Karachi 74800, Pakistan; Weill Cornell Medicine, New York, NY, USA
| | - Adnan Ali Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Mohammed Z, Aledhaim A, AbdelSalam EM, El-Setouhy M, El-Shinawi M, Hirshon JM. Factors associated with injuries among preschool children in Egypt: demographic and health survey results, 2014. BMC Public Health 2020; 20:595. [PMID: 32357864 PMCID: PMC7193349 DOI: 10.1186/s12889-020-08658-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Childhood injuries are a significant and growing global public health problem, often with high morbidity and, at times, mortality. A large proportion of injuries in preschool children occur in or around the home. We aimed to identify socioeconomic and demographic factors associated with preschool children injuries in Egypt. Methods Secondary data analysis were done for the Egyptian Demographic and Health Surveys (EDHS), 2014. Potential associated factors were measured from data on child welfare and questions on the prevalence of accidents and injuries of preschool children. These data were linked to the children demographic data, maternal age at marriage, working status of the mother, and questions on childcare arrangements. Results Out of the 634 injured children, 520 (83.4%) children required medical care for their injuries. The most common reported injury was an open wound 288 (45.5%), followed by fractures 237 (35.7%), burns 124 (19.7%), electrical shock 12 (1.9%) and other unknown types of injury 15 (2.4%). There was a positive correlation between injury and child’s age, household wealth, mother’s age at marriage, and unsupervised children or children left in the care of a minor. Conclusion Leaving children unsupervised or in the presence of other young children is significantly associated with the occurrence of child injuries.
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Affiliation(s)
- Zeinab Mohammed
- Public Health and Community Medicine Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt. .,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Ali Aledhaim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Maged El-Setouhy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.,Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed El-Shinawi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Nwanna-Nzewunwa O, Ngamby MK, Cox J, Feldhaus I, Motwani G, Monono ME, Etoundi GA, Dicker RA, Hyder AA, Juillard C. Epidemiology and cost of pediatric injury in Yaoundé, Cameroon: a prospective study. Eur J Trauma Emerg Surg 2019; 46:1403-1412. [PMID: 30976820 DOI: 10.1007/s00068-019-01104-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/25/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Unintentional injury is the leading cause of death among children aged 10-19 years and over 95% of injury deaths occur in low- and middle-income countries (LMICs). As patterns of injury in the pediatric population may differ from those in adults, risks specific to children in LMICs need to be identified for effective injury prevention and treatment. This study explores patterns of pediatric injury epidemiology and cost in Yaoundé, Cameroon to inform injury prevention and resource allocation. METHODS Pediatric (age < 20 years) trauma patient data were collected at the emergency department (ED) of Central Hospital of Yaoundé (CHY) from April through October 2009. Univariate, bivariate, and multivariate analyses were used to explore injury patterns and relationships between variables. Regression analyses were conducted to identify predictors of receiving surgical care. RESULTS Children comprised 19% (544) of trauma cases. About 54% suffered road traffic injuries (RTIs), which mostly affected the limbs and pelvis (37.3%). Half the RTI victims were pedestrians. Transportation to CHY was primarily by taxi or bus (69.4%) and a preponderance (71.1%) of the severely and profoundly injured patients used this method of transport. Major or minor surgical intervention was necessary for 17.9% and 20.8% of patients, respectively. Patients with an estimated injury severity score ≥ 9 (33.2%) were more likely to need surgery (p < 0.01). The median ED cost of pediatric trauma care was USD12.71 [IQR 12.71, 23.30]. CONCLUSIONS Injury is an important child health problem that requires adequate attention and funding. Policies, surgical capacity building, and health systems strengthening efforts are necessary to address the high burden of pediatric injuries in Cameroon. Pediatric injury prevention efforts in Cameroon should target pedestrian RTIs, falls, and burns and consider school-based interventions.
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Affiliation(s)
- Obieze Nwanna-Nzewunwa
- Center for Global Surgical Studies, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, USA
| | | | - Jacob Cox
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Isabelle Feldhaus
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Girish Motwani
- Center for Global Surgical Studies, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, USA
| | - Martin Ekeke Monono
- World Health Organization (WHO) Regional Office, Brazzaville, Republic of the Congo
| | | | - Rochelle A Dicker
- Department of Surgery, University of California, Los Angeles, 10833 Le Conte Ave, 72-215 CHS, Los Angeles, CA, 90095, USA
| | - Adnan A Hyder
- International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Juillard
- Department of Surgery, University of California, Los Angeles, 10833 Le Conte Ave, 72-215 CHS, Los Angeles, CA, 90095, USA.
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Khan U, Hisam B, Zia N, Mir M, Alonge O, Jamali S, Hyder AA, Razzak J. Uncovering the burden of intentional injuries among children and adolescents in the emergency department. BMC Emerg Med 2015; 15 Suppl 2:S6. [PMID: 26692292 PMCID: PMC4682402 DOI: 10.1186/1471-227x-15-s2-s6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan. Methods The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries. Results Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders. Conclusion Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention.
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Bhatti JA, Farooq U, Majeed M, Khan JS, Razzak JA, Khan MM. Fall-related injuries in a low-income setting: Results from a pilot injury surveillance system in Rawalpindi, Pakistan. J Epidemiol Glob Health 2015; 5:283-90. [PMID: 25725473 PMCID: PMC7320534 DOI: 10.1016/j.jegh.2015.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 12/01/2022] Open
Abstract
This study assessed the characteristics and emergency care outcomes of fall-related injuries in Pakistan. This study included all fall-related injury cases presenting to emergency departments (EDs) of the three teaching hospitals in Rawalpindi city from July 2007 to June 2008. Out of 62,530 injury cases, 43.4% (N = 27,109) were due to falls. Children (0–15 years) accounted for about two out of five of all fall-related injuries. Compared with women aged 16–45 years, more men of the same age group presented with fall-related injuries (50% vs. 42%); however, compared with men aged 45 years or more, about twice as many women of the same age group presented with fall-related injuries (16% vs. 9%, P < 0.001). For each reported death due to falls (n = 57), 43 more were admitted (n = 2443, 9%), and another 423 were discharged from the EDs (n = 24,142, 91%). Factors associated with death or inpatient admission were: aged 0–15 years (adjusted odds ratio [aOR] = 1.35), aged 45 years or more (aOR = 1.94), male gender (aOR = 1.15), falls occurring at home (aOR = 3.38), in markets (aOR = 1.43), on work sites (aOR = 4.80), and during playing activities (aOR = 1.68). This ED-based surveillance study indicated that fall prevention interventions in Pakistan should target children, older adult women, homes, and work sites.
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Affiliation(s)
- Junaid A Bhatti
- Sunnybrook Health Sciences Centre Research Institute, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Umar Farooq
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Mudassir Majeed
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Jahangir S Khan
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Junaid A Razzak
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Muhammad M Khan
- Surgical Unit I, Department of Surgery, Holy Family Hospital, Rawalpindi, Pakistan
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He S, Lunnen JC, Puvanachandra P, Amar-Singh, Zia N, Hyder AA. Global childhood unintentional injury study: multisite surveillance data. Am J Public Health 2014; 104:e79-84. [PMID: 24432924 DOI: 10.2105/ajph.2013.301607] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). METHODS We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. RESULTS Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. CONCLUSIONS Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children's safety and underscoring the need for intensified context-appropriate injury prevention.
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Affiliation(s)
- Siran He
- Siran He, Jeffrey C. Lunnen, Prasanthi Puvanachandra, Nukhba Zia, and Adnan A. Hyder are with Johns Hopkins International Injury Research Unit, Bloomberg School of Public Health, Baltimore, MD. Amar Singh is with the Paediatric Department, Ipoh General Hospital, Perak, Malaysia
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Khan UR, Chandran A, Zia N, Huang CM, De Ramirez SS, Feroze A, Hyder AA, Razzak JA. Home injury risks to young children in Karachi, Pakistan: a pilot study. Arch Dis Child 2013; 98:881-6. [PMID: 23995075 PMCID: PMC4316730 DOI: 10.1136/archdischild-2013-303907] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To pilot an in-home unintentional injury hazard assessment tool and to quantify potential injury risks for young children in a low-income urban setting. METHODS Two low-income neighbourhoods in Karachi, Pakistan, were mapped, and families with at least one child between the ages of 12 and 59 months were identified. Using existing available home injury risk information, an in-home injury risk assessment tool was drafted and tailored to the local setting. Home injury assessments were done in June-July 2010 after obtaining informed consent. RESULTS Approximately 75.4% of mothers were educated through at least grade 12. The main risks identified were stoves within the reach of the child (n=279, 55.5%), presence of open buckets in the bathroom (n=240, 47.7%) within the reach of the child, and pedestal fans accessible to the child (n=242, 48.1%). In terms of safety equipment, a first-aid box with any basic item was present in 70% of households, but only 4.8% of households had a fire extinguisher in the kitchen. CONCLUSIONS This was the first time that an in-home, all-unintentional injury risk assessment tool was tailored and applied in the context of a low-income community in Pakistan. There was a significant burden of hazards present in the homes in these communities, representing an important opportunity for injury prevention. This pilot may have future relevance to other LMICs where child injury prevention is a critical need.
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Affiliation(s)
- Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Aruna Chandran
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nukhba Zia
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan,International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cheng-Ming Huang
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sarah Stewart De Ramirez
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Asher Feroze
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Adnan Ali Hyder
- International Injury Research Unit (IIRU), Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Sindh, Pakistan,Aman Healthcare Services, Karachi, Sindh, Pakistan
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Disseminating childhood home injury risk reduction information in Pakistan: results from a community-based pilot study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1113-24. [PMID: 23502323 PMCID: PMC3709307 DOI: 10.3390/ijerph10031113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 02/02/2023]
Abstract
Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools. Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. A follow up assessment was conducted 4–5 months later. Results: 503 households were enrolled; 256 received a tutorial and 247 a pamphlet. The two groups differed significantly (p < 0.01) in level of maternal education and relationship of the child to the primary caregiver. However, when controlling for these variables, those receiving an in-home tutorial had a higher odds of hazard reduction than the pamphlet group for uncovered vats of water (OR 2.14, 95% CI: 1.28, 3.58), an open fire within reach of the child (OR 3.55, 95% CI: 1.80, 7.00), and inappropriately labeled cooking fuel containers (OR 1.86, 95% CI: 1.07, 3.25). Conclusions: This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home hazards in a low-income neighborhood in Pakistan. A longer-term randomized study is needed to assess actual effectiveness of the use of allied health workers for home-based injury education and whether this results in decreased home injuries.
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