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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 25-30

A study on the prevalence of accidents among under-five children in an Urban field practice area of Mysuru


Department of Community Medicine, School of Public Health, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India

Date of Submission09-Oct-2020
Date of Decision14-Oct-2020
Date of Acceptance14-Oct-2020
Date of Web Publication12-Jan-2021

Correspondence Address:
Dr. Amogha Shree
Department of Community Medicine, School of Public Health, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_125_20

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  Abstract 


Background: The World Health Organization defines “Accidents as an unexpected and an unintended event causing physical and mental injuries.” In many developing countries, injuries due to accidents are one of the major causes of deaths among under-five children. In India, 15%–20% deaths among children are due to injury according to the National Crime Bureau. Objectives: To determine the frequency and prevalence of accidents among the under-five children and to identify the risk factors associated with accidents. Methodology: A cross-sectional study was conducted using probability proportionate to size sampling technique in the urban field practice area of JSS Medical College, Mysuru. Based on the reported prevalence of 46.3% of childhood injuries, a total sample size of 438 was obtained. Data related to sociodemographic characteristics, risk factors, and injury profile were collected by interviewing parents who had children less than 5 years. Analysis was done using SPSS V.25. Results: Majority (60.8%) of the caretakers had male children. The prevalence of accidents among under-five was 22.1%. Fall (68%) was the common type of accident. 55.7% of the under-five children received the treatment from allopathic system of medicine. Education level and stress among the caretakers showed statistically significant association with the occurrence of accidents. Conclusion: This study revealed the prevalence of domestic accidents among under-five as 22.1%. Caretakers are failing their responsibility of caring their children due to lack of education among them.

Keywords: Accidents, children, domestic, fall, under-five


How to cite this article:
Krishnamurthy K V, Murthy M R, Kulkarni P, Shree A, Gopi A. A study on the prevalence of accidents among under-five children in an Urban field practice area of Mysuru. Indian J Med Spec 2021;12:25-30

How to cite this URL:
Krishnamurthy K V, Murthy M R, Kulkarni P, Shree A, Gopi A. A study on the prevalence of accidents among under-five children in an Urban field practice area of Mysuru. Indian J Med Spec [serial online] 2021 [cited 2021 Jan 16];12:25-30. Available from: http://www.ijms.in/text.asp?2021/12/1/25/306741




  Introduction Top


Injuries among the children are an emerging public health problem. Accidental injuries are one of the leading causes of death, hospitalization, and disability across the World. In developing countries, injuries are one of the major causes of death in children between age group of 1 and 5 years. Injury among the children can happen anywhere: the road, home, or playground. Studies on childhood injuries have observed that majority of the accidents occur inside the home. According to the World Health Organization (WHO), injury-specific mortality rate in the under-five age group was 73 per 100,000 population and 3654 years of life was lost per 100,000 population (WHO 2015).[1]

Under-five children are more at risk for domestic accidents because of their normal curiosity, impulsiveness, and desire to master new skills and children imitate adult behavior from an early age, and boys are more likely to have accidents than girls. Most injuries take place in or near a child's home where unsafe play areas and play things may often be found. Age, sex, and economic factors are important determinants of injury's incidence and severity.[2]

Although home is the place which is safe and secure for the children, unfortunately, home is where many injuries and deaths occur. The main causes of accidents in the home are falls, burns, drowning, suffocation, choking, poisoning, and cuts. They learn to walk, run, jump, and explore the physical environment by falling which is the normal part when growing, and most falls are of little consequence, but some goes beyond the resilience of a child's body, making them the fourth largest cause of unintentional injury death for children. Any form of injury can lead to significant physiological, psychological, social, environmental, and financial burden, thereby affecting the day-to-day routine of children as well as their families.

In Karnataka, at least 30,000 children are dying annually due to accidents, drowning, and poisoning, and nearly 2045 children (0–14 years) died due to unintentional injuries in 2017, accounting for 11.89% of all deaths.[3]

The advent of modernization in the developing world has posed a threat to the young ones. Most of the parents fail in their responsibility of caring for their children. Varied circumstances such as employment or any other task involvement predisposes the young children to vulnerable circumstances. With the above background, this study was conducted in urban field practice area of Mysuru, Karnataka. The main objective of the study was to determine the frequency and prevalence of accidents and to identify the associated risk factors among the under-five children in an urban field practice area of Mysuru, Karnataka.


  Methodology Top


It was a cross-sectional study conducted in urban primary health center (UPHC), Bannimantap, Mysuru, which comes under urban field practice area of JSS Medical College. The study was done for a period of 6 months (December 2019–April 2020). After taking the prevalence of childhood accidents as 46.3%,[4] allowable error of 5%, and nonresponse rate of 10%, the sample size obtained was 438 through the formula, n = Z2pq/d2.

As UPHC comprises five subcenters (Hanumantanagar, H.U.D.C.O., Manjunathapura, B.M. Shrinagara and Metagalli.), sample from each subcenters was selected using probability proportionate to size sampling technique. Thus, 96 eligible caretakers from H.U.D.C.O., 110 caretakers from Hanumantanagar, 104 caretakers from B.M. Srinagara, 103 caretakers from Metagalli, and 25 caretakers residing in Manjunathapura were included in the study.

The data were collected using a pretested, semistructured pro forma by interviewing method after obtaining ethical clearance from the Institutional Ethics Committee of JSS Medical College, JSS Academy of Higher Education and Research, Mysuru. House-to-house visits were made in each area starting from the first house using right hand rule, and the study was continued until the required sample size for each area was attained. Caretakers of under-five children who were residing in the study area and who gave consent for the study were included.

The data thus obtained were entered in Microsoft Excel sheet and were analyzed using SPSS V.25 (Licensed to JSSAHER). The results were represented in mean, standard deviation, and percentage. Chi-square was applied to find out the association, and P < 0.05 was considered statistically significant.


  Results Top


The mean age of the caretakers was 28.7 ± 8.2 years, and majority were in the age group of 25–29 years (42.4%), followed by 20–24 years (25.5%). Out of 438 caretakers, 386 (88.1%) were mothers and 52 (11.9%) were other family members (grandmother/mother's sister/father). 231 (52.7%) belonged to nuclear family and 204 (46.6%) belonged to joint family. According to the Modified Kuppuswamy's Classification (updated for the period from January 2019 to December 2019), majority, i.e., 57.3%, belonged to upper lower class followed by lower middle class (19.4%) [Table 1].
Table 1: Distribution of caretakers based on the sociodemographic profile

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Among 438 caretakers, 151 (34.5%) had studied up to high school and 85 (19.4%) had completed intermediate/ Pre-University College (PUC)/diploma, whereas among the head of the family, majority had completed high school (40.4%) and 74 (16.9%) had studied up to higher primary school [Figure 1].
Figure 1: Distribution of caretakers and head of the family according to educational level

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Most of the caretakers were homemakers (89%), followed by unskilled worker (4.1%), semiskilled worker (2.5%), and skilled worker (2.1%) by occupation. Among the head of the family, nearly half of them were unskilled worker, 20.3% were semiskilled worker, and least was unemployed [Figure 2].
Figure 2: Distribution of caretakers and head of the family according to occupational status

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Among the under-five children in this study, 56.2% were male and 43.8% were female. 66.7% of children belonged to the age group of ≥3 years and 33.3% belonged to <3 years of age group. Out of 438 under-five children, 155 (35.4%) had no siblings, whereas 215 (75.97%) had <2 siblings and 68 (24.02) had >2 siblings.

In the present study, 97 (22.1%) gave a history of accidents. Out of these, fall (68%) was the most common type of accident, followed by burns (14.4%), injuries from sharp instruments (11.3%), electrical injury (2.06%), road traffic accidents (2.06%), poisoning (1.03%), and other accidents (1.03%).

Among the 97 children who had met with accidents, 60.8% were male. Accidents were seen more among children whose age was ≥3 years (72.2%) compared to those who were < 3 years. Majority of the children who met with accidents belonged to upper lower socioeconomic status (63.9%), followed by lower-middle (17.5%) [Table 2].
Table 2: Distribution of under-five children according to sociodemographic profile with a history of accidents

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Among the 66 children with a history of fall, 33 (50%) fell from same level, 13 (19.7%) fell from steps, 12 (18.2%) fell from cot/table, 5 (7.6%) fell into pit/other opening in the surface, and 3 (4.5%) fell from building. Among 14 children with a history of burns, majority got burnt from container of hot liquid (42.8%) and candle flame (21.4%). None of them got injured from kerosene stove/match box. Among 11 children with a history of injuries, 9 (81.8%) were injured by window glass and 2 (18.2%) were injured by knife. None of them were injured by blade/sickle [Table 3].
Table 3: Distribution of under-five children based on the type/source of accidents

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Most of the time accidents occurred in their immediate surrounding (53.6%), followed by in living room (33%), terrace (8.24%), and bathroom (5.15). None of them met with any kind of accident in the kitchen. Children met with accidents more during evening time (58.8%) than in the afternoon (27.8%), morning (10.30%), and night (3.09%).

Out of 97 children who met with accident, 43 (44.3%) had given home care, whereas 32 (33%) and 22 (22.68%) children were taken to private clinic/hospital and government hospital, respectively. Allopathic system of medicine was followed at 54 (55.7%) houses and traditional system of medicine at 43 (44.3%) houses. Complete recovery was seen among 95 (97.9%) children and 2 (2.1%) were in the recovery phase. No deaths or disability were noted.

Statistically significant association was noted only between educational status of the caretaker with a history of accidents among under-five children [Table 4].
Table 4: Association between sociodemographic profile of caretakers and history of accidents among children

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  Discussion Top


It was a cross-sectional study conducted in UPHC, which comes under urban field practice area of JSS Medical College. The mean age of caretakers in the present study was found to be 28.71 years with standard deviation of 8.25 years. Majority (42.4%) of the care takers belonged to the age group of 24–29 years and 25.5% were in the age group of 20–24 years. Whereas, the study conducted by Bharathi[5] showed that majority of the caretakers were in the age group of 25–29 years, and 30% and 20% were in the age group below 25 years and above 29, years respectively.

In the present study, 34.47% of caretakers had completed their high school and 19.4% had completed intermediate/PUC/diploma. This result is in concordance with the study done by Sharma et al.,[1] where more than 50% of the caretakers had completed their high school and least (10%) had completed their graduate and higher education. The study done by Shriyan et al.[4] showed that 33.68% of study participants had completed their college and above and 30.52% had completed their high school. A similar result was found in our study, where majority of the caretakers are literate and least were illiterate.

Sharma et al.,[1] where more than 50% of the caretakers had completed their high school and least (10%) had completed their graduate and higher education. The study done by Shriyan et al.[4] showed that 33.68% of study participants had completed their college and above and 30.52% had completed their high school. A similar result was found in our study, where majority of the caretakers are literate and least were illiterate.

The current study reveals that majority of the head of the family had studied up to high school (40.4%), followed by higher primary school (16.9%). A study conducted by Shriyan et al.[4] reported that 41.26% of the head of the family had education qualification of high school and 22.42% had primary school. This result was similar to ours, and in both the studies, more than 40% of heads of the families had qualification of high school, which might help in taking the health-related decision.

In our study, majority of the caretakers were homemakers (89%) followed by unskilled workers (4.1%). Similar results were found in the study conducted by Yadav et al., in Moradabad, and Hemalatha K and Prabhakar V R in Tirichirapalli, where 76.81% and 51.3% were homemakers, respectively, followed by 21.36% and 32.7% who were unskilled workers.[6],[7]

Majority of the head of family in our study were unskilled workers (49.1%), followed by 20.3% who were semiskilled, whereas similar results were seen in the study conducted by Sharma et al.,[1] where majority were unskilled workers (59.2%).

A study conducted by Kaushik Tripura et al. showed that majority of the study participants, i.e., 60%, live in nuclear family, followed by 39.4% in joint family.[8] Similar results were noted in our study, where >50% of them lived in nuclear family, followed by 46.57% in joint family.

According to the modified Kuppuswamy classification, 57.3% in the current study belonged to upper lower class and least in upper class (0.7%). Similar result was found in a study by Sharma et al., where 92% of caretakers were in the upper lower class.[1]

In the present study, 66.6% of the children belonged to the age group of ≥3 years and 33.3% were in the age group of <3 years. Similar results were found in the study conducted by Mahathesh V Pujar et al. and Anitha Nath et al., where 71.39% and 57.06% of the children belonged to the age group of ≥3 years and 28.61% and 42.94% belonged to <3 years, respectively.[9],[10]

Out of 438 under-five children, 155 (35.39%) had no siblings, whereas 283 (64.61%) had siblings.

The overall prevalence of accidents in the present study among under-five children was found to be 22.1%. Our results were in accordance with the studies conducted by Mahalakshmy et al., Yadav et al., and Moumitha Basak et al., where the prevalence of accident was reported to be 23%, 20%, and 21.2%, respectively.[6],[11],[12]

Fall (68%) was the most common type of accident noted among the children in our study, followed by burns (14.4%), injuries from sharp instruments (11.3%), electrical injury (2.1%), road traffic accidents (2.1%), poisoning (1%), and other accidents (1%), whereas our result was similar to the results of the study by Sachin Yadav et al.[6] who reported fall as the most common (47.3%) injury followed by injury due to sharp instruments and road traffic accidents. Another study by Khan et al.[13] also reported similar result, where the most common type of accident was fall (53.4%) followed by road traffic accidents (12.6%). Our results are in accordance with the results of these studies as under-five is the age where children learn to walk, run, and play, and during this learning, they tend to fall often and this could be the reason for reporting more number of falls in this age group.

In the current study, accidents were noted more among males (60.8%) compared to females (39.1%). Studies done by Tripura et al. and Yadav et al. also reported similar findings, noting that 55.6% and 62.5% of male children met with injuries/accidents, respectively, when compared to females.[8],[6] These results reveal that male children are more prone for accidents.

The highest prevalence of accidents was noted in children in the age group of ≥3 years (72.2%) and least was found in <3 years of age group (27.9%). This result was at par with the study by Shriyan et al.,[4] where majority (56.8%) of injury occurred in children in the age group of >3 years and 40.9% in <3 years. Statistical association (P < 0.05) between injuries and age of the children was noted in the study conducted by Yadav et al.,[6] where injuries were seen more among the children of 2–3 years (37.2%), followed by 4–5 years (25%) and least in 3–4 years (14.8%). This result was in contrast to our findings.

A study done by Ramesh Masthi et al.[14] showed that 59% children who met with an accident belonged to low socioeconomic status, 38% children belonged to medium socioeconomic status, and the remaining 3% children belonged to high socioeconomic status. In our study, majority (73.2%) of the injuries were noted in children who belonged to lower socioeconomic status, followed by middle (25.7%) and high socioeconomic status (1%). Similar results were seen in a study by Ramesh Masthi et al.,[14] where the prevalence of domestic accidents was 59.2% in low socioeconomic status and 38.5% and 2.3% in medium and high socioeconomic status, respectively. A contrast result was observed in the study done by Navya et al.,[15] where 54.3% children who met with an accident belonged medium socioeconomic status, followed by low socioeconomic status (38.3%) and high socioeconomic status (7.45). This study also showed that there was a statistically significant association (P < 0.05) between injury and socioeconomic status of the family.

Most of the falls were due to fall from the same level (50%) and followed steps (19.7%) and cot/table (18.2%). This result was in par with the study by Navya et al.,[15] where majority of fall occurred due to slipping, tripping, and stumbling from the same level (47%), followed by fall on and from stairs and steps (13.8%). Whereas, in a study conducted by Yadav et al.,[6] majority of the falls were due to fall from furniture or bed.

Among the objects responsible for burns, majority of burns occurred by touching container of hot liquid/spillage of liquid (42.8%) and followed by candle flame (21.4%), gas stove (14.3%), hot water tap (14.3%), and hot Iron box (7.1%). A study by Pujar et al.[9] showed that 40% of burns were due to exposure to specified smoke, fire, and flames, followed by contact with hot metals (33.3%) and hot fluids (26.7%). Another study reveals that 55.5% burns were due to fall of boiling water/dal/milk, 22.2% due to touching burning wood/coal, and another 22.2% due to touching live wire/socket.[16]

A study conducted by Bhuvaneswari et al. reported that the common place of domestic injury was the living room (53.6%), followed by stairs (20.1%).[17] In our study, 53.6% of the accidents occurred in the immediate surroundings, followed by living room (33%), terrace (8.3%), and bathroom (5.1%).

In the current study, 58.8% met with accident in the evening, followed by afternoon (27.8%), morning (10.3%), and night (3.1%). Similar results were found in the study conducted by Navya et al.,[15] where about 40.3% of the injuries were sustained in the evening, 21.7% each in the morning and night, and 16.3% in the afternoon.

Home care as a treatment was given to 44.3% of children in our study. The remaining took treatment at private hospital/clinic (33%) and government hospital (22.7%). Similar results was found in the study conducted by Ramesh Masthi et al., where majority were treated at home (53.6%), followed by 43.3% treated at outpatient department care and 3.1% treated as in-patients.[14] A contrast result was observed by Navya et al., where majority of the children received treatment at private clinic (66%), 20.5% home remedies, and 6.7% at government hospital.[15]

Among those who received the treatment at hospital, 55.7% received the treatment from allopathic and 44.3% from traditional system of medicine. Similar results were found in the study by Ramesh Masthi et al., where 74.9% had taken allopathic treatment and least 1% had taken ayurvedic treatment.[14]

In this study, 97.9% had there complete recovery and 2.1% were in recovery phase, which is comparable with the results found in the study done by Ramesh Masthi et al., where 92% of domestic accident victims had recovered completely, 6% (32) of victims were in the recovery phase at the end of the study period, and 2% (10) of victims recovered with disability.[14]

Statistically significant association was noted between accidents and education of caretakers (P = 0.001) as well as stressors among care takers (P < 0.001). Similar result was noted in the study by Khan et al., where an association (P = 0.031) between injury and education of the mother was statistically significant.[13]


  Conclusion Top


Our study revealed that male child (56.2%) was more prone to accidents compared to females (43.8%). Accidents were more among the children in the age group of ≥3 years (66.7%) compared to <3 years of age group (33.3%). The overall prevalence of accidents was 22.1% among the under-five children and fall (68.1%) was the most common type of accident. 44.3% of children were given home care following accident. Among the injured, 97.9% children were completely recovered and 2.1% were in recovery phase. There was a statistically significant association between education level of the caretakers with accidents, and this could be due to lack of education and ignorance among the caretakers towards child care.

Recommendations

Many factors such as education, occupation, socioeconomic condition, and surroundings of the child along with lack of knowledge, lack of supervision, and ignorance among the caretakers affect the child's health. Majority of these can be averted by adopting preventing measures and raising the level of knowledge of people mainly who are going to take care of their children. This can be done by health education, creation of healthy environment for children, and raising of awareness of the risk to children's health in the setting where they live. Many household-level injury risks are avoidable requiring environmental modification, which can be done with minimal efforts, suited to the affordability and feasibility for the family.

Limitations

The study was restricted to accidents among children who were below 5 years of age. If more than one child of less than 5 years of age was present in the house hold which was visited, the eldest among them were included for the study. The history regarding the accidents among the under-five children during the past 6 months was taken. This long period could have led to increased chances of difficulty in remembering the occurrence of accidents by the care takers.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
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