July 2004, Volume 54, Issue 7

Short Communication

Importance of Health Education in Injury Prevention among Children

Y. Ahmed  ( Department of Family Medicine, Ziauddin Medical University, Karachi. )
Qudsia Anjum  ( Department of Family Medicine, Ziauddin Medical University, Karachi. )
Y. Usman  ( Department of Family Medicine, Ziauddin Medical University, Karachi. )
A. F. Qureshi  ( Department of Family Medicine, Ziauddin Medical University, Karachi. )

Introduction

Preventive medicine has always been part of the medical curriculum, but during the clinical training more stress is given to treat diseases. Most of the doctors hardly consider effective education and counseling as part of their practice, which is creating a gap in the knowledge of parents regarding their role in preventing injuries. A community-based study done in Canada showed that parent view injuries largely as a natural corollary of childhood and believe children learn about risk avoidance from injury experiences. It stated that parents neither considered injuries as preventable nor assume responsibility for preventing injuries among children.1

The American Academy of Pediatrics believes that office-based health education and counseling can contribute to childhood injury prevention. To help pediatricians implement injury prevention counseling, the Academy has developed The Injury Prevention Program (TIPP).2,3 A benefit cost comparison revealed that pediatrician injury counseling is a cost-effective method of preventing childhood injuries and should be more widely adopted.4 Another review article showed that education, environmental modification and legislation all have a part to play in injury prevention and their effect in combination is important.5 A recent comprehensive literature review on injury prevention counseling in primary care settings demonstrated positive results including improved knowledge, improved behavior and a decrease in injuries. Given proper advice and encouragement, parents can be motivated to protect their children from injuries. 6

The objective is to assess the information mothers have regarding injury prevention in children and has any of the health professional ever discussed the related issues.

Methods and Results

This is a cross-sectional survey, using purposive sampling method. A self-administered piloted questionnaire was administered to mothers belonging to middle and higher socioeconomic strata in various areas of Karachi. The data entry and analysis was done in Epi-info 6.04b.

A total of 53 mothers with mean age and standard deviation of 33+7 years were interviewed, 36% had qualification upto matric (10 years of education) and 64% above matric. All mothers had their children vaccinated, 93% knew about the Expanded Programme on Immunization (EPI), but only 57% mothers knew about booster vaccines.

A majority (79%) used baby walkers, 58% felt they are safe for children, 89% thought head injury and 67% thought fractures could be a consequence of using walkers. Half of the mothers (51%) had window guards and a quarter (25%) knew about spacing of bars in the baby crib. According to mothers the average age of children when they can be left unattended is 35 months, and that they can start using walkers at 10+5 months.

Eighty-nine percent (89%) mothers said that a child can be drowned at home and 60% said they can be drowned either in a bucket or a bathing tub. On inquiring about the amount of water in which a child can drown, 92% said it depends on age of the child and 49% considered height. Almost all (96%) considered choking as a complication of sweets, nuts and suparis and 93% would consult a hospital in case of emergency.


Car is driven by 86% mothers, 81% knew about seat belts, 28% used them for children and 22% thought injury due to impact can be prevented by using belts. Only 17% had car seats; knew about the specifications of their use and the age of children when to use them face back and front. Less than one percent thought these are important, safe or convenient. The mean age when seat belts could be used for children was said to be 25+18 months.

Over half (53%) considered lead as a poison; 40% knew paint contains lead and 53% knew petrol fumes contain lead, 36% thought lead effects IQ level and 25% felt lead causes behavior changes. The detergents, soaps and insecticides were kept under the sink by 17%, under the sink locked by 34%, above the sink by 51% and above the sink locked by 36% mothers. In case of ingestion of any hazardous material, 81% mothers would induce vomiting and almost all (98%) would immediately consult a doctor.

The percentage of mothers answering "yes" to whether health professionals discussed preventive measures on various issues were: immunization 64%; walker 30%; drowning 32%; seat belts 21%; car seats 11%; fall prevention 28%; sweets, nuts & suparis 53%; lead 15%; and hazardous material 38%.

Comments

This paper had concluded that the information of mothers on this important issue is inadequate and the injury prevention programmes that targets parents, need to focus on increasing awareness of the scope of the problem and promoting attitudes and beliefs related to prevention.

Counseling parents and children about the prevention of common childhood injuries is an important contribution towards preventing the major cause of childhood morbidity and mortality.

Owing to the complexity of the problem, simple solutions are unlikely to bring change. The need for further research remains and the intervention programmes should be implemented both locally and nationally.

References

1. Morrongiello BA, Dayler L. A community-based study of parents' knowledge, attitudes and beliefs related to childhood injuries. Can J Public Health 1996;87:383-8.

2. Office based counseling for injury prevention (RE9427). Policy statement American Academy of Pediatrics. Pediatrics 1994;94:566-7. http://www.aap.org/policy/00410.html.

3. American Academy of Pedicatrics. The Injury Prevention Program Introduction. http://www.aap.org/family/tippintr.htm updated: 5/21/2002 ref:12 /08/2003.

4. Miller TR, Galbraith M. Injury prevention counseling by pediatrician: a benefit-cost comparison. Pediatrics 1995;96:1-4.

5. Doswell T, Towner EM, Simpson G, et al. Preventing childhood unintentional injuries - what works? A literature review. Inj Prev 1996;2:140-9.

6. Kelly B, Sein C, McCarthy PL. Safety education in a pediatric primary care setting. Pediatrics 1987;79:818-24.

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