|Year : 2018 | Volume
| Issue : 1 | Page : 27-32
Prevalence of childhood injuries: A survey of injury epidemiology in rural population of Tamil Nadu, India
Kumarasamy Hemalatha1, V Ram Prabhakar2
1 Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Tiruchirappalli, Tamil Nadu, India
2 Department of Community Medicine, Government Theni Medical College, Theni, Tamil Nadu, India
|Date of Web Publication||18-Jun-2018|
Dr. Kumarasamy Hemalatha
Department of Community Medicine, Chennai Medical College Hospital and Research Centre, Tiruchirappalli - 621 105, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Injuries among children lead to disability in early years of life affecting their opportunities to lead a healthy life. It also has multiple impacts on family and society.
Objectives: The study was planned to find the prevalence of injuries among children and to study the pattern and determinants of injuries.
Materials and Methods: A community-based cross-sectional study was conducted for 3 months among children aged <18 years. Occurrence of injuries during the previous 6 months was included in the study. Data were analyzed using SPSS version 20.0 and presented in the form of mean and percentage.
Results: A total of 410 children have participated in this study. Injuries were more common among children aged 6–9 years compared to children of other age groups. Male children (52.8%) had more number of injuries than female children (47.2%). Lower limb (33.9%) was the most common body part injured. Cut injuries and laceration accounted for 56.2% of the injuries. Majority (43%) of the injuries occurred due to falls. Eighty-seven percent of the injuries were mild.
Conclusion: Severity of injury was mild in most of the injuries. Still pediatric injuries had contributed to economic loss to the family and affected schooling of the children.
Keywords: Children, injury, pattern, prevalence, rural
|How to cite this article:|
Hemalatha K, Prabhakar V R. Prevalence of childhood injuries: A survey of injury epidemiology in rural population of Tamil Nadu, India. J Med Soc 2018;32:27-32
|How to cite this URL:|
Hemalatha K, Prabhakar V R. Prevalence of childhood injuries: A survey of injury epidemiology in rural population of Tamil Nadu, India. J Med Soc [serial online] 2018 [cited 2020 Jan 28];32:27-32. Available from: http://www.jmedsoc.org/text.asp?2018/32/1/27/213954
| Introduction|| |
Almost 15% of the global population is living with some form of disability due to injuries and violence. Injuries-related deaths account for 9% of mortality worldwide. Among the leading causes of global burden of diseases, road traffic injuries and war-related injuries contribute to large proportion of disability-adjusted life years. Globally, every year about 950,000 children <18 years of age die due to injury and violence. Nearly 90% of these deaths were due to unintentional injuries. Children between 0 and 14 years shares one-third of the total population in India. Mortality due to injuries was 8.2% among children aged <14 years and injuries are the second leading cause of death among children between 5 and 14 years of age. Injuries in any form results in physical, psychological, social, and economic impact. Disability occurring in early years of life affects an individual's quality of life due to its impact on various domains such as self-care, mobility, daily activities, psychological effects, and social participation. Resulting disability due to injuries make an individual depend on the family members for all his activities of daily living and it also leads to stigma and discrimination by the family members and society. Lack of adequate community-based rehabilitation services, inaccessible transport facilities, and buildings also makes their life tough. The impact of injuries among children will be very huge compared to adults due to their lifelong disability, loss of educational opportunities, and loss of earning capacity. Domestic injuries, road traffic accidents, workplace injuries, injuries due to war and conflict, and child abuse contribute to the total burden of injuries among children. In India, child laborers have increased from 11.28 million in 1991 to 12.66 million in 2001. Nearly 30% of these children were involved in dangerous occupations such as construction works and weaving which has high chances of injury occurrence. Of the total road traffic-related injury deaths in the year 2004, children accounted for 21%. Almost 2/3rd of these deaths occurred in South East Asia and Pacific regions. Road traffic injury-related mortality was high low-income and middle-income countries which account for 93% of the deaths. Drowning is the leading cause of injury-related deaths among children aged <5 years. For children aged <5 years, household environment also serves as an important risk factor for injuries. Globally, several initiatives have been taken to increase awareness regarding the impact of injuries among general public and to reduce the occurrence of injuries, especially among children. Injury prevention regulations are often not properly enforced in rural, shanty towns and informal dwelling. Studies from different countries have reported that the rate of occurrence of unintentional injuries is high in rural area compared to urban area and the rate of health-care utilization is also less in rural area.,, Occurrence of injuries among children is more important than adults because of the lifelong impact of disability in the child, impact on the family, and high health-care cost. And also, children are not aware of the risk and consequences of the injuries. For each injury-related death, there will be hundreds of unreported mortality and morbidity. Most often, injury-related data are the estimates from the reported events. Since many injuries are mild in severity, all the injuries occurring in the community may not need medical treatment and hence not be reported to a hospital. Thus, hospital-based studies will not provide a holistic report of injuries occurring in the community. Hence, a community-based study was planned to assess the prevalence and also the pattern and determinants of injuries among children residing in a rural area of Tamil Nadu.
| Materials and Methods|| |
A community-based cross-sectional study was conducted for 3 months from September to November 2015 in the Rural Health Training Centre (RHTC) service area of a tertiary care teaching hospital in Tiruchirappalli district of Tamil Nadu. For the purpose of this study, a child is a person aged <18 years as defined by the United Nations Children's Fund. Calculated sample size was 215 households taking prevalence as 11%, household size as 3.9, and population proportion of children aged <18 years as 41%. Since cluster sampling was used a design effect of 2 was included in the sample size calculation. Sample size was calculated using the formula from guidelines for conducting community surveys on injuries and violence by the World Health Organization. Two-stage cluster sampling with probability proportion to size (PPS) was used to select the households. Cluster size was decided to be 20 and 10.75 clusters were needed to cover the calculated sample size of 215. It was decided to take 11 clusters to cover the sample size, and hence, the sample came to 220 households. Eleven clusters were selected from the 10 villages in RHTC area using PPS. Since household was the unit of study all children aged <18 years in that household were included in the study. For the purpose of this study, injury was defined as any bodily injury that occurred due to external cause, resulting from a sudden exposure to energy (which includes mechanical, chemical, thermal, radiant, and electrical) generated by agent–host interaction. Both intentional and unintentional injuries were included in the study. Ethical clearance was obtained from the Institute Ethical Committee of the teaching hospital. After obtaining informed written consent from the parents, a pretested, semistructured questionnaire was used to obtain information about the injuries. Injuries that occurred within a period of the past 6 months were included in the study and a recall period of 5 years was used for injury-related death among children. For children aged <5 years, the information regarding the injury was collected from mother and in the families where mother is not alive, fathers were considered as respondent. For 2 children, their parents have migrated to another area for occupation-related reasons, and hence, their grandfathers were the primary respondents. For children those who aged above 5 years, the child himself/herself was the respondent and the information was again verified from the parents of the child. One additional visit was made if the child was not available during first visit. The pro forma included information about the sociodemographic details, cause of injury, type of injury, number of events, treatment-seeking behavior. The collected data were entered in Microsoft Office Excel and was analyzed using Statistical Package for Social Sciences version 20.0 (IBM SPSS software, Armonk, NY, USA). The results were presented in the form of mean and percentages. Chi-square test was used to find the association between the variables. P < 0.05 was taken as statistically significant.
| Results|| |
A total of 220 families were interviewed for the study purpose. There were a total of 994 individuals in the study sample, of which 410 (41.2%) were children aged <18 years.
[Table 1] shows the sociodemographic information of the child and their families. Among the children aged <18 years, 56.1% were male children and rest were female children. Majority of the children (30%) belong to Class III socioeconomic status family based on modified BG Prasad's scale. Seven percent of the mother were illiterates and majority (59%) of the children's mother have completed high school education.
Fifty-three (12.9%) children had experienced at least one type of injury in the past 6 months. No deaths have been reported during the study recall period. Of the 53 children who suffered injuries, 5 children had more than one event of injury and the rest 48 had one injury event.
[Table 2] reveals that the proportion of injuries was high among children aged 6–9 years (17.3%) followed by under 5 years of children (16.5%). The age difference in the occurrence of injury was statistically significant with P = 0.04. Proportion of injuries was more in female children (13.9%) compared to male children (12.2%). However, the difference was not statistically significant.
Most common body part injured was lower limb (33.9%) followed by injuries in upper limb (25.8%) and head (24.2%).
From [Table 3], it was evident that minor cut wounds and laceration were the most common type (56.2%) of injuries occurred in the study participants. Scalds due to hot liquids contributed to 6.3% of injuries. Two children (3.1%) had fracture which occurred due to road traffic accidents and resultant fall from the vehicle (two wheeler). Majority of the injuries occurred during morning hours (38%). Injuries in afternoon and evening shared common proportion (29.3%).
|Table 3: Distribution of injuries based on its type and time of occurrence|
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[Table 4] shows that most common mechanism of injury in the study participants was falls (43.1%). Handling of sharp objects resulted in injuries among 15 (25.8%) children. Four children (6.9%) suffered injuries due to scalds and road traffic accidents. One event of dog bite was reported in a 7-year-old child. Except for 8 injuries, all others were mild in severity which did not require admission in a health facility and has not resulted in any form of disability. Of the eight injuries which resulted in some form of disability, 6 (9.4%) has resulted in temporary disability of the injured child for 1 week and 2 (3.1%) injuries made the affected child temporarily disabled for more than 1 month [Figure 1]. All these injuries have resulted in a mean expense of Rs. 521 among the study participants of 410 children and 4 families had borrowed money to meet the health-care expenses due to the injury. Mean school days lost among the injured children was 3.5 days and mean days of work lost for the caregivers was 3 days.
| Discussion|| |
In the present study, the prevalence of injury was 12.9%. All the injuries were unintentional in nature. None of the injury was due to intentional injury. As per the reports from several studies done in various parts of India, the prevalence of injury ranges from 11% to 64%.,, the prevalence of injury in the present study lies within this range. There were no deaths during the recall period of previous 5 years. Occurrence of injury was high among female children compared to male children. This is contradicting the results obtained from other studies.,, One study done in Agartala did not find any relation between gender and injury prevalence. In the present study, we observed that the injuries were more common among children aged 6–9 years compared to children aged <5 and 10–18 years. This result was similar to results reported by other studies.,, However, categorization for age group was different in these studies. Participants of the present study had injuries more commonly in lower limb. Similar result was reported by two other studies., Upper limb and head were the next two body parts which got injured in the current study. This result is concordant with the reports from other studies done among children., One child had injury in the abdomen region due to scalds. More than 50% of the children in the present study had cut injuries and lacerated wounds. Abrasion and contusion contributed to around 1/3rd of injuries. In contrast, another study done in Aligarh  reported that superficial injuries among under-five children and cut injuries were common among children aged more than 6 years. Most of the injuries occurred during morning hours (38%) and afternoon and night contributed to similar proportion of injuries (29%). Similar result was reported by global unintentional child injury surveillance report. Falls contributed to 43% of the injuries among the children participated in the present study. Similarly, many other studies reported falls to be the most common mechanism of injury among children.,,, Of the total number of falls reported, fall from level contributed to almost 90%. This was mainly because of the falls while playing within indoors and also outdoors. Handling of sharps has led to 29% of the injuries in the present study. This proportion of injury could have been avoided if the elders in the household have kept the sharps in a place which was not reachable to the child. Scalds contributed to 7% of injuries, which occurred due to spilling of hot liquids over the body surface. This could also be avoided if the child's mother has properly stored the prepared food items at higher level from floor which the child may not reach. None of the families reported injuries due to burns and drowning. Proportion of head injury among the children was 24% in the present study. This was mainly because of the higher proportion of falls among the children. More than 80% of the injuries in the present study were mild which was similar to another study done in Aligarh. Two injuries (3%) were severe enough to cause disability for more than a month. These two injuries were due to road traffic accidents which have led to fracture and the limb was immobilized. This has led to loss of 90 school days for the child.
| Conclusion|| |
Although majority of the injuries were mild in severity, injuries have also contributed to temporary disability among children and had led to loss of school days. A sizable proportion of injuries had occurred due the carelessness of the household members in maintaining the safety for their children such as keeping sharp instruments and hot liquids away from children.
| Recommendations|| |
To reduce the occurrence of injuries and to reduce the severity, multipronged approaches are essential which could focus on many factors leading to injury. Two major areas of focus could be (1) education of the community mainly mothers regarding safety practices at home which can reduce occurrence of majority of the injuries and (2) measures to reduce road traffic injuries so that severe and life-threatening injuries can be reduced.
| Strengths|| |
The current study being a community-based study has contributed in providing the true picture of injuries at community level and also the determining factors.
Information regarding the occurrence of injury was collected from both the child and parents. Hence, there is less chance of missing data.
| Limitations|| |
Recall bias would have affected the prevalence of injuries among children. For young children, mothers acted as respondents and if the child has not reported trivial injuries that proportion of injury would have been missed. Since this was a cross-sectional study, incidence of injuries could not be calculated. The study recall period covered only 6 months, and thus, we were not able to account for the seasonal variation of the injury occurrence.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]