The determinants and extent of home accidents in children under five years in Kisumu District, Kenya

Abstract

A cross sectional survey was carried out in Kisumu Municipality, Kenya to measure the extent and determinants of Home Accidents in 1465 children under the age of five years who were obtained from a total of 774 households. The objectives of the study were: a) To determine the prevalence of Home Accidents in children under five years, and the extent of the injuries resulting from these accidents with emphasis on the three most common ones; namely burns, poisoning and falls. b) To determine and compare the socio-demographic and environmental determinants of accidents in these children. c) To determine the types of injury, severity of injury, the immediate intervention and the outcome status of the victim following the occurrence at home, of an accident. d) To identify and recommend preventive measures that are feasible within the household \and its environment aimed at reducing the 0-5 years morbidity and mortality due to accidents. The sample was obtained randomly using multistage sampling procedure and the data was collected over a period of one month from the sampled clusters (villages and town estates). The child under five was the sampling unit. The main tool of the study was a semi structured questionnaire administered by trained enumerators, fluent in the local dialect (Dholuo), Kiswahili and English. Data analysis was done using the SPSSPC computer program. The study sample was found to have a male:female ratio of 1:1.04 and a population distribution not different from the national one. Judging from the parents education and occupation status, as well as the housing, they were mainly of low to middle socio-economic standing. Mothers were leading (80%) as the caretakers of children. The main caretaker other than parents was the maid (11%), followed by the grandparents (4%). The maids wereof primary level of education and mainly aged 13-18 years. This was a predominantly urban (63%) population, 22% were in the peri-urban and slum areas while 15% were in the rural area. Observation of risk factors, revealed that 59% of households used unprotected or open fire places; 58.1% homes had children under five years playing without routinely being supervised; 29.4% homes had custody of medicines and potentially harmful chemicals within easy reach of the children; Sharp instruments were within easy reach of the children in 36.1% of the homes; litter was scattered around the compound in 31% of homes; 36.6% of the households were assessed as crowded and only 15% had homes being used as work place such as workshops. These risks pose unknown danger and contribute to the occurrence of accidents such as bums and scalds, poisoning, falls, and others. A total of 456 children were reported to have suffered accidents within one year giving a prevalence rate of 32.1%. The most commonly occurring accident was due to falls (42%), followed by bums (31%), and poisoning (10%). The other accidents such as cuts, drowning and suffocation altogether formed 17%. About half of the injuries were of moderate severity while 32% were mild and 18% severe. The severe injuries were contributed to mainly by bums/scalds and falls in equal proportion and totalling 80%. The other 20% were due to poisoning and other accidents. Of all the accidents, mothers thought that 55% were preventable, 34%, not preventable while 11% did not know. The most important factors significantly associated with accidents occurrence were: the age of a child; gender or sex was not found to predict one's risk of getting an accident ( 33.6% and 30.8% for boys and girls respectively). The none educated mothers, unemployed mothers and the house wives were associated with lowest accident rates (29%) because they took direct care of their children as compared to the mothers with secondary or higher education who were more likely to leave their children in other people's hands when they went to work in formal or professional jobs (35%). The leading accident rates were found in those staying in semi-permanent houses, and in those staying in peri-urban and slum areas (42%) as compared to the urban (32%) and the rural with 22% (p=0.0000). Accidents occurring within the house structure predominated (51 %), whereas those occurring in the compound were 49%. The kitchen was found to be the place of accidents for the majority of accidents mainly burns (50%) and poisoning (39%). It was found that the accident rates were slightly higher in those homes with observed risks as open fire places and where children played without supervision although this was not statistically significant. Most of the accidents were found in households using hurricane lamps (55%) and the open flame lamp (30%). The highest accident occurrence rates were observed in those using firewood (35%), then those using gas (33%), charcoal (32.5%), lastly kerosene (28%) and electricity ~28%). The course of action following accidents was found to be appropriate as 88% of them were acted upon within two hours ( or 30 minutes in the case of poisoning). Of all the accidents, 25.5% resulted in admissions to health care institutions; 38.5% treated as outpatients; 31.5% were given home remedy; 2.5% were given other treatments such as prayers; and 2% were not acted upon. Most of the admissions were due to bums and scalds (46%), then falls formed 21%; and lastly poisoning (l5~). It was noted that of the accidents that led to admissions and outpatient treatments, bums/scalds and falls were the leading; those that were treated as out patients, bums were still leading together with poisoning. This shows the seriousness of these accidents as compared to falls which are leading in the treatments given at home and those that were not treated at all. It then follows that poisoning, bums and scalds have the mostimplications on the health system in general. These were all statistically significant findings. The outcome of injuries due to home accidents was satisfactory. Many (85.7%) resulted in recovery; while 12.2% had residual damages and chronic problems and 2% resulted in death. Bums and scalds and falls contributed the most to residual damages and scarring. These meant a certain amount of chronic problems and therefore additional burden after thel initial recovery or partial recovery. The deaths occurred due to poisoning (67%) and falls (11%) and others (22%). The highest fatality rate was found in the category of poisoning (13%); followed by others (accidents other than bums and scalds, poisoning and falls) (5%); and falls (0.5%). There were no deaths reported with bums. From this research it is recommended that more commitment and research is still needed in Kenya in the area of accidents prevention and particularly on the specific contributory factors. In order to curb childhood accident mortality and morbidity therefore, children should be given, more supervision which is age specific and appropriate as well as be encouraged to play out of the house in deliberately made safer environment and specifically not be allowed in the kitchen. There should also be laws that ensure protection of fireplaces, safe keeping of medicines and harmful substances, which can be monitored by health workers at the grassroots level, advocacy for repeated education of caretakers such as maids and accident prevention programs with active parental participation.