Recent reports indicate that accidental injuries are one of the most frequent causes of death and disability in the world; accidents comprise 16% of the burden of diseases worldwide. The traditional view of injuries as accidents or random events, has resulted in the historical neglect of this area of public health (Krug et al., 2000).
Even in developed countries, accidental injuries comprise 40% of deaths in children aged between 1 and 14 years, with an annual estimate of 20,000 deaths in children in these countries, many of which are preventable (Roach and O'Neale, 2001).
Home-type injuries in children are of importance regarding the home environment and the role of parents. In the study performed by Kopjar in children less than 3 years, the chance of accidents was less in nurseries than homes. However, a difference did not exist regarding children aged between 3 and 6 years of age. In a study performed by Kashaninia on injured children aged between 3 and 5 years of age, most children lived in homes considered to be at moderate to high risk areas. Most home injuries, however, occurred in places considered safe by parents (Kashani-nia, 1992; Hu et al., 1993; Wortel et al., 1993).
Among the most challenging problems in the next century will be to decrease the burden of accidents and injuries (Krug et al., 2000). In Iran, although during the previous decade, respiratory infectious diseases and diarrhea have been the most common causes of death in the under-fives, but in the recent years accidents still remain to be the most common cause of death in children.
However, till today, there has been a lack of attention toward research and scientific studies about home injuries in children, such that in the First National Health Congress of Iran, there were not enough well published articles in this regard in Iran. In this study, our aim was to assess the status of home injuries in pre-school aged children and its distribution according to variables including, age, sex, site, type of accident and damaged organ.
MATERIALS AND METHODS
Injury data were taken from a national community based injury registry for injuries caused by home injuries in rural areas of Iran. All children aged below 7 years who resided in the villages of Ardabil and who had been reported to be involved in Home injuries during the years 2000-2002, were included in this study. This included 6875 home injuries in preschool children reported by the Health Centers and general hospitals in Ardabil. Data of damaged organs, type of accidents, type of injuries and other background data were recorded in a pre-defined questionnaire for injury registry and analyzed by EPI info 2000. Frequency and relative frequency tables were used.
Among the total 22911 home injuries in all age groups reported during the years 2000-2002, 6875 aged less than 7 years were involved in home injuries. Of these, 2294 (43.6%) were girls and 3876 (56.4%) were boys. Mean age was 2.93±1.75 years, with median age of 3 years. A significant difference did not exist in mean age of the two sex groups. On the whole, 61% of the accidents occurred in the living room or bedroom, 23.9% in the kitchen, 12.9% in the yard and yard-garden and the remainder occurred in other parts of the house including the bathroom, roof, stable, stairs and stock room. The hands and fingers were injured in 2784 cases (40.6%); the legs and feet along with toes in 2396 cases (35%); multiple traumas in 234 cases (3.4%) and the other organs in the remaining cases (Table 1).
|| Main injured parts during home injuries to preschool children
|| Type of accidents causing injury to preschool children
|| Types of home injuries to preschool children
According to type of accident, 64.6% of cases were caused by hot liquids and 8% by hot objects. The remaining were caused by other objects (Table 2). The majority (75%) of accidents were due to burn s (Table 3).
Of the 6875 accidents, 5277 (76.8%), 993 (14.4%) and 605 (8.8%) were reported by the Primary Health Centers, Secondary Health Centers and general hospitals, respectively. Of these cases, 34 died, 15 became disabled and the remaining improved or was undergoing therapy.
In this study, children comprised 30% of all registered Home injuries, while only 10% of the total population of Ardabil involved children less than 7 years of age. In a study by Kopjar on home injuries, it was shown that per-population incidence was highest among children aged 6 years or younger (Kopjar and Wickizer, 1996). Cermaria and Simeoni (1998), reported that the 1 to 5 years age group and the over 10 year age group were most susceptible to home injury. In a study by Laflamme and Eilert (1998) on home injuries in preschool children, injury incidence was higher for children aged 1 and 2 years old and for boys at all preschool ages. Accidents were more frequent (56.4%) in boys than girls, which is in concordance with the results of a study performed by Kashaninia (1992) in which most home injuries also occurred in 3 to 5 year old children attending a educational Hospital in Tehran. In another study performed on under 5 year old children attending the hospitals of Ardabil, the relative frequency of accidents were 61.7% in boys and 38.3% in girls (Mazheri and Fuladi, 2000). The prevalence of home-injuries in boys is higher than that reported for girls. This is also true for accidents which take place outside the home. Most accidents (84.9%) occurred in the rooms and kitchen. In Kashaninias study most accidents had taken place in the garden or rooms of their home. In the current study, the majority of children lived on the first floor in homes with only 1 or 2 rooms. However, this study included children from both urban and rural areas, most of whom were city dwellers (Kashani-nia, 1992).
In the present study, more than 5157 (75%) of home injuries in children were caused by burns, 4439 of which were caused by hot fluids, however only 1640 (23.9%) of the accidents took place in the kitchen where we may assume to be the main place for such kind of burn accidents. This could be explained by the custom to serve tea and hot food and sometimes even use cooking utensils including kettles, not only in the kitchen, but also in other rooms as well. The difference in type of injury between nationalities has been notified in Hjerns et al. (2001) study in Sweden in which children of mothers born in a nonwestern country were more likely to have been admitted to hospital because of scald injuries. In a study performed by Mazaheri, burns comprised 33.4% of all accidents and 38.7% of the accidents resulted in fractures, whereas in our study, 75% of accidents were due to burns and only 2.1% resulted in fractures. Pelech et al. (1998) reported that most (52.2%) accidents resulted in fractures. Falls and burns predominated as the cause of injury in a study by Jordan et al. (1993) on injuries of children in Baltimore.
Fall from altitude occurred in 5.6% of accidents in our study, while it was 4% in Kashaninias study. Of course, fall from altitude is not much unexpected inside the home. Hu and his colleagues reported that 51% of home injuries in children are falls from heights. The high frequency of falls and low frequency of burns in Canada reported by Hu et al. (1993), compared to the villages of Ardabil can be expected by the difference in living habits and facilities. A study performed in a rural population in the northern areas of Pakistan showed that burns, fall from heights and road accidents together constituted 82% of accidents (Mushtaq and Ali, 1999). In this study, death and disability occurred in 49 (less than 1%) of cases. Of course, home injuries rarely lead to disability or death.
On the whole, 75% of home injuries in children were caused by burns alone and 86% of these were caused by hot fluids, that is considered to be preventable type of accident and suggests health sector policy makers to act seriously on increasing peoples knowledge about the prevention of accidental injuries.
Limitations of the study
||Little cooperation of private clinics.
||Lack of data about some important variables such as total number of children
in each house hold and total floor area of each home.
We hope future researchers will consider these factors in their studies.
This work could not have been completed without help of Dr. Derakhshan, Dr. Shami, Dr. Sepehram and Mrs. Amini. We thank also to professor Lucie laflamme for her kind recommendations.