|Year : 2018 | Volume
| Issue : 1 | Page : 6-12
Prevalence and pattern of unintentional domestic accidents and trauma amongst children attending public hospitals in Kano, Nigeria
Sanusi Abubakar1, Abdulazeez Ahmed2, Zubaida Farouk3, Mukhtar Gadanya1, Mustapha Lawal Jimoh4
1 Department of Community Medicine, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Otorhinolaryngology, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Pediatrics, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
4 Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||21-May-2018|
Dr. Abdulazeez Ahmed
Department of Otorhinolaryngology, College of Health Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano
Background: Unintentional injury remains the leading cause of morbidity and mortality among children worldwide. This study assessed the knowledge, attitude, prevalence, and practices toward the prevention of domestic accidents and injuries among caregivers of under-five in Kano, Nigeria. Materials and Methods: Three hospitals located within Kano metropolis were chosen because they are the main referral hospitals located strategically in three local government areas and well patronized by the populace as evidenced by their patient turnover. Respondents (caregivers) were selected for administration of the questionnaires using systematic sampling technique based on the order of their presentation at the emergency pediatric unit (EPU). Results: Overall prevalence of domestic accidents in the three hospitals in the study was 13.7%. The mean age of caregivers was 29.6 ± 9.7 years and the majority of them were female 81.3%. Nearly 64.6% have formal education out of which 27.8% have up to tertiary education and most with at least five and above under-five under their care, with mean ages of the under-five children of 2.87 ± 2.82 years. Only 7.7% of the respondents had an overall good knowledge of domestic accident and injuries. Kerosene poisoning was the commonest domestic accident reported (34.4%) followed by falls (17.5%). Significantly, 30% of respondents had good practice toward domestic accident prevention largely due to preventive behaviors such as self-motivation (9.7%) and perceived danger (41.5%). Conclusion: This study demonstrates that domestic accidents especially those involving kerosene is common among children aged less than 5 years in a large sized family.
Keywords: Attitude, domestic accidents, practice, prevalence, prevention, under-five
|How to cite this article:|
Abubakar S, Ahmed A, Farouk Z, Gadanya M, Jimoh ML. Prevalence and pattern of unintentional domestic accidents and trauma amongst children attending public hospitals in Kano, Nigeria. Sahel Med J 2018;21:6-12
|How to cite this URL:|
Abubakar S, Ahmed A, Farouk Z, Gadanya M, Jimoh ML. Prevalence and pattern of unintentional domestic accidents and trauma amongst children attending public hospitals in Kano, Nigeria. Sahel Med J [serial online] 2018 [cited 2018 Dec 14];21:6-12. Available from: http://www.smjonline.org/text.asp?2018/21/1/6/232787
| Introduction|| |
Domestic accidents are inevitable events that can occur; however, they are largely preventable and their occurrence minimized among children and the elderly. Accidents are the main cause of injury and even death in children, as a matter of fact, the place where people regard as the safest place–home–hides many “hazards.” Domestic accidents are potentially harmful, unexpected, unintended, and abrupt occurrence affecting mostly a child which may or may not produce injuries and which leads to medical consultations. Domestic accidents can take place at home or the immediate surroundings of the home, and it is not related to traffic, vehicle, or sports. Domestic accidents are a worldwide public health problem, and in some European countries, domestic accidents kill more people than road accidents. Some sources consider accidents to be the leading cause of death worldwide  while others yet put it among the five leading causes of death. Over 700,000 children die yearly as a result of injuries, especially in the developing world where 13% of the total burden of disease among children <15 years has been attributed to accidents and injuries. Moreover, even though the impact of accidents among under-five is substantially obscured by the high burden of infections and perinatal problems  in developing countries, with a reversal in this trend due to the success of infectious disease control programs, accidents are now reemerging as the leading cause of morbidity and mortality in developing countries.
National figures for the prevalence of domestic accidents among children in Nigeria are unavailable because of lack of an accident registry system or poor and/or under reporting, but the figures from different studies (mostly hospital based) from across the country indicate that they are high.,,,,, The most common causes for these domestic accidents ranged from accidental falls, poisoning, especially kerosene and food poisoning, accidental drowning, burns and scalds, etc., Children are vulnerable to domestic accidents because they are still developing and have not learnt to be aware of various environmental dangers;, this together with their curiosity, impulsiveness, and desire to master new skills put them at greater risk. The home is supposed to be the most safe and secure place for the child, unfortunately, many life-threatening yet preventable accidents can happen there. Hence, preventive and safety measures need to be instituted in the home to prevent domestic accidents among children because injuries sustained during the developmental period of a child can lead to permanent disability or even death, thus making the child unable to fulfill their full potential of living a productive and active life.
There are three main strategies for accident prevention, and these include education of both child and parents, modifying the environment of the child by ensuring safety measures and enforcing changes in the environment by the law. Moreover, research suggests that while education is the backbone for successes in many aspects of accident prevention, most successes however in accident prevention have followed environmental changes without undermining the role of education in the preventive process. The Haddon phase-factor matrix  is used as a tool and framework for understanding the origins of injury problems and for identifying multiple countermeasures to address injuries of many types. Different preventive strategies are identified within each cell of the matrix and they aim to prevent accident, injury, or health worsening/disability. It is usually necessary to perform several different strategies at the same time to achieve more effective results, for example, safe behavior, implementation of safety measures by adults, supervision, teaching children how to use playground equipment safely, buying safe playground equipment, etc., The use of the matrix can help to clarify which interventions might work at any or all phases of an event.
The general objective of this study was to assess the prevalence of knowledge, attitude, and prevention practices toward domestic accidents in children by their caregivers in Kano State.
| Materials and Methods|| |
Three hospitals in Kano metropolis were purposively selected for this study from a list of all tertiary and secondary health facilities located within Kano Metropolis because these tiers of hospitals were the major referral units that handle the various types of domestic accidents among children that are serious enough to warrant going to the hospital. The selected hospitals were Aminu Kano Teaching Hospital, Abdullahi Wase Specialist Hospital, Nassarawa, Kano and Murtala Muhammad General Hospital, Kano.
Aminu Kano Teaching Hospital is a Tertiary Health Institution is a 500-bed tertiary hospital that provides highly specialized services and general care for various disease conditions for different categories of patients coming from within Kano and the neighboring states. The hospital has staff strength of 1443, comprising both administrative and clinical staff. Murtala Muhammad Specialist Hospital is one of the oldest and largest hospitals in West Africa. The hospital serves the majority of people of Kano State, especially inhabitants of the old Kano City and also serves the people from neighboring states and countries. The facility has 20 departments and a bed capacity of about 250. The hospital has a monthly turnover of about 18,000 patients and staff strength of about 1000. Abdullahi Wase Specialist Hospital is the third hospital used in the study. It is located in Nassarawa GRA, Kano, Nigeria. The hospital renders specialist and general curative services and it is also a referral center. All the emergency pediatric units (EPUs) of the selected hospitals were then identified as the primary point of call for all cases of domestic accidents affecting children. A descriptive cross-sectional study design was used to conduct the study. Information was obtained through the use of an interviewer-administered questionnaire from a sample of caregivers of children attending the EPUs of the three selected hospitals involved in the study. A calculated sample size of 325 respondents was obtained after using the Fisher's equation for calculating sample size. The respondents were interviewed using the questionnaire consisting of both open- and close-ended-type questions. Each eligible respondent was selected using systematic sampling technique on presentation at the EPU during the study period after obtaining their informed consent. The study commenced after obtaining approval 6th April 2015 from the Health Research Ethics Committee of Aminu Kano Teaching Hospital, Kano. Two trained research assistants helped with collecting data from consenting caregivers, and respondents were assured of the confidentiality of any information they provided. The interviewer-administered questionnaire that was used in the study is divided into 5 sections, i.e., sociodemographic characteristics, knowledge of mothers of under-five children, attitude and beliefs about prevention of domestic accidents, past experiences of domestic accidents, and knowledge of risk factors and preventive practices.
In addition, a form was used to record the diagnoses, number and types of domestic accidents that presented to the respective EPUs during the period of the study.
The collected data were analyzed using MINITAB statistical software version 12 (Minitab Inc. Pennsylvania, USA). The results were presented in the form of tables and charts using Microsoft Word and Microsoft Excel, respectively. Quantitative data were summarized using measures of central tendencies, whereas qualitative data were summarized using percentages. The (χ2) statistical test was used to determine significant associations between categorical variables and a P ≤ 0.05 was considered statistically significant.
| Results|| |
Two hundred and ninety-nine out of 325 caregivers were interviewed, giving a response rate of 92%. The present study revealed that the mean age of caregivers is 29.6 ± 9.7 years, with a higher female preponderance (female: male ratio 4.3:1). Majority of the caregivers are married 257 (86%) with only 36(12.0%) in single parenthood, while 201 (67.2%) of them are adjudged to be the biological mothers of the children [Table 1].
During the study, question regarding knowledge of domestic accident prevention showed that only 62 (20.7%) respondents had poor knowledge while 237 (79.3%) in total had fair to good knowledge [Figure 1].
In order to determine if there was any association between variables in the study, bivariate analysis revealed significant associations between all the variables depicted [Table 2] in varying proportions. This was particular quite significant between knowledge of domestic accidents and educational status (0.001), and between practice of domestic accidents prevention and educational status of caregivers [Table 2].
|Table 2: Causes, age, and sex distribution of children noted to be involved in domestic accident during the study (n=212)|
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Regarding previous history/experience of domestic accidents about 76.2% of respondents had experienced domestic accidents that affected their children in the past while 22.1 had no previous history about 1.7% do not know or were unable to recall [Figure 2].
|Figure 2: Reported prevalence of 76.2% respondents who had experienced domestic accidents that affected their children in the past|
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The prevalence of domestic accidents at the various study sites were; AKTH, Kano (8; n=79; 10.1%), Abdullahi Wase Specialist Hospital, Kano 5 (n=52; 9.6%), MMSH, Kano 16 (n=82; 13.7%), table not shown.
The causes of domestic accidents ranged from kerosene poisoning (34.4%) to foreign body ingestion (11.3%) and animal bites (9.4%) in the home, usually more prevalent among male children from 1-2years and 7years. [Table 3]
|Table 3: Statistically significant association between variables in the study|
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| Discussion|| |
Two hundred and ninety-nine out of 325 caregivers were interviewed, giving a response rate of 92%. Accidents among preschool children are an important cause of injuries and deaths and are an important public health problem that needs active harm reduction interventions.
The present study revealed that the mean age of caregivers is 29.6 ± 9.7 years. This finding agrees with studies conducted in Ibadan, Assiut, and Abia  where the mean and standard deviation of the caregivers in those studies were 28.7 ± 5.8 years, 28.23 ± 6.91 years, and 31.6 ± 7.7 years, respectively. This is not surprising as the study areas are all located in developing countries where majority of caregivers are young mothers. This is because females in developing countries generally marry early due to gender, cultural, and religious reasons. This can be an increased risk factor for domestic accidents because a very young mother is likely to be inexperienced herself and unable to properly supervise her young child. The findings from the study also revealed that majority of caregivers are females 81.3% [Table 1], this agrees with findings in studies conducted in Abia  and Madagali. A likely explanation is that gender roles within most developing world settings such as the Northern Nigerian cultural setting dictates that women are responsible for handling visits to health facility in their roles as homemakers.
The results of the study also indicated that majority of caregivers belonged to a nuclear family (58.5%) although a significant number (41.5%) [Table 1], was from an extended family which is an additional risk factor for domestic accidents because when there are many people living under one roof, there is overcrowding, stress, and lesser ability to supervise a child. All of these can make a child more susceptible to having an accident. In fact, the study revealed that 70.6% of respondents had family size of six and above which is in contrast with what was reported in Assiut  and Sharkia, Egypt, where 34.9% and 20% of the respondents, respectively, in that study had a family size of six or more [Figure 1].
Only 7.7% of the respondents in our study had a good knowledge score of domestic accident and injuries types, cause, prevention, and practice, which agrees with the studies in Baghdad and Assiut  where only 9.2% and 11%, respectively, had good knowledge but this finding contradicts the findings of the studies in Nepal  and Abia, which reported 26% and 21.7%, respectively, as having good knowledge of domestic accidents. This may be as a result of low level of western education among caregivers in both the study area and Assiut  and Bagdad  as compared to Abia  and Nepal, which reported a larger number of caregivers with higher level of western education in their studies.
There were statistically significant associations found between the educational status of caregivers and knowledge of domestic accidents, and although it was in contrast to findings from a study  conducted in Ibadan, this may be explained by the fact that a significant number of caregivers in the study area had tertiary education compared to the caregivers in the Ibadan study  where most of the respondents had only secondary education. The findings of the study also showed that 55% of caregivers had a negative attitude toward domestic accident prevention which is similar to the findings in Ibadan  where most caregivers had negative attitude.
The number of cases of domestic accidents in children presenting at the various EPUs of the hospitals studied were 10.1% AKTH, Kano, 9.6% Abdullahi Wase Specialist Hospital, and 13.7% Murtala Muhammad Specialist Hospital, respectively. These findings are less than that obtained from similar studies conducted at public hospitals in Adamawa (40.25%) and Ibadan (45.6%), respectively. These findings may be relatively lower than that seen in other centers because this study took place during the 2015 industrial action in the health sector, when hospital services were virtually grounded and attendance by patients was significantly reduced. The history of previous domestic accidents among children of caregivers in this study was 76.2% [Figure 2], and this agrees with the findings of a similar study in Qalyubia Governorate and Abia, which reported figures of 72.66% and 74.2%, respectively.
The findings from the study showed that kerosene poisoning was the most common domestic accident reported (34.4%) followed by falls (17.5%) and burns (13.7%) [Table 2]. This is in contrast to what was found in Ibadan, Abia, Sharkia-Egypt, and Assiut were falls accounted for 32.8% and 45.4%, whereas cut wounds 37.35% and wounds 37.4% were the most common domestic accidents, respectively. The study also revealed that 56.1% of children were <3 years old, and this is similar to the findings in Sharkia 59.35%. More boys are affected by domestic accidents than girls in both studies, and this may be because male children are engaged in more physical activities in schools such as sports. In addition, anecdotally the preferred role models for boys are generally occupations where males dominate, for example, the military and these occupations encourage aggressive and more inquisitive behavior, all of which places them at additional risks for accidents or injuries.
The study showed that domestic accidents among children constitute a significant part of cases presenting at the EPUs of public hospitals in Kano [Table 3]. This is a major public health concern because of the pain, emotional turmoil, disability, and even mortality that can potentially follow domestic accidents and injuries among children. This is in addition to the burden and drain that domestic accidents have on the human and material resources of the public health system of Kano State.
A major limitation of this study is the fact that it is a hospital-based study and thus it suffers from the limitation of selection bias in terms of the kinds of patient injuries that attend these hospitals. More so, not all cases of domestic accidents go to these hospitals, and a significant number of domestic accidents are treated at home because it is thought that they are not serious enough to warrant going to the hospital, and all of this is in addition to an ongoing strike action during the study period.
| Conclusion|| |
This study demonstrates that domestic accidents especially those involving kerosene is common among children aged less than 5 years in a large sized family. Childproofing of homes, use of safer cooking fuels, and proper storage of cooking fuels, and better supervision of children among others is recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]