Anticipatory Guidance in Childhood Safety: How do Parents Fare? A Survey from a Tertiary Hospital

Unintentional home injuries are a major cause for childhood morbidity and mortality. Aims and Objective: To find the KAP among mothers about common home injuries and methods to prevent them. To assess how safe the houses of the study population is. Materials and Methods: 200 mothers attending the paediatric OPD of a tertiary care hospital in a sub-urban area of South India were enrolled. They were interviewed with a structured questionnaire. Details regarding socio-demographic aspects, knowledge, attitude and practices about common household accidents and ways to prevent were asked. The safety aspects of their homes were also noted down. The collected data were analysed with sigma plot 13(system software, USA). In the above statistical tools the probability value <0.05 was considered as significant. Result: The mean age of mother was 28.82 ± 4.93 years and age at marriage, 21.7 ± 3.55 years. 54% belonged to lower middle class and nearly 20% each in upper lower and upper middle class. Fall from height, Road traffic accidents followed by electrical injuries were the commonest Original Research Article Narayan et al.; JPRI, 33(47B): 974-981, 2021; Article no.JPRI.75496 975 accidents known by mothers. Socioeconomic status and educational levels had statistical correlation with few of the variables. Conclusion: Knowledge about home accidents is poor in the study population. Most of the houses are not child safe. Parent education about home injuries and training on first aid should be part of newborn follow up.


INTRODUCTION
A safe and healthy environment is of utmost importance for children for their healthy growth and development. Children are susceptible and vulnerable to injuries due to their physical size, difficulty in risk perceptions, impulsivity and risk taking behaviours. There are myriads of way that children can meet with an unintentional injury at home.
According to a report released by NIMHANS on "Advancing Child safety in India" [1] about 165 children die every day due to unintentional injury. Most of these injuries (around 60%) occur due to Road traffic accidents and the rest occur at home or school.
The common unintentional injuries occurring at home include fall from height, accidental ingestion of poisonous substance, drowning, electric shock, scalds, burns, cut injuries due to sharps, fall of heavy objects on children. Most of these injuries can be prevented by awareness of the problem and appropriate safety measures taken at home.
Hemalatha K et al. [2] in her study in rural population of Tamilnadu found home injuries to occur in 12.9% of the children. Most of the injuries occurred indoor and most were simple injuries, with laceration and cut injury being the commonest followed by scalds. Children of age 6-9 years were more prone to accidents.
Khan S et al. [3] in their study done at a sub urban area of Aligarh found a higher incidence of childhood accidents (64.4%). Most of the accidents occurred at home. Falls were the commonest accidents followed by Road traffic accidents, sharp injuries and scalds. Children of educated mothers were less prone for accidents in their study. Age and sex of child, mothers working status did not affect the home accidents significantly. In the study done by Sharma SL et al. [4] at an urban slum in Tamilnadu they found a prevalence of 39.1% of home injuries in children. In their study they found that accidents to occur more in overcrowded houses and in children of working mothers. Falls, burns and RTA were the common injuries noted in the study period.
This study was planned to take a survey about the knowledge, attitude and practices regarding unintentional injuries occurring at home and their prevention by parents of children aged 0-14 years.

MATERIALS AND METHODS
After obtaining clearance from the Institutional Review Board, (SMC/IEC/2021/03/037) a prospective descriptive study was carried out from March 2021 to May 2021. After obtaining informed consent, mothers of children attending the paediatric OPD where interviewed. Their socio demographic details, knowledge about common house hold accidents, their attitude regarding the safety of their house and preparedness if an accident occurs at home and the steps they have taken to make their home safe to children were collected in a semistructured questionnaire. Apart from this the details of their house with regards to safety like storage of sharps, medicine, inflammable items, water storage, access to terrace, balcony and main road were also collected. The socioeconomic status (SES) was graded based on Modified Kuppuswamy scale [5].

Inclusion Criteria
Mothers of children aged 0-14 years.

Exclusion Criteria
Mothers who did not give consent for the interview.

Data Analysis
For descriptive statistics, mean ± SD was used for quantitative variables, while number and percentage were used for qualitative variables.
For analytic statistics, independent samples t-test and One-Way ANOVA test were used to assess differences in means of quantitative variables. A p value of < 0.05 was assumed as significant.

RESULTS
The mean age of mother and father was 28.82 ± 4.93 years and 33.58 ± 5.3 respectively. The mean age of marriage was 21.7 ± 3.55 and 26.7 ± 3.9 years respectively for women and men. Out of this 31 (15.5%) females got married before the age of 18 years. The education and job profile of the parents and Socio economic status and the type of house are depicted in Tables 1 & 2. Of the 200 respondents, 98 (49%) of the respondents had 1 child, 82 (41%) had 2 children and 20 (10%) had 3 children. The primary caretaker was the parent in 159 (79.5%) of the cases, 36 (18%) were looked after by the grandparents. Siblings and servants were the primary caretaker in 2 (1%) and 3(1.5%) families respectively.
Knowledge of parents regarding the common accidents and the steps that can be taken to prevent them are depicted in Table 3. Analysis shows that the mother belonging to Upper middle and upper class were well aware of accidents than the mothers belonging to lower socioeconomic class and mother with lower educational status.
Attitude analysis shows that nearly 33% of respondents feel that accidents can occur at home and 55.5% are worried about it, 82.5% of them feel their house is safe. More than half of the respondents (63%) have talked about house hold accidents and 46% have had known personally of childhood accidents in the immediate family and surroundings.
The common accidents that the respondents heard about are RTA, scalds, fall from height. Irrespective of social economic status and educational qualification nearly 80% of mothers feel their house is safe for their children. Mother belonging to higher social status and with higher educational qualification talked about childhood accidents than the rest of the mothers. 79.5% said they would take their child to hospital if accidents occurred and 33.5% responded that they would give first aid before taking to hospital. 18.5% responded by saying they would inform their spouse first.     Analysing respondent's knowledge about common home accidents and the safety of their home are depicted in Table 4. We find that knowledge about home accidents and safety aspects of home do not match. Most of the respondent's home environment had issues that could lead to unintentional accidents. The safety features of the respondents' home environment are depicted in Table 5. Analysing the data on knowledge, attitude and practices based on SES and education, we found that there was not much significance. However mothers of higher SES and higher education had comparatively more knowledge, positive attitude and better safety practices at home Tables 6 & 7.

DISCUSSION
Literature review of childhood accidents and the KAP among parents did not yield many results in the Indian context. Most of the studies on childhood accidents are about prevalence of child hood accidents in particular locality and the safety issues of house and environment. The present study is about how knowledgeable parents are about childhood accidents and their attitude and practices with regards to the same. The knowledge about accident is largely limited to falls and road traffic accidents. Though their household environment is prone to accidents, awareness is very low amongst the parents. Most of the household store water in buckets or small tanks; Place Television on tables, have an open kitchen allowing children to access sharps, inflammables and thereby making them prone to fire and scald injuries. Electrical plug points are at low levels in majority of the respondent's house. In houses with terraces and balconies, most of children are able to access them and the parapet walls heights are not according to standard heights prescribed. Storage of inflammables and medicines is another aspect in which most of the interviewees fail. A miniscule percentage only stores it under lock and key and rest say they keep it out of reach.
This lack of awareness could be due to not reading newspapers or not watching news on TV or other social media. Almost every day there is news about RTA, accidental poisoning, fire, scalds and drowning but parents are not aware about it. With so many safety issues in the houses of the respondents a surprising 80% of them feel their house is safe for their children.
N Bhuvaneshwari et al. [6] did a study in Delhi. Their study was to find the prevalence of unintentional injuries in children and safety aspects of the home. They reported fall as the commonest injury followed by injuries by sharps and fire. The home was found not safe with regards to unsafe electrical points, unsafe stairs, and kitchens with access to sharps and fire. This is similar to the present study where the houses were not safe with regards to kitchen, plug points, access to inflammables and medicines. One more aspect we included was water storage. As in the present study area there is water scarcity throughout the year and most of the house-holds store water in buckets, tanks and other containers. This can lead to drowning due to lower centre of gravity in children.
G Gururaj et al. [7] in his letter to editor on injury prevention and care states that road traffic injuries in particular and other injuries are more common in lower socio economic group and the fatalities are also higher in this group. Non-fatal injuries are falls, burns and RTI and common cause for fatal injuries are RTI, drowning and suicides. He suggests strong policies, legislation, environment modification, capacity strengthening and human resources and public awareness and implementation of solution that are evidence based. The authors of this study feel that it should start at grass root level with education of mothers from antenatal period, during postnatal visits for immunization and during regular checkups. The parents should be educated about child rearing and about common accidents that can occur at a home and ways to prevent them. In the present study also we find that mothers belonging to lower socioeconomic status have less knowledge and practices regarding home accidents and their prevention respectively.
Nour O M et al. [8]. In their study included mothers of children aged 2-6 years. The age range of mothers was from 20-40 comparable with the present study. The percentage of working mothers was comparable with 37% in the present study vs. 41.4% in their study. The comparison of educational levels of mother in both studies show the percentage with regards to University degree, high school and primary being, and 34.5 and 57.6; 32 vs.32.9 and 34 vs.9.5 respectively. Mothers in both studies with higher educational status were more aware about childhood home accidents.
Comparing the present study with one done by Arturk U et al. [9] at Turkey we find that the mean age of the mothers to be similar (28.8 vs. 30.1years).
Educational status and socioeconomic status positively correlated with knowledge and attitude in their study as well as the present study. Comparing the safety issues in both studies we find that access to sharps was more in Turkey study (66.2% vs.32.5%), storing water in buckets and other containers was more in the present study (75% vs. 50%), safety aspects while cooking were more positive in the present study with 58 % turning the handles in as compared to 40.4% in the Turkey study. Access to balcony when one was present is more in the present study (60.4%) as compared to (51.4%) to Turkey study. Storage of inflammables and poisonous substance the present study failed miserably with 86% of them not storing it safely. In the Arturk study 41.1% did not store them safely.
Comparing our study with the study conducted by Al-Hajj S et al. [10] in Lebanon, it is found that the respondents were slightly older than the present study population (32.7 vs.28.8 years). The education levels were also higher in their study with more than 56.9% having a university degree as compared to 34.5% in the present study. Working mothers were more as compared to present study (48.1 % vs 37.5%). The present study had more than 75% from the lower socioeconomic strata as compared to their study (30%). The knowledge, attitude and practices about childhood accidents compared favourably with higher education and socioeconomic status.

CONCLUSION
Children are the future of the country, it is our responsibility to nourish and protect them so that they become useful citizens of the country. The bringing up of children is such an important task which is being done with no formal training or knowledge by parents in general. It is believed it is a natural instinct and there is no need for any training. But the modern environment is very accident prone for children. So it becomes imperative to educate parents starting from the antenatal stage about child rearing, home safety, first aid for common childhood accidents along with nutrition advice and immunization. This would reduce home accidents and help in bringing up healthy children with less strain to the hospital system.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).