Epidemiology, impact and prevention of unintentional child injuries in Makwanpur District of Nepal

Background: Injury is a major health problem in children throughout the world and its burden is home particularly in poor countries. Nepal not only has a challenging economic environment but has a uniquely challenging physical environment, which exposes children to injury risk. Aims and objectives: The aim of this study is to estimate the burden of unintentional injuries and injury risk factors among children aged 0-17 years in the Makwanpur district of Nepal; and to assess preventive strategies used in the community. Methods: The study applied a mixed methods approach. This thesis includes three studies: I) A systematic review of the literature on childhood unintentional injuries was conducted for countries in the WHO's South-East Asian region. 2) A community-based household survey on childhood unintentional injuries was conducted across Makwanpur district. The aim of this survey was to identify the magnitude of and risk factors for injuries in children and the burden faced by families and the community. 3) A qualitative study, whose aim was to obtain an in -depth understanding about the issue of child injuries using: focus groups (FGDs) and key informant interviews (KIIs). Results: The systematic review included 26 papers published between 2000 and 2009. Studies were available from only five countries out of eleven countries in the SouthEast Asia region. A wide variation in the definitions of non-fatal injury was observed in the included studies. Most of these papers simply presented the rates and proportions of injuries and very few papers analysed risk factors in detail. The community-based survey covered 7,844 children from 3,441 households. The response rates were 98 and 90 percent tor rural and urban households respectively. More females were engaged in agriculture while more males are engaged in occupations such as service, labour work and business. Overall median of per capita monthly expenditure was below the level of I US$ per day. The annual rate of non-fatal injuries among children (aged 0•17 years) was 24.60 (95% CI 21.2•28.0) per 1,000 children, with the rates 101' boys almost double [32.5 (95%CI. 27.0-38.1 )] that for girls [16.7 (9S%CI 12. 7•20.8)]. The injury rate among children aged 5-9 years was found to the highest i.e. 30.3 (9S%Cf 22.9.40.0) per 1,000 children followed by 1-4 years. Falls, cuts/wounds and road traffic injuries were the major causes of non-fatal injuries. Injury rates varied greatly across the survey village development committees (VDCs) and geographical settings. Non-fatal injury rates varied for different geographical areas: high hill 12.3 (95%CI 7.6-19.7), mid-hill 27.5 (95%CI 20.9-36. 1), low land 28.6 (95%CI 22.1-37.0) and urban area 25.5 (95%CI 17.2- 37.5). Over 83% of the survey households have at least one child in them; the proportion of households having J or more children was 50% in the mid hills and 55% in low land VDCs. This thesis found a strong relationship between injury and the number of children in the household. Among the households with at least one injured child, the proportion of the households from the two lower quintiles of socioeconomic status was 58.1 % (95%CI 45.8~ 70.3) for mid hill and 60.3% (95%CI 48.2~ 72.4) for low land VDCs. The trend for the high hill and urban town of Hetauda was not consistent. The survey also examined the costs of treatment and time for caring for injured children. A total 53 households (29.28%) took loans to cover the costs of treatment (median USD 47; IQR 18-94). About 84% of all injured children received some treatment (including home treatments). Direct and indirect costs summed to be about NRs 1.3 million (-15,000 USD); two-thirds of which was medical expenses. Nearly 60% of families applied any safety measures after their child was injured. Most of the respondents actually provided some sort of instructions to their children or parents (in ease of infants and toddlers). Only a small proportion of parents applied any environmental modifications. The qualitative study presented the findings from 27 focus group participants and 5 key informants from different parts of Makwanpur district. Overall a lack of knowledge about childhood injuries was observed. However, lack of supervision was identified as a major risk factor for injuries to small children. Community people were keen to contribute in the prevention of injuries and to safeguarding children in the future. Achievement: There is a lack of data on the epidemiology of injury and relatively little research has been conducted on child injuries in Nepal and the community-based studies in this thesis fill an obvious gap. As well as providing useful information for both practice and policy in Nepal, it is hoped that the findings have wider implications that will be helpful for other low- and middle- income countries.EThOS - Electronic Theses Online ServiceGBUnited Kingdo