A STUDY ON AWARENESS AND PREVENTION OF

CHILDHOOD INJURIES AMONG MOTHERS

BY

INTERNSHIP STUDENTS BATCH NO: 17

V.S.EDUCATIONAL TRUST, SKS SCHOOL OF NURSING

SKS HOSPITAL, ALAGAPURAM, SALEM -4.
 CERTIFICATE

This is to certify that the dissertation a study on AWARENESS

AND PREVENTION OF CHILDHOOD INJURIES

AMONG MOTHERS IN URBAN HEALTH CENTRE,

KUMARASAMYPATTI, SALEM. was carried out by

internship students in V.S. Educational Trust, SKS School of Nursing,

Salem, submitted in partial fulfillment for the diploma in Nursing

Programme.

Mrs. S. SUMATHI., BSc(N)

Principal
 ACKNOWEDGEMENT

Praise be to the lord my rock, trains my hands for war my fingers for
battle.

With profound gratitude we wish to express our sincere indebtedness

to Mrs. V. Vasantha, Managing Director and Dr.V.SureshKumaran Director at
SKS School of Nursing run by V.S.Educational Trust, Salem for providing
opportunity to undertake the course.

We express our deepest gratitude to Mrs. Pushphalatha, Principal and

Mrs. S. Sumathi, Vice Principal, SKS School of Nursing for their expert
guidance and valuable suggestion which has continuously motivated us for
the successful completion of this dissertation.

We express our heartfelt gratitude and exclusive thanks to

Mrs.K.Shyamala, Faculty, SKS School of Nursing for her patience,
encouragement and valuable suggestions which helped us to lay a strong
foundation for this study.

We extend our special gratitude to all the experts for their validation
of tool to improve this dissertation.

We express our sincere thanks to Medical Officer , Salem who gave us

enthusiastic guidance and permitted us to utilize the sample for this study.

We express our sincere gratitude to all Mothers who participated in the

study, with out their Co- Operation the study would not have completed.

Internship Students

Batch No: 17
 CONTENTS

S.NO. TOPICS Page No.

CHAPTER I

1. INTRODUCTION: 1

TYPES OF CHILDHOOD INJURIES AND

HOW THEY OCCUR

PREVENTIONOF CHILDHOOD INJURIES

NEED FOR THE STUDY

CHAPTER - II

2. REVIEW OF LITERATURE 16

CHAPTER III

3. METHODOLOGY 25

CHAPTER IV

4. DATA ANALYSIS AND INTERPRETATION 27

5. CHAPTER V

DISCUSSION, SUMMARY, CONCLUSION, 35

IMPLICATION AND RECOMMENDATIONS

6 CHAPTER VI

BIBLIOGRAPHY 41
 CHAPTER I
1. INTRODUCTION

Every child in the world matters. The landmark convention of United

Nations Organization on the rights of the child, ratified by almost all
governments promises to protect children from injury and violence and to
provide a safe environment for them. It further states that the institutions,
services and facilities, responsibility for the care of protection of children
should conform with established norms. Implementing these rights
everywhere is not easy. But it can be achieved by concerted action.

Children are exposed to hazards and risks as they go about their daily
lives and are vulnerable everywhere to the same types of injury.

What is an injury?

An injury is defined as The physical damage that results when a

human body is suddenly subjected to energy is amounts that exceed the
threshold of physiological tolerance or else the result of a lack of one or
more vital elements such as oxygen.

Who is a child?

The definition of the United Nations Convention on the rights of the

child says a child means every human being below the age of 18 years.
Other concepts related to children, though, are more fluid Childhood is a
social construction, whose boundaries shift with time and place and this has
implication for vulnerability to injury.

A 10 years old is one country may be protected from economic and

domestic responsibilities, but in another country subjecting tasks may be
the norm and considered beneficial for both the child and the family. Thus,
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 childhood and developmental stages are inter wined with age, sex, family
and social background, school work and culture. Rather than being rigidly
measures they should be viewed through Context culture and
competences.

WHY IS CHILD INJURY IMPORTANT?

Childhood injury is a major public health problem that requires urgent

attention. Injury and violence is a major killer of children throughout the
world, responsible for about 9,50,000 deaths in children and young people
under the age of 18 years each year ( Who Global Burden of Disease, 2004
update). Unintentional injuries account for almost 90% of these cases. They
are the leading cause of death for children aged 10-19 years.

In addition to the deaths Tens of millions of children require, hospital

care for non fatal injuries. Many are left with some form of disability, often
with lifelong consequences.

The burden of injury on children falls unequally. It is the heaviest

among the poor with the burden greatest on children in the poorer
countries with lower incomes. Within all countries, the burden is greatest on
those from low-income families. Overall more than 95% of all injury deaths
in children occur in low-income and middle income countries. Although the
child injury death rate is much lower among children from developed
countries, injuries are still a major cause of death, accounting for 40% of
all child deaths.

TYPES OF CHILDHOOD INJURIES AND HOW THEY OCCUR.

Childhood injuries often occur because parents and caretakers undermine

what there are kids are capable of doing and not doing. Sudden milestone
achievements such as rolling over for the first time also cause babies to

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fall. Child development and child safety are so closely linked together that
you cannot ever expect the first one to occur and allow yourself to ignore
the latter, even for a few moments. Developmental milestones in a child are
also an indicator of increased risk of injuries for the child. It has been
noticed that most children under 15 years of age that need to go to an
emergency to get an injury treated are one to two year old. In this section,
we will cover the most common childhood injuries and ways to prevent
them.

Active toddlers that are about 15 to 17 months are known to have products
like gasoline and lead-based paints. They can open drawers and pry open
the bottles, become taller and can reach places where they couldn't in the
past and act like an insatiable explorer.

Babies who accidentally slip or crawl into bathrooms, unsupervised by

adults, are known to drown in toilets, buckets and pools, even with all the
supporting ring devices. By 9 to 11 months, babies try to put anything they
can lay their hands on in their mouth including broken parts of toys,
buttons, coins and medicines that they can find on floor. These can get into
their tiny air and esophageal passages and cause them to choke on them.
Children less than 4 years of age, do not have total control over there body
and may misjudge their movements, causing them to fall from furniture,
stairs or playground equipment.

Children less than Six months old are most susceptible to serious and
sometimes fatal injuries that occur due to falls.

Children who are about 6 to 8 months old start sitting on their own and
thus, parents often assume that they can let the baby alone in the bathtub
for a few moments while they answer the phone or the door. In such case,
3
babies have been known to drown or get submerged in water less than two
inches. Hot liquids and vapor can scald a baby worse than a grown up adult,
as his kin is thinner and much softer. So, keep your cup of tea or coffee out
of baby's reach and keep them away from hot tub or water.

Infant walkers are more hazardous than helpful, if babies are left alone wit
them. Babies use them to try to climb off the stairs (and fall in the
process), get tipped over very easily and reach things that are dangerous
for them and supposedly have been kept out of their reach.

Injuries that occur due to accidentally hitting a child, who suddenly runs out
of street, falling out of a car or accidentally set the car in motion while
playing with steering and keys, mostly occur when caretakers are not
vigilant enough for the child who is increasingly becoming more active and
is innately curious.

Newborns to five months old have limited mobility so most of the injuries
that they face, occur due to caretakers' fault or neglect. A young sibling or
who may accidentally let the baby fall may cause an injury to the baby.

The intense curiosity of children to try and experiment with anything they
can find peaks around 21 to 23 months and this is also the peak time for
injuries such as drowning and poisoning occur.

When kids learn to crawl and roll, they love to perform their antics and if
you let them alone for just a while, they may fall from bed, sofa or crib.

Child injury and gender

Boys tend to have both more frequent and more severe injuries than girls.
Sex differences in injury rates appear within the first year of life for most

4
types of injury. According to WHO data, in children under 15 years, there
are, on average, 24% more injury deaths among boys than there are
among girls.

Data from developed countries indicate that, from birth onwards,

males have higher rates of injury than females, for all types of injury. The
pattern is less uniform in low-income and middle-income countries, but the
overall gender differential is clear, with injury death rates around one third
higher for males under 20 years of age than for females.

A number of reasons for these differences in injury have been put forward
and investigated. One study found that sex differences were not completely
explained by differences in exposure to risk and that differences in injury
rates begin to appear at the same age as differences in behaviour. Various
theories have been proposed for the difference in injury rates between boys
and girls. These include the idea that boys engage in more risk taking than
girls, that they have higher activity levels, that they behave more
impulsively. Also included are the suggestions that boys are socialized in a
different way from girls and are less likely to have their exploration
restrained by parents, that they are more likely to be allowed to roam
further, and that they are more likely to be allowed to play alone.

Child injury and socioeconomic factors

Most of the childhood injury burden rests in low-income and middle-income

countries, and within these countries, poor children are disproportionately
affected. Some of the most vulnerable groups are those who live in chronic
poverty. They are a heterogeneous group, often living in remote rural areas
or conflict zones or else displaced. In the Islamic Republic of Iran, for
example, a community based survey has shown that the majority of fatal
5
unintentional injuries to children under the age of 15 years occur in remote
or rural areas. The chronic poor have few buffers against shocks such as
income and social networks. The first target of the Millennium Development
Goals is to halve, between 1990 and 2015, socio economic factors and risk
for injury. A broad range of socioeconomic factors associated with injury
risk has been identified. These factors include:

economic factors such as family income;

social factors such as maternal education;

factors related to family structure including single parenting, maternal

age, numbers occupying the household, and number of children; factors
related to accommodation such as type of tenancy, type of housing, level
of overcrowding and various factors describing the neighbourhood.

Socioeconomic factors affect injury risk in a number of ways. In poor

households, parents may not be able to:

properly care for and supervise their children, who may need to be left
alone or in the care of siblings;

afford safety equipment, such as smoke alarms or safety helmets.

Children living in poverty may be exposed to hazardous environments,

including:

a high volume of fast-moving traffic;

lack of space and facilities for safe play;

cramped living conditions, with no proper kitchen and open cooking fires;

6
unprotected windows and house roofs, and stairs without handrails.

Access or the lack of it, to good-quality medical services is an

important explanatory factor for variations in mortality rates. In a Nigerian
study, 27% of 84 children admitted to hospital for a burn injury died as a
result of their injury, in contrast with a similar study from Kuwait, where 1%
of a sample of 388 children died. This discrepancy, though, may also be
related to differences in the severity of burns seen.

PREVENTION OF CHILDHOOD INJURIES

Preventing Burns in Kids:

Babies have thinner and softer skin and naturally, burns caused by hot
liquids and vapor scald them more deeply and at lower temperature. Water
with a temperature above 104 Fahrenheit can cause third degree burns
in a baby in just a few seconds. Infants who can crawl and toddlers like to
experiment with things and can just twist open a hot tap water in the
bathroom or the sink or may fall in a hot water bath tub while trying to
touch it. They may even pry open a thermos flask with hot coffee and let
the liquid fall on them in the process, causing severe burns.

One has to be careful while drinking or doing anything with hot liquids such
as soups and hot tea near a baby or they may just given the vessel a push
with their hands or legs. They can also just try to touch the handles of pots
and pans, causing them to tip and the hot contents can scald the baby quite
seriously. Here are some tips and ideas on how to prevent burns in kids.

Annual checkup of heating system is necessary, especially in families with

small children to avoid any malfunctioning such as fires and carbon
monoxide poisoning. Electrical appliances and cords should always be kept
7
 out of your kids' reach. Keeping fire extinguishers at home that can be
easily used and well within your reach at all times ensure greater safety for
you and your family.

Never allow children near space and kerosene heaters, wood stoves,
barbecue grills and fireplaces and erect barriers or install child locks, if
required to keep them out of the places where they are kept.

Never place hot liquids near the edge of a table, where your toddler can
teach it or from where they may fall easily if a table gets little unbalanced
accidentally.

Never try to hold your baby and carry hot liquids or drink hot tea or coffee.

People who smoke should be careful never to smoke in bed and dispose of
butts and ashes properly and not before they are fully extinguished.

Smoke detectors warn you in case of any fire or short circuit that may
cause your house to burn, so install them for your and your baby's safety.

The hot water heater should be sent at 120 F to prevent scalding in babies
even if they touch it accidentally.

Using table cloths in not safe in households with small babies for they can
just pull the cloth and make everything kept on it to fall including hot
liquids kept on the table.

While cooking, never allow the children in the kitchen. Naughty children can
be made to sit on a high chair while toddlers may be made to sit away from
the stove with handles of pots and pans turned away from them.

While travelling outdoors, be sure to cover young infants with hats and

8
shades and keep them out of direct sunlight. If necessary, use sunscreen.

CHOKING IN KIDS:

Toddlers would chew on small objects, right when they get their first tooth.
The little ones cannot be resisted to do this forcibly, because at this stage of
development, it is inherent in them to explore new things, by smelling,
touching and tasting them. They are curious to put whatever they come
across into their mouths and figure out the taste, in the process, they would
try to gulp the objects. During the process, chewing on objects often leads
to choking, because the little ones are distracted or playful while eating.

The prime reason behind choking in kids is the very small diameter of the
airway passage and gastrointestinal tract. Moreover, the swallowing
mechanism of babies is not fully mature. Apart from chewing on things, the
toddlers wound try to 'smell' the objects, which leads to a choke in their
larynx or the bronchi as well. They tend to insert small things, such as color
pencils and chalks into their nostrils, which chokes them and causes
suffocation. It is the sole responsibility of the parents and caretakers to
prevent the children from placing objects in the little mouth, because
almost anything and everything are potential choking hazards. Read the
article and learn how to prevent choking in kids.

Choking Hazards for Babies:

Avoid putting anything around baby's neck, including string or scarves.

Make sure that you remove clothespins from the children's clothing.

Never buy chap toys, because they break very easily. Make sure the toys
you purchase are safe enough for the toddler to play and do not cause
choking hazards in your child. Buy toys, whose smaller parts cannot be
9
detached by the kids. Children less than four years old should not be given
grapes, raw vegetables, sliced hot dogs, popcorn nuts, grapes, fruit chunks,
seeds and hard candy, because such food stuff get lodged in their throats,
easily. Cribs should always be placed away from cords, hanging from blinds
or draperies.

Small objects such as plastic bags, detachable parts on toys, buttons and
coins should be kept out of the reach of children.

Balloons such as latex and inflatable ones should be kept far beyond the
reach of the children, because they often tend to play with the stuff and end
up gulping them, which chokes them.

Large bites of food, when chewed on by kids, can causing choking when
they get caught in the throat. When they are choked in the throat, the food
stuffs block the airway, preventing oxygen from getting to the lungs and the
brain. Hence, always make sure that you feed your baby small bites of food.
Cut the food stuffs into very small pieces. The food slices should not excess
the limit of inch thickness for their diameter.

PREVENT DROWNING ACCIDENTS IN KIDS:

Since the infants start to sit on their own, as early as when they are 6
to 8 months old, most of the parents and caretakers presume that the little
ones could sit in the bathtub as well, without drowning. Contrary to this
assumption, studies reveal that the cases of submersion injuries and
drowning of infants in bath tubs are increasing day by day. Babies drowned
even for a few minutes are often admitted to the hospitals. Little more
grown toddlers are also at a risk of injuring themselves seriously, when
drowned in water bodies like fish tank, toilet, ponds and swimming pools.

10
The little kids need to be safeguarded whenever they are in contact with a
water body, because they are irresistibly attracted to the sparkling water.
With the guidelines given in the following lines, you will know how to
prevent the kids from drowning.

AVOID CHILDREN DROWNING:

At Home

After using your bathroom, always bolt the door, so that your toddlers do
not sneak into the room, especially when he / she is not supervised by a
caretaker.

Never leave your child alone in the bathtub. Always be with him / her, or
assign a caretaker to supervise the bath time.

Drain water from the bathtub as soon as you bathe your toddler in it.

Keep the toilet seal closed with it lid. You may also install childproof locks
on the toilet lid.

Empty the buckets or containers, filled with water , immediately after use.
Make sure that you keep them out of the reach of your toddler.

At Swimming pool:

Surround your swimming pool with a 4 feet tall fence. Ensure that the gaps
between the fences are no wider than 4 inches. Add an underwater pool
alarm that sets off, when something hits the water. That way, you will
ensure that your toddler, who doesn't known swimming, doesn't approach
the pool. Even if he / she approaches, make sure that the alarm is loud
enough to be audible, when you are indoors, so that you could take

11
 immediate action for his / her rescue. Install a rigid, motorized safety
cover to refrain the access to the pool, when it is not in use.

You can also prevent the toddler from approaching your pool, when not in
use, by locking the pool steps or ladders.

Do not leave the pool toys floating in water. In an attempt to retrieve the
toy, your child might jump into the pool, which may in turn lead to an
accident.

You may teach your child to swim, when he / she is 5 years old. Be sure to
drown proof your child when he / she is learning to swim.

Never allow your child to swim without the supervision of an adult.

FATAL FALLS & ACCIDENTAL INJURY IN KIDS

The most common reason for deaths in infants between 1 month and
1 year age is Sudden Infant Death Syndrome (SIDS). Next to it is
accidental injury due to falls from furniture, stairs, or playground equipment
and other places. Fall can cause serious injury and even turn fatal in young
children less than four years old. The risk of falls of course increase with
increased mobility in the child. Babies less than 5 months old have limited
mobility and fall or suffer injuries, mostly, due to caretaker's neglect or fault
or the environment. Here are some tips to prevent falls and accidental
injury in kids.

Never allow the young sibling to carry the child the child around or
he / she may let the baby fall accidentally.

Keep the floor clear of obstacles so that caretaker does not lose balance
because of toys lying around while carrying the child.
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If a young child persists and cries to take the baby into his or her lap, then
make him sit in the middle of the bed and make him or her sit cross-
legged. Then Place the baby safely in to the child's lap. Do not leave them
alone even for a second and be constant there to supervise them. Babies
normally start rolling over at the age of 4 or 5 months and may roll over the
furniture at this age. They may roll for the first time suddenly and fall
down. When the baby is on a high piece of furniture such as the changing
table, examining table in a doctor's office, sofa or bed, do not turn your
back or your neck even for an instant. If you must move, there must be
pillows or barriers around the baby to prevent her from falling down.

Make sure that the crib sides are raised and firmly secured.

Install child gates at the top and bottom of stairways.

Never places any furniture near windows.

Install operable window guards on all windows.

Do not let the child use an infant walker, unsupervised by an adult.

POISONING IN CHILDREN

Toddlers are quite active, curious and fearless explorers in their own right.
At their tender age, they learn to use chairs and climb up to reach things
that are kept supposedly out of their reach. The highly active toddlers
would strive to open the bolted doors, drawers and closets. In the process,
they might come across things that seem to attract them, but are
hazardous for their health. The little ones are not aware of the health
hazards of the harsh chemicals, medicines and paints that they come
across. In a way to 'taste' the new things, such as paints, medicines, they

13
tend to swallow the chemicals. Eventually, they end up in being poisoned
due to eating and drinking toxic things that cannot be ingested. This is the
case with most of the toddlers, because at their tender age, they cannot
understand what is edible and what is not. There fore, it is the duty of the
parents or the caretakers to store 'potential poisons' in such a way that the
toddlers never reach them. Learn how to decrease the risk of poisoning in
children, by following the tips given below.

Prevent poisoning in Child:

All the potential poisons like medicines, detergents, paints should be kept
out of the reach and sight of your children.

Make sure that all the medications syrups, ointments and capsules are
stored in a medicine box. The syrups and ointments should have child
safety caps on, so that your baby does not pry them open and drink them.
Store them in a locked cabinet.

Clear all the expired medications from your medicine box. This is because
outdated medicines are even more hazardous, when consumed.

Always keep your dustbin covered with a lid, so that you kids cannot dig
into the toxic things that you have thrown away.

Never transfer potential poisons like naphthalene balls, phenyl, paints and
cleaning products into coffee cans, milk containers, soda bottles etc. This
may lead your child to drink or eat it, accidentally, mistaking them for
edibles.

Install childproof locks in your cabinets and drawers, before your kids learn
to crawl and stand up straight.

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Keep some common poison treatments at home within your reach, so that
you can treat the kid during emergencies, in the absence of a doctor.
However, it is always suggested to call upon a doctor in case of poisoning.

Be precautions while using household products in locked cabinets

immediately after using them.

Do not take medications in front of your children. Never refer these

medicines as candy, because the children might swallow the 'candy' in your
absence, when they get an opportunity to get a hold of medicine bottles.

15
 II. REVIEW OF LITERATURE

Andrea Carlson Gielen et al., (1995) conducted a study In-Home

Injury Prevention Practices for Infants and Toddlers: The Role of Parental
Beliefs, Barriers, and Housing Quality. The research was designed to
contribute to the empirical literature on the scope and determinants of
parents' injury prevention practices among families living in disadvantaged,
urban areas. One hundred fifty mothers were interviewed about their living
environment when they brought their children (ages 6-36 months) to a
hospital-based, pediatric primary care clinic. Only 37% of respondents
reported that they knew their hot water temperature was 125 or less. A
majority (59%) of families reported that they did not use stair gates. More
than one fourth (27%) of respondents said they did not have smoke
detectors. Mothers uniformly reported very favorable attitudes and beliefs
and strong support from others for in-home injury prevention practices.
Factors significantly associated with the number of injury prevention
practices implemented were family income, housing quality, and
environmental barriers. Instead of attempting solely to persuade parents
about the value of injury prevention practices, skill-based interventions are
needed to help parents overcome specific barriers that result from living in
substandard housing and having very limited financial resources.

Barbara A. Morrongiello & and Sophie Kiriakou (2002)conducted a

study Mothers' Home-Safety Practices for Preventing Six Types of
Childhood Injuries: What Do They Do, and Why? to identify determinants of
mothers' home-safety practices for preventing six types of common injuries
to children (burns, poisoning, drowning, cuts, strangulation/suffocation

16
/choking, and falls).Methods: Home interviews

were conducted with mothers of children 1924 and 2530 months old
about home-safety practices. For each of 30 safety precautions to prevent
these six types of injuries, mothers indicated whether ornot they engaged
in the practice, and explained why.ResultsRegression analyses revealed
both common and unique determinants of mothers' home-safety practices
to prevent these six types of home injuries. For burns, cuts, and falls,
beliefs that child characteristics and parent characteristics elevated the
child's risk of injury were the key determinants of the mother's engaging in
precautionary measures. For drowning, poisoning, and suffocation /
strangulation / choking, health beliefs also contributed to predict mothers'
practices, including beliefs about potential injury severity and extent of
effort required to implement precautionary measures.Conclusions The
factors that motivated mothers to engage in precautionary measures at
home varied depending on the type of injury. Intervention programs to
enhance maternal home-safety practices will need to target different factors
depending on the type of injury to be addressed.

Barbara A. Morrongiello et al,. conducted a study

(2004) Understanding Unintentional Injury Risk in Young Children II. The
Contribution of Caregiver Supervision, Child Attributes, and Parent
Attributes to identify child and parent attributes that relate to caregiver
supervision and examine how these factors influence child-injury risk.
Methods Mothers completed diary records about supervision of their young
child (25 years) when at home. Standardized questionnaires provided
information about child attributes, maternal attributes, and childrens
history of injuries. Results Correlations revealed that child attributes and
parent attributes related both to actual maternal supervision and child
17
-injury scores. Regression analyses to predict injury scores revealed child-
temperament factors alone predicted all levels of severity (minor,
moderately severe, and medically attended), but parent supervision also
contributed to predict medically attended injuries. Conclusions; Both child
and parent factors influenced caregivers supervision of young children at
home and related to child-injury risk. For medically attended injuries, child
attributes and parent supervision both predicted risk, whereas for less
serious injuries, child factors alone determined risk.

G.Saluja et al., (2004) conducted a study The role of supervision in

child injury risk: definition, conceptual and measurement issues. The
purpose of this paper was to examine caregiver supervision and its role as
an active strategy in childhood injury prevention. Through a review of the
literature, the authors addressed conceptual and methodological issues
related to supervision, such as the question of how to define 'adequate
supervision.' Three critical dimensions (attention, proximity and continuity)
of caregiver supervisory behaviors are identified as important areas for
measurement. Presented is a framework for understanding the role of
passive and active supervisory behaviors within the social context. The
framework includes family and community characteristics and
policies/regulations that may be important in caregiver decisions to use
active or passive injury prevention strategies.

T. Tandon et al., (2005) conducted a study Paediatric trauma

-epidemiology in an urban scenario in Indiato identify the epidemiology of
paediatric trauma in an urban scenario of India and compare results with
studies from developed countries, and to formulate preventive measures to
decrease such traumas. Methods. Between January 2004 and 2005
inclusive, 500 paediatric, orthopaedic trauma patients presenting to the
18
 hospital were prospectively studied. Information was recorded in a
prescribed proforma. Results. The childrens ages ranged from 0 to 16years;
274 were males. Most fractures occurred in children aged 7 to 12 years and
decreased in older children. The ratio of fractures in left versus right upper
extremity was 2:1. In children aged 0 to 6 years, the most common injured
site was the elbow, whereas in children aged 7 to 16 years it was the distal
radius. In descending order, most injuries were sustained at home (47%),
in school (21%), due to sports (17%), and due to vehicular accidents
(13%). Conclusion. An effective accident prevention programme in
developing countries requires changes in lifestyle and environment, and
overcoming obstacles such as ignorance, illiteracy, and inadequate
resources.

Kendrick D et al., conducted a study (2007) Parenting interventions

for the prevention of unintentional injuries in childhood to assess the
effects of parenting interventions for preventing unintentional injury as well
as increasing possession and use of safety equipment and parental safety
practices. They included randomised controlled trials (RCTs), non-
randomised controlled trials (non-RCTs) and controlled before and after
studies (CBAs), which evaluated parenting interventions administered to
parents of children aged 18 years and under, and reported outcome data on
injuries (unintentional or unspecified intent), and possession and use of
safety equipment or safety practices. Parenting interventions were defined
as those with a specified protocol, manual or curriculum aimed at changing
knowledge, attitudes or skills covering a range of parenting topics. Results
indicated that intervention families had a significantly lower risk of injury
(RR 0.82, 95% CI 0.71 to 0.95). Several studies found fewer home hazards,
a home environment more conducive to child safety, or a greater number of

19
safety practices in intervention families.Conclusion: Parenting interventions,
most commonly provided within the home using multi-faceted interventions
may be effective in reducing child injury. The evidence relates mainly to
interventions provided to families at risk of adverse child health outcomes.

Jagnoor et al., (2011)conducted a study Unintentional injury deaths

among children younger than 5years of age in India: a nationally
representative study to determine the mortality burden associated with
unintentional injuries among children younger than 5years of age in
India.Methods The Registrar General of India conducted verbal autopsy for
all deaths occurring in 20012003 in a nationally representative sample of
over 1.1 million homes. These verbal autopsy reports were coded by two of
130 trained physicians, who independently assigned an ICD-10 code to
each death. Discrepancies were resolved through reconciliation and, if
necessary, adjudication. The probability of death during the first 5years of
life (per 1000000 live births) was estimated from the 2005 United Nations'
population and death estimates for India, to which the proportions of
deaths from the mortality study were applied. Results: Unintentional
injuries were the sixth leading cause of death among children under 5 years
of age. In 2005, unintentional injuries led to 820000 deaths (99% CI
710000 to 880000) among children under 5years of age, a mortality rate
per 1000000 live births (MR) of 302 (99% CI 262 to 323). Mortality was
higher in rural areas (MR=339, 99% CI 282 to 351), mostly due to more
drowning deaths, than in urban areas (MR=173, 99% CI 120 to 237),
where falls were the leading cause of child injury mortality. Conclusion
Unintentional injuries, specifically drowning and falls, lead to substantial
mortality in children younger than 5years of age in India. There is a need
for continued monitoring of the injury burden and investigation of risk

20
factors for evidence-based effective injury prevention programmes.

Gururaj G (2011) conducted a study Injury Prevention and Care: An

Important Public Health Agenda for Health, Survival and Safety of Children.
He concluded that injuries affect the lives of thousands of young people and
their families each year in India. With the gradual decline of communicable
and nutritional diseases, injuries will be a leading cause of mortality,
morbidity and disabilities and the success achieved so far in child health
and survival is in jeopardy. Available data indicate that among children less
than 18 y, 10-15 % of deaths, 20-30 % of hospital registrations and 20 %
of disabilities are due to injuries. Based on available data, it is estimated
that injuries result in death of nearly 1, 00,000 children every year in India
and hospitalisations among 2 million children. Road Traffic Injuries (RTI's),
drowning, falls, burns and poisoning are leading injury causes in India.
Drowning and burns are major causes of mortality in less than 5 y, while
RTIs, falls and poisoning are leading causes in 5-18 y. A shift in the
occurrence of suicides to younger age groups of 15-20 y is a matter of
serious concern in recent years. More number of males, those in rural
areas, and majority of poor income households are affected due to injuries.
Child injuries are predictable and preventable. Children have limitations of
size, development, vision, hearing and risk perceptions as compared to
adults and hence are more susceptible and vulnerable to injuries. Thus, it is
important to make products and home - road and school environments
safer along with greater supervision by parents and care givers. The key
approaches include vehicle and product safety, environmental modification,
legislation and enforcement, education and skills development along with
availability of quality trauma care. Child injury prevention and care requires
good quality data, building human and financial resources, strengthening

21
policies and programmes based on evidence and integrated implementation
of countermeasures along with monitoring and evaluation. Child injury
prevention and control is crucial and should be an integral part of child
health and survival.

Sadia Bukhari et al., (2011)conducted a study Ocular Trauma in

Children in Pakisthan to evaluate the causes of ocular trauma,
management and visual outcome in children. Materials and Methods: This
prospective observational case series was conducted at the Department of
Pediatric Ophthalmology, Isra Postgraduate Institute of Ophthalmology / Al-
Ibrahim Eye Hospital, Karachi from November2009 to October 2010. All
patients of Ocular trauma aging less than 15 years were included in the
study. Results: A total number of 173 children (174 eyes) presented with
ocular trauma from November 2009 to October 2010. Minimum age of
presentation was 2months, while the maximum age was 180 months with
mean of 97.172 months (SD = 41.82). Out of total number of children, 125
(72.25%) were male and 48 (27.75%) were female. Blunt mode of trauma
was the most frequently observed mode of injury among children and was,
seen in 88 (50.6%) patients. The causes included Vegetative material in 25
(14.4%) and wooden stick in 23(13.2%) patients. Fifty four (31%) patients
were treated surgically while rest of the patients was treated medically.
Most common cause of decreased vision was disorganized globe seen in 21
(12.1%) patients followed by corneal opacity in 18(10.3%) patients.
Conclusion: Pediatric ocular trauma is a common cause of ophthalmic
consultation. These injuries are mainly result of the blunt trauma. Majority
of patients are young boys. There is a need for increasing awareness among
parents to prevent such injuries.

Reich SM et al., (2011) conducted a study Using baby books to

22
increase new mothers' safety practices to determine whether educational
baby books are an effective method for increasing low-income, first-time
mothers' safety practices during their child's first 18 months. METHODS:
Primiparous women (n = 167) were randomly assigned to 1 of 3 groups: an
educational book group, a non-educational book group, or a no-book group.
Home visits and interviews measured safety practices when women were in
their third trimester of pregnancy (baseline) and when their children were
2, 4, 6, 9, 12, and 18 months of age. RESULTS: Women in the educational
book group had fewer risks in their homes and exercised more safety
practices than the no-book group (- 20% risk reduction; effect size = -.30).
When the safety practices involved little time or expense (eg, putting away
sharp objects), the educational book group was significantly more likely to
engage in these behaviors than the no-book group (40% higher practices;
effect size = 0.19) or non-educational book group (27% higher practices;
effect size = 0.13). However, no differences were found between groups for
behaviors that required high effort in time, money, or hassle (eg, installing
latches on cabinets).Conclusion: Educational baby books appear to be an
easy and low-cost way to increase the safety practices of new mothers,
especially if the practices involve little to no time, money, or hassle.

Barbara A. Morrongiello & Stacey L. Schell (2012) conducted a study

Child Injury: The Role of Supervision in Prevention. They concluded that as
the leading cause of death and major contributor to hospitalization for
children, unintentional injury is a significant health problem in the United
States. How supervision influences childrens risk of injury has been of
interest for some time, and much progress has been made recently to
address definitional and measurement issues pertaining to supervision.
Increasing evidence supports the notion of a general relationship between

23
increased supervision and decreased injury risk, but also reveals that child
behavioral attributes and environmental characteristics can interact with
level of supervision to affect injury risk, making it challenging to develop
guidelines regarding what constitutes adequate supervision.

24
 CHAPTER 3

III- METHODOLOGY

The methodology of research indicates the general pattern of

organizing the procedure for gathering valid and reliable data for the
problem under investigation.

Research design and approach:

Descriptive design with survey approach was used in the present

study.

Setting of the Study:

The study was conducted in Kumarasamypatti, Salem, TamilNadu

Which is 5 Kms from SKS School of Nursing.

Population:

Mothers having children under the age of five years who were residing
in Kumarasamypatti, Salem.

Sample Size:

The sample size consists of 150 mothers having children under five
years.

Sampling Technique:

Convenient sampling technique was used for the present study.

Criteria for Selection of sample:

Inclusive criteria:

The mothers who have children under five years

25
Can speak and understand Tamil

Willing to participate in the study

Present during the period of data collection

Instrument:

Questionnaires and broad structured interview schedule was used to

collect information from mothers who are having children under five years.

Description of Tool:

The tool consist of questionnaires and broad structured interview

schedule for demographic data which include the age, occupation, number
of children, education and awareness about childhood injuries.

Development of the tool:

Questionnaire and Broad structured interview schedule was prepared

after reviewing related literature such as books, journals, periodical report
etc.

Data collection procedure:

Prior to collection of data permission was obtained from the Medical

Officer Urban Health Centre, Kumarasamypatti, Salem. Then the consent
was taken from the all mothers prior to the data collection.

Summary:

Descriptive survey design was carried out among 150 mothers in

Kumarasamypatti, Salem to identify the knowledge level of awareness
about childhood injuries and the knowledge about prevention of childhood
injuries.

26
 CHAPTER 4

IV. DATA ANALYSIS AND INTERPRETATION

The term analysis refers to the computation of certain measures along

with searching for patterns of relationship that exist among data groups,
analysis of data and closely related operations that are performed with
purpose of summarizing the collected data, organized in such a manner that
they answer the research questions.

TABLE I

DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS

No. of Participants

Age Occupation No of child Educational Status

Working

Non Working

High School
One

More than One

Illiterate

Graduate
Frequency

Frequency

Frequency
Percentage

Percentage

Percentage

Percentage
Frequency

Frequency

Frequency

Frequency
Percentage

Percentage

Percentage

150 20-35 73 49% 77 51% 62 41% 88 59% 52 35% 40 27% 58 38%

Years

27
 FIGURE 1

PERCENTAGE OF DEMOGRAPHIC CHARACTERISTICS OF

PARTICIPANTS

Occupation
65 Working
60
55
50
Non Working
45
40
No of Child
35 One
30
25 More than
20 One
15
Educational Status
10
Illiterate
5
0
High School

Graduate

28
 TABLE - II

LEVEL OF AWARENESS AMONG THE PARTICIPANTS ON

CHILD INJURIES.

S.No. Injuries Level of Percentage No of Children Educational Status

Awareness of
One More Illiterate High Graduate
Awareness
than One School

1 Burns High 103 69% 56 47 36 30 37

Low 47 31% 21 26 15 17 15

2 Drowning High 100 67% 58 42 30 34 36

Low 50 33% 26 24 16 14 20

3 Cutting High 95 63% 26 69 20 35 45

Injuries
Low 55 37% 25 30 24 12 19

4 Chocking High 78 52% 56 22 42 20 16

Low 72 48% 37 35 30 14 28

5 Poisoning High 102 68% 29 73 19 70 13

Low 48 32% 18 30 12 13 23

6 Falling High 97 65% 57 40 42 20 35

Low 53 35% 26 23 22 12 19

7 Emergenc High 88 59% 45 23 40 18 30

y aid
Low 62 41% 25 37 21 23 18

29
Table II Describe the level of awareness among the participants
on child injuries, no of children the participants had and their
educational status.
FIGURE 2

69%
70

60

50

40 High Level
31%
30 Low Level
20

10

Regarding Burns injuries 69% had High level and 31% mothers had Low
level of awareness.

FIGURE 3

Regarding Drowning injuries 67% had High level and 33% had Low level of
awareness.
70 67%

60
50
40 33%
High Level
30 Low Level
20
10
0

30
 FIGURE 4

70 67%

60

50

40 High Level
33%
Low Level
30

20

10

Regarding Cutting injuries 63% had High level and 37% had Low level of
awareness.

FIGURE 5

70

60
52%
50 48%

40 High Level
Low Level
30

20

10

Regarding Choking injuries 52% had High level and 48% had Low level of
awareness.
31
 FIGURE 6

70 68%

60

50

40 High Level
32%
Low Level
30

20

10

Regarding Poisoning injuries 68% had High level and 32% had Low level of
awareness.

FIGURE 7

70 65%

60

50

40 35% High Level

Low Level
30

20

10

Regarding Falling injuries 65% had High level and 35% had Low level of
awareness.

32
 FIGURE 8

70

59%
60

50
41%
40 High Level
Low Level
30

20

10

Regarding Emergency 59% had High level and 41% had Low level of
awareness.

TABLE III

PERCENTAGE OF AWARENESS ON CHILD INJURIES AMONG

THE PARTICIPANTS

S.No. No. of Injuries Level of Awareness Percentage

Participa
High Low High Low
nts

1 150 All injuries 103 47 69% 31%

33
 FIGURE 9

PERCENTAGE OF AWARENESS ON CHILD INJURIES AMONG

THE PARTICIPANTS

69%
70

60

50

40 High Level
31% Low Level
30

20

10

Table III shows that among the 150 participants 69% of participants had
High level of awareness on child injuries 31% had Low level of awareness.
Majority of participants had High level of knowledge on child injuries.

34
 V.DISCUSSION

A descriptive design was used to collect data from 150 mothers to

identify the demographic characteristics of participants such as occupational
status of the participants, number of children the participated had and their
educational status.

In the present study, among 150 participants who are aged between 20-35
years 49% were working and 51% were non working.

Among the participants 41% had one child and 59% had more than One
child.

Among the participants 35% were illiterate and 27% had completed High
school and 38% were graduates.

A descriptive design was used to collect data from 150 mothers to identify
the level of awareness among the participants.

Burns:

1) Among the participants One hundred and three mothers had High level
of awareness on Burns injuries.

i) Among them Fifty Six mothers had One child and Forty Seven
mothers had more than One child.

ii) Thirty Six mothers were illiterate and Thirty mothers had completed
high school and Thirty seven mothers were graduates.

2) Among the participants Forty Seven mothers had low level of awareness
on Burns injuries.

35
 i) Among them Twenty one mothers had one child and Twenty Six
mothers had more than one child.

ii) Fifteen mothers were illiterate and Thirty mothers had completed
high school and Thirty seven mothers were graduates.

Drowning:

1) Among the participants hundred had high level of awareness on

drowning injuries.

i) Among them Fifty eight mothers had one child and Forty Two had
more than one child.

ii) Thirty mothers were illiterate Thirty Four had completed high school
and Thirty Six were graduates.

2) Among the participants fifty had low level of awareness on Drowning

injuries.

i) In that Twenty Six mothers had one child and Twenty four had more
than one child.

ii) In that sixteen were illiterate, fourteen had competed high school
and twenty were graduates.

Cutting Injuries:

1) Among the participants Ninety Five mothers had high level of awareness
on Cutting injuries.

i) In that Twenty Six mothers had one child and Sixty Nine mothers
had more than one child.

36
 ii) In that Twenty mothers were illiterate, Thirty five had completed
high school, Forty five were graduates.

2) Among the participants Fifty Five mothers had low level of awareness on
Cutting injuries.

i) In that Twenty five had one child and Thirty mothers had more than
one child.

ii) In that Twenty Four mother were illiterate, Twelve mothers had
completed high school, Nineteen were graduates.

Chocking:

1) Among the participants Seventy eight mothers had high level of

awareness on Chocking injuries.

i) In that Fifty Six had one child and Twenty Two mothers had more
than one child.

ii) In that Forty two where illiterate, Twenty had completed high
school, Sixteen were graduates.

2) Among the participants Seventy two mothers had low level of awareness
on Chocking injuries.

i) In that Thirty Seven mothers had One child, Thirty Five had more
than One child.

ii) In that Thirty were illiterate, Fourteen had completed High school,
Twenty Eight were graduates.

37
Poisoning:

1) Among the participants One hundred and two mothers had high level of
awareness of poisoning injuries.

i) In that Twenty nine mothers had One child, Seventy three had more
than One child.

ii) In that Nineteen were illiterate, Seventy had completed high

school, Thirteen were graduates.

2) Among the participants Forty Eight mothers had low level of awareness
on poisoning injuries.

i) In that Eighteen mothers had One child, Thirty mothers had more
than one child.

ii) In that Twelve mothers were illiterate, Thirteen had

completed high school, Twenty three were graduates.

Falling:

1) Among the participants Ninety Seven mothers had high level of

awareness on Falling injuries.

i) In that Fifty Seven mothers had one child, Forty mothers had more
than One child.

ii) In that Forty two were illiterate, Twenty mothers had completed
high school and Thirty five were graduates.

2) Among the participants Fifty three mothers had low level of awareness
on falling injuries.

38
 i) In that Twenty Six mothers hadne child, Fifty three had more than
one child.

ii) In that Twenty two mothers were illiterate, Twelve had completed
high school, Nineteen mothers were graduates.

Emergency aids and services:

1) Among the participants Eighty eight mothers had high level of awareness
on Emergency services.

i) In that Forty Five mother had one children, forty three mothers had
more than one child.

ii) In that Forty mothers were illiterate, Eighteen had completed

high school, Thirty were graduates.

2) Among the participants Sixty two mothers had low level of awareness on
Emergency services.

i) In that Twenty five mothers had one child, Thirty Three had
completed high school, Eighteen mothers were graduates.

ii) In that Twenty one mothers were illiterate, Twenty three had
completed high school, Eighteen mothers were graduates.

CONCLUSION:

From the findings it can be concluded that Among the 150 participants,
majority of the mothers (69%) had high level of awareness and 31% of
mothers had low level of awareness. Giving health education and creating
awareness regarding prevention of childhood accidents will help to gain
100% safety of the children.
39
IMPLICATION:

Nursing Service:

The findings will help the Nursing professionals to gain knowledge

regarding childhood injuries and mothers awareness regarding this.
Working in hospitals and community health care centers it is the nurses
duty to teach the patients and their caretakers how to prevent injuries and
illness. To educate people preparing teaching programmes is very
important. This study will help a nurse to prepare and implement such a
teaching programme based on the need of prevention of childhood injuries.

Nursing Education:

Nursing students can utilize the findings to educate the people of their
area especially those who have inadequate knowledge regarding childhood
injuries.

Nursing Research:

These findings of the study can be utilized for conducting further

research among mothers about childhood injuries in various socio-economic
and cultural settings.

40
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Wissow, Judith D. Harvilchuck, In-Home Injury Prevention Practices for
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http://heb.sagepub.com/content/22/1/85.abstract

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WEB ADDRESS:

www.Childrenssafetynetwork.org/cites/childrenssafetynetwork.org/files/
Injury prevention whatworks.pdf

www.healthypeople.gov/2020

www.cdc.gov/injury/wisqars/index.html

http://www.babyhomesafety.net/safety_tips.htm

http://www.childinjuryprevention.org/

44