A STUDY TO ASSESS THE INCIDENCE OF ACCIDENTS AMONG MOTHERS OF UNDER FIVE CHILDREN IN THE SELECTED AREAS OF BANGALORE.

M.Sc. Nursing Dissertation Protocol submitted to

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

By

MS.JISMY MOL JOSEPH

M.Sc NURSING 1ST YEAR

2012-2014

Under the Guidance of

MR.THIRU KUMARAN

HOD, Department of Pediatric Nursing

K.T.G College of Nursing

Hegganahalli Cross

Vishwaneedam Post

Bangalore –91

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, KARNATAKA

CURRICULAM DEVELOPMENT CELL

THE HEALTH SCIENCES,

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS
/
Ms. JISMY MOL JOSEPH
1st YEAR M.Sc NURSING
K.T.G COLLEGE OF NURSING, BANGALORE
2 / NAME OF THE INSTITUTION / K.T.G COLLEGEOF NURSING
GANDHADAKAVAL
HEGGANAHALLI CROSS
VISHWANEEDAM POST, MAGADI ROAD
BANGALORE-91
3 / COURSE OF THE STUDY AND SUBJECT / M.Sc. NURSING
(CHILD HEALTH NURSING)
4 / DATE OF ADMISSION TO COURSE / 15TH MAY 2012
TITLE OF THE STUDY
“A STUDY TO ASSESS THE INCIDENCE OF ACCIDENTS AMONG
MOTHERS OF UNDER FIVE CHILDREN IN THE SELECTED AREAS OF BANGALORE ”.
6 / BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
Accidents currently form the third leading causes of morbidity and mortality in the developing and developed countries WHO. Accidents can take place in a wide variety of environment and there is a possibility of accidents in every sphere of humans life.1
A child’s community includes a number of places such as playground , gardens, fields, Ponds, rivers, and most crucially home itself. But their relative importance depends on a child’s way of life. For instance millions of children throughout the world live on the street and are vulnerable to a myriad of hazards and unintentional injuries. Although the WHO had taken strategies such as on the world health day 2002 was dedicated to “Healthy Environment for Children initiative” and in 2003 “Healthy Environment for children”, yet the number of incidences are soaring high.2
As per Vipul today’s “modern” risks result from the unsafe use of dangerous chemicals, the inadequate disposal of toxic wastes and other environmental hazards, noises and industrial pollution , unsafe chemical toys and house hold products may significantly harm the under five children. 3
Children are often exposed not to one risk factor at a time, but to several simultaneously. They frequently live in unsafe and crowded settlements, in undeserved rural areas or in slums on the edges of cities. Which lack access to basic services such as electricity, health care facilities, and meticulous supervision
6.1 /

of the care takers. Henceforth are likely to suffer suffer unintentional injuries and poisoning associated with unsafe housing and consumer products. Every year over 5 million ages from 0-14 , especially the under-fives are the victims of unintentional injuries. At times the injuries are so severe that it costs one’s life or renders them to permanent disabilities.2

Most injuries in children up to the age of five happen in the home. They can happen very quickly and are more likely to happen when adults are under stress or in a rush, or when there is a change to the usual routine. The kinds of accidents children have are linked to their level of development, so there are particular things to watch out for depending on the age of your child.
Babies 0-1 years old:
At this stage babies are able to wriggle, grasp, suck and roll over. There are a number of possible accidents that are common in this age group.
Suffocating and choking in babies:
Babies can swallow, inhale (breathe in) or choke on things like small toys, peanuts and marbles. Choose toys designed for the age of your baby and make sure that small objects such as marbles, peanuts and small toys are kept out of reach. Encourage older children to keep their toys away from the baby. Lay your baby on its back in a cot to sleep - don't put babies to sleep alone in an adult bed or on the sofa.
Falls:
Falls can happen if you leave your baby on a raised surface. When you are changing nappies, make sure your baby can’t roll off a bed or sofa. You can use a baby mat on the floor.
Burns and scalds:
Burns and scalds are possible if your baby is near hot objects. Avoid putting your baby near things like ovens, light bulbs, radiators, hairdryers, irons and fires. Place hot drinks well out of your baby's reach. Fit short power leads on kettles and heaters. Remember hot water can scald for up to 30 minutes after it has boiled.
When bathing your baby, check that the water isn’t too hot. A good test is to put your elbow in first. If the water feels hot, it could possibly burn your baby. When filling the bath, run the cold water first and then add hot water. This reduces the risk of your baby slipping into scalding water.
Poisoning:
Babies have a natural instinct to suck anything that comes into contact with their mouths. Many ordinary household cleaners can be poisonous, so it’s important to keep them out of reach.
Take care when washing your baby’s bottle so it doesn’t come into contact with poisonous substances. Older brothers or sisters should be supervised when around a baby to stop them feeding tablets or other poisonous substances to the baby. Remember a baby’s stomach is much more sensitive than an adult's.
Children 1-3 years old:
Toddlers can move very quickly, so accidents often happen in seconds. As children get older they will explore more, which means they are more likely to have knocks and bruises.
Burns and scalds:
Make sure that you use an appropriate fireguard for all fires. Fit a smoke alarm on each floor of your home and make sure you check that it is working properly on a weekly basis. It’s important to have a fire escape plan worked out and to tell your children what to do in case of a fire. Keep matches and lighters out of children’s reach.
Place hot drinks out of children's reach. Fit short power leads on kettles and heaters. Use the back rings on the cooker, and turn pan handles away from the edge. Children are curious and will reach for the handle of a pan on the stove – it’s best to keep young children out of the kitchen altogether if possible.
As with babies, it’s important to test the temperature of bath water before putting your child in, to avoid burning or scalding them. As they get older, teach them to test the water first, too.
Poisoning:
By the age of 18 months or earlier children can open containers, and by three years they may also be able to open child-resistant tops within minutes.4

NEED FOR STUDY

Children under five years have the incidence of the most severe injuries. Children under five like to explore every nook and cranny in their expanding world. As per WHO, unintentional injuries are a leading cause of death among children . the unintentional injuries comprises of accidents such as, falls, collisions, heat related injuries, burns and scald, poisoning and ingestion accidents, cuts and abrasion, drowning. This challenges the children’s morbidity and mortality.3
As per WHO, the burden and pattern of child injuries are just now being studied in low-middle-income countries, where the age distribution of the population compounds the problem posed by child injuries. In 2005 23% of the world’s population of children <5 years of age(ie.141 million children) lived in Africa, while only 10% lived in high income countries. According to WHO report of 2008, the leading cause of childhood injury and death is road accidents which kill 260,000, drowning 175,000, burns 96000, falls 47,000 occurs a year globally and injured around were 10 million. About 50,000 aged 0-14 years ,especially <5 years ,die every as a result of unintentional poisoning.10
In UK 2002 , There was nearly 480,000 injured accidentally at home ,they were <5 years age. Another study in2005 states over 40% of all childhood injuries occur at home and its premises. Where 75 children under 15 died of home accidents, with 49 of these(65%) being under five.4
Injuries associated with falls were assessed in the royal Aberdeen Children’s hospital In Scotland,UK,2001.The assessment of severity of injuries to falls due from upper bunks and lower beds and cotts.85 children was taken of which majority (78%) of them were <5 years. 25 sustained a fracture, 27 a head injury, 12 laceration, 21 soft tissue injuries.5
As per R.Murddock, Joycee Eva (India, 2008.) Home accidents in children-A survey study of 910 cases. Out of 910 accidents sustained by children under 14. 678(74.5%) were <5 years who attended local hospital. Boys were prone to accidents than girls, and children of highest incidence was among the 2-3 years old of both sexes. Common kinds of fall were from cot and furniture.6
Child Accident Prevention Foundation Of Australia in 2005, Each year in Queensland almost 850 children aged 4 and under were present at Queensland hospital as a result of poisoning. Almost 94% of child poisoning cases (0-4 years).Queens land Hospital triaged them as “urgent, “Emergency”, or “resuscitate” indicating seriousness of the cases. Over 90% of poisoning occurred at home. Approximately 88% of those were children aged 1 to 3 years.7
In USA (2000) The most industrialized country ,drowning ranks second cause of unintentional injury deaths to under the age of 14.Death rates from drowning are highest I n children <5 years of age 95% of incidence rates calculated for drowning and near drowning.8
In Bangladesh 2008, population based cross-sectional study was done I epidemiology of child drowning. I about 352000 children 0-15 years were selected from over 171000 households. drowning was leading cause of death in children aged 1-15 years. The highest incidences (86.3 per 100,00 child years) was children aged 1-4 years. More than one-third of drowning in ponds and ditches. Drowning is a major cause of childhood mortality in Bangladesh.9
In UK 2002, as per British burns Association, Burns and scalds are the common types injury .There were almost 37000 attendances in the hospitals. The majority of causalities were <5 years of age. 75% of burns and scalds occurred at home (kitchen and dining area). Every day 10 children receive burns from hot drinks or hot tub water. Two children die each year as a result of injuries caused by very hot bath water. Many children under 3 years suffer 20 to 50% body burns. Plastic surgery is common for these cases.4
As per WHO news bulletin ,the global childhood unintentional injury conducted a pilot study in 2007,to determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries. Sequential sample of children <10 years of age of either gender was taken. Emergency departments of selected countries such as Bangladesh, Colombia, Egypt, and Pakistan over a 3-4 month period, which varied for each site. Of 1559 injured across all sites, 1010(65%) were male, 941(60%) were aged <5 years, 32 (2%) were <1 year old. Injuries were especially frequent (34) during the morning hours. The occurred In and around the home I 56% of the cases ,outside while children in 63%. Of all injuries observed ,913(56%) involved falls, 350(22%) road traffic injuries, 210 (13%) burns,66(4%) poisoning, 20(1%) near drowning or drowning. 10
Anita Nath and vijaya Naik from the department of community medicine from KLE university at Belgaum in Karnataka, India 2005, found marked increase of incidence in unintentional injuries at Shindoli village. The number of under-fives was estimated to be 325. Where (70.3%), of accidents occurred in under five age boys. Abrasion accounted for (72.6%), Cuts and lacerated wound (11.8%), avulsion (6.6%), contusion (4.4), burns (38%). In some episodes of accidents , more than one type of injury was observed in the injured child. Studies eventually showed childhood injuries in majority occurred at home.11
In 2006 at Bengaluru the unintentional injuries witnessed on an average of 250 deaths and nearly 10,000 children hospitalized ,which approximately occurs every year. The usual age groups, 1-14 years. Where nearly (50%) were <5 years. Road traffic injuries is the leading cause for deaths and hospitalization were seen to a higher extent in male children(79%), falls second leading cause of hospitalization among children <5 years, and the commonest places of falls was home(70%).burns (9%) commonly due to kitchen fires, spillage of hot liquids. 90% of the burn injuries occurred at home. Drowning and burns occurred (6% and 5%).animal bites were generally due bites. Dog bites in Bengaluru were an issue of intense media and policy debates in recent months.12
The advent of modernization in the developing world has posed a threat to the young ones. Most of the parents fail with their responsibility of caring for their children. Varied circumstances such as employment or any other task involvement, predisposes the young children to vulnerable circumstances. Henceforth the nurse place a crucial role in assessing and preventing the accidents among the under-fives. The nurse tends to educate the parents in respect with increased supervision and parent behavior modification, the nurse also educates the family regarding the environment safety. Thus endeavoring in investigation to mitigate the incidences of accidents among under-fives.
6.2 /
REVIEW OF LITERATURE
INTRODUCTION
Review of literature is a key step in the research process. The typical purpose of analyzing a review of existing literature is to generate questions and to identify what is known and what is unknown about the topic. The major goals of review of literature are to develop a strong knowledge base to carry out research and non-research scholarly activity.
A study was conducted about accidental injury among children under five years old by studying children registered with one general practice (total list size 9425) who presented at the surgery and/or the accident and emergency department at the North Staffordshire Hospital Centre during a 12 month period. Details were obtained from answers to a questionnaire sent to parents within two weeks of a child's accident. Of 511 children under five years of age, 100 children (57 boys, 43 girls) had 120 accidents. The maximum number of accidents occurred in the second year of life. Parents took their children directly to the casualty department in 105 (85%) accidents. Eighty six children had only one accident and four children required hospital admission. The most common cause of injury was a fall (56%). The majority of accidents happened at home (79%), and occurred between 09.00 hours and 21.00 hours (88%). Children identified in the study following an accident were matched with other children in the practice of the same age and sex who had not had an accident. Information about the families and social factors were compared. Children who had accidents had younger mothers and were more likely to have a sibling who had had an accident in the previous year. 13