Caregiver Supervision Practices and Risk of Childhood Unintentional Injury Mortality in Bangladesh

Abstract

Unintentional injury-related mortality rate, including drowning among children under five, is disproportionately higher in low- and middle-income countries. The evidence links lapse of supervision with childhood unintentional injury deaths. We determined the relationship between caregiver supervision and unintentional injury mortality among children under five in rural Bangladesh. We conducted a nested, matched, case-control study within the cohort of a large-scale drowning prevention project in Bangladesh, “SOLID—Saving of Children’s Lives from Drowning”. From the baseline survey of the project, 126 cases (children under five with unintentional injury deaths) and 378 controls (alive children under five) were selected at case-control ratio of 1:3 and individually matched on neighborhood. The association between adult caregiver supervision and fatal injuries among children under five was determined in a multivariable conditional logistic regression analysis, and reported as adjusted matched odds ratio (MOR) with 95% confidence intervals (CIs). Children under five experiencing death due to unintentional injuries, including drowning, had 3.3 times increased odds of being unsupervised as compared with alive children (MOR = 3.3, 95% CI: 1.6–7.0), while adjusting for children’s sex, age, socioeconomic index, and adult caregivers’ age, education, occupation, and marital status. These findings are concerning and call for concerted, multi-sectoral efforts to design community-level prevention strategies. Public awareness and promotion of appropriate adult supervision strategies are needed.

Association of socioeconomic factors and the risk for unintentional injuries among children in Japan: a cross-sectional study

“…A previous study suggested lack of supervision made children under 5 years at risk of high mortality by unintentional injuries. 22 Therefore, the age of the children, which was under 6 years old in our study, might help to decrease the risk of unintentional injuries in lower socioeconomic status families. Second, the following characteristics specific to Japan might reduce the socioeconomic differences: relatively low exposure to environmental hazards, the social support network and ethnic homogeneity.…”

Prevention of childhood unintentional injuries in low- and middle-income countries: A systematic review

“…These studies mainly reported an increase in caregiver knowledge of injury prevention methods. Nine studies reported positive outcomes directly related to injury rates, incidence, mortality, and severity [86,91,92,96,97,99,100,102]. Interestingly, 2 studies conducted in LICs evaluated implemented environmental changes, as recommended by the WHO, and found varying results.…”

Under 10 mortality patterns, risk factors, and mechanisms in low resource settings of Eastern Uganda: An analysis of event history demographic and verbal social autopsy data

“…Gastrointestinal disorder and injuries were substantial emerging morbidities after 4 years of age. These emerging morbidities could be resulting from the transition of new behaviours and curiosity among children aged 5-9 years and thus, their limited supervision may predispose them to unintended injuries such as poisoning, falls, drowning, burns and suffocation [42][43][44]. Similarly, children aged 5-9 years may be exposed to ingestion of unhealth items that may lead to gastrointestinal disorders such as worms and typhoid.…”