Environmental change interventions to prevent unintentional home injuries among children in low‐ and middle‐income countries: A systematic review and meta‐analysis

Abstract

IntroductionUnintentional home injury is an important cause of death and disability among children, especially those living in low‐ and middle‐income countries (LMICs). This systematic review aimed to synthesize evidence about the effectiveness of environmental interventions to prevent unintentional child injury and/or reduce injury hazards in the home in LMICs.MethodsSeven electronic databases were searched for randomized controlled trials (RCTs) and controlled before and after (CBA) studies published up to 1 April 2018. Potentially eligible citations were screened by title and abstract and full texts of studies obtained. Synthesis was reported narratively, and where possible, meta‐analysis was conducted.ResultsFour studies met the inclusion criteria: One CBA study reported changes in injury incidence, and three RCTs reported changes in frequency of home hazards. In one study, child resistant containers were found effective in reducing the incidence of paraffin ingestion by 47% during and by 50% postintervention. A meta‐analysis of two trials found that home inspection, safety education and safety devices reduced postintervention mean scores for poisoning hazards [mean difference (MD) −0.77; 95% CI [−1.36, −0.19]] and burn‐related unsafe practices (MD −0.37; 95% CI [−0.66, −0.09]) but not for falls or electrical and paraffin burn hazards. A single trial found that home inspection and safety education reduced the postintervention mean scores for fall hazards (MD −0.5; 95% CI [−0.66, −0.33]) but not for ingestion hazards.ConclusionThere is limited evidence that environmental change interventions reduce child injuries but evidence that they reduce some home hazards. More evidence is needed to determine if altering the physical home environment by removing potential hazards reduces injuries in LMICs.

Home-related and work-related injuries in Makwanpur district, Nepal: a household survey

“…High rates of home injuries in children in Nepal have previously been reported 9 and have also been found in Bangladesh. 15 Our study found that falls and cuts/piercings were the main mechanism for both home-related and work-related injuries.…”

“…8 The incidence of non-fatal home injuries among children aged less than 5 years living in rural areas of Makwanpur district was found to be as high as 232 per 1000. 9 The different estimates of injury incidence use different types of data and varied definitions of injury in diverse population groups and settings. These sources identify the place of injury but not whether they were home or work related, nor have they reported on costs associated with injuries.…”

Characterization of Acute Poisoning in Hospitalized Children in Southwest China

“…For example, pesticide packaging should further emphasize its toxicity labeling, uses, and safe storage methods; food safety supervision should be strengthened to avoid the inflow of rat poison contaminated rice, noodles, and meat into the market; and "street pesticides" should be reduced by strengthening enforcement of illegal pesticides. However, there is limited evidence that environmental change interventions could reduce the risk of accidental poisoning in children (25,26). Therefore, there is also a need to strengthen child safety awareness to avoid accidental poisoning.…”

Home and work-related injuries in Makwanpur district, Nepal: a household survey

“…High rates of home injuries in children in Nepal have previously been reported 9 and have also been found in Bangladesh. 15 Our study found that falls and cuts/piercings were the main mechanism for both home- and work-related injuries.…”

“…8 The incidence of non-fatal home injuries among children aged less than 5 years living in rural areas of Makwanpur district was found to be as high as 232 per 1000. 9 These sources identify the place of injury but not whether they were home- or work-related, nor have they reported on costs associated with injuries. A recent systematic review of injury research in Nepal identified an absence of evidence about inequalities in injury occurrence.…”