Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial

Abstract

Objective: To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings. Methods: The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged (10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls. Results: Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks. Conclusions: Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities.

Prevention of childhood poisoning in the home: overview of systematic reviews and a systematic review of primary studies

“…Interventions promoting the use of child resistant containers (CRCs) were reported from two studies (see Table 4) included in six reviews (Elkan et al, 2000;Kendrick, Coupland et al, 2007;Lyons et al, 2006;Lyons et al, 2003;Pearson et al, 2009;Towner et al, 1996) and a further two studies not included in reviews. One RCT evaluating the effects of home visits providing safety education, home safety inspection, and provision of child proof locks and child resistant caps (CRCs) reported significantly more intervention group families stored paraffin in containers with CRCs (OR 3.39, 95% CI 1.28À9.02) (Swart et al, 2008). The remaining three 22 P.M. Wynn et al…”

“…Interventions to promote other poisoning prevention practices. Twelve reviews reported nine studies (see Table 4) evaluating interventions promoting other poisoning prevention practices (Elkan et al, 2000;Guyer et al, 2009;Kendrick, Coupland et al, 2007;Lyons et al, 2003Lyons et al, , 2006Nilsen, 2004;Nixon et al, 2004;Pearson et al, 2009;Spinks et al, 2004;Towner et al, 1996United States Preventive Services Task Force, 1996) as did a further four studies not included in any reviews (Kendrick Groom et al, 2007;Odendaal, van Niekerk, Jordaan, & Seedat, 2009;Reich et al, 2011;Swart et al, 2008). Of the 13 primary studies, one CBA study (Garcia, 1996) reported that the intervention group showed a significant improvement in poison safety scores after a school safety fair but no figures or p value were reported.…”

“…Interventions promoting safe storage of household and other products. Interventions promoting the safe storage of household and other products (defined as use of safety catches or locks on cupboards/drawers, use of CRCs, and storage out of reach of children), were reported in 24 primary studies included in 11 reviews (DiGuiseppi & Roberts, 2000;Elkan et al, 2000;Guyer et al, 2009;Kendrick, Barlow et al, 2007;Kendrick, Coupland et al, 2007;Lyons et al, 2006;Lyons et al, 2003;Pearson et al, 2009;Towner et al, 1996United States Preventive Services Task Force, 1996) and in a further 7 studies not included in any reviews (Bulzacchelli et al, 2009;Gielen et al, 2007;LeBlanc et al, 2006;Nansel et al, 2008;Phelan et al, 2011;Reich et al, 2011;Swart et al, 2008) (see Table 4). One meta-analysis (Kendrick, Coupland et al, 2007) found evidence that education, with or without the provision of safety equipment was effective in increasing safe storage of household products (OR 1.63, 95% CI 1.22À2.17).…”

“…Of the 13 primary studies, one CBA study (Garcia, 1996) reported that the intervention group showed a significant improvement in poison safety scores after a school safety fair but no figures or p value were reported. Two RCTs (Odendaal et al, 2009;Swart et al, 2008) both evaluated the effects of education, provision of safety equipment and home safety inspections on poisoning hazards scores with both finding significant effects favouring the intervention group (difference between means) 1.1 95% CI 0.44À1.77 (Odendaal et al, 2009) and ¡0.45, 95% CI ¡1.01 to 0.11 (Swart et al, 2008)) and one found significantly safer storage in the intervention group of beauty products OR 2.13 95% CI 1.00À4.53, and paraffin properly labelled and stored in tightly closed non-glass containers OR 5.02, 95% CI 1.26À19.98 (Swart et al, 2008). The remaining 10 studies (see Table 4) evaluated a range of interventions including community injury prevention programmes, safety education, tailored safety education and provision of safety equipment but found no significant differences between the intervention and control groups.…”

Paraffin-related injury in low-income South African communities: knowledge, practice and perceived risk

“…storage of the fuel on upper shelves) and making people feel more vulnerable to the threat of injuries in their own home. 18,19 Perception of risk must be a primary target for behaviour change because people are only likely to change when they feel vulnerable. We found that those at risk for paraffin-related injury perceive some degree of risk, which is promising, although perhaps still less than the actual threat, especially for fires.…”