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Risk factors for injury in Pakistani children
Michael S Singer1, Abdul Ghaffar
1Harvard University, Cambridge, Massachusetts 02138, USA. msinger@fas.harvard.edu
Insights
Child injury deaths are high globally, especially in developing nations. In Pakistan, poor supervision, crowded homes, and low maternal education are key risk factors for pediatric injuries.
Area of Science:
- Pediatric Injury Prevention
- Global Child Health
- Environmental Health Risk Factors
Background:
- Child fatalities exceed 1 million annually, predominantly in less-developed countries.
- Identifying personal and environmental risk factors for child mortality is crucial globally.
- Pakistan's large pediatric population (60 million) necessitates localized injury risk factor analysis.
Purpose of the Study:
- To identify situational risk factors for child injuries in Pakistan.
- To determine peak risk times and age-specific patterns (preschool vs. school children).
Main Methods:
- A case-control study was conducted over two months.
- Interviews were conducted with families of 300 consecutive pediatric inpatients at Children's Hospital, Islamabad.
- Data collected included maternal education, home environment, and child supervision status.
Main Results:
- 79% of injured children were unsupervised at the time of injury.
- Significant risk factors identified: low maternal education, small home size, and high number of children per home (p < 0.05).
- Peak injury risk occurred between 3-6 PM. School children had higher weekend risk (OR 4.0) and lower weekday risk (OR 0.2) compared to preschoolers.
Conclusions:
- Poor supervision, domestic crowding, and low maternal education are significant risk factors for pediatric injury in Pakistan.
- Interventions should focus on improving supervision, parental education, and creating safer home environments.
- Targeted strategies are needed, considering age-specific risk patterns (e.g., weekends for school children).
Abstract:
Over 1 million child fatalities occur per year, the bulk of them in less-developed countries. There remains a need, from country to country, to identify personal and environmental risk factors correlated with this mortality. The present study focused on Pakistan, home to a sizeable pediatric population of 60 million. The study employed case-control methods (i) to identify situational risk factors and (ii) to test when children were most at risk, and whether these patterns differed for preschool versus school children. For two months the families of 300 consecutive inpatients were interviewed at Children's Hospital in Islamabad. Most children (79%) were unsupervised at the time of the injury. The casecontrol study found risk factors in the mother's level of education, size of the home, and number of children in the home (all p < 0.05). With respect to temporal patterns, the time period of greatest risk was 3-6 PM. Compared to preschoolers, school children showed elevated risk on weekends (odds ratio 4.0, p < 0.001) and reduced risk during school (odds ratio 0.2, p < 0.0001); in contrast, the risk of injury for preschool children remained constant throughout the week. The results support the conclusion that overall, poor supervision, domestic crowding, and low maternal education were risk factors for injury in our sample of Pakistani children. Based on this conclusion, we recommend further efforts to keep children off roofs, isolate them from hazards, promote supervision, educate parents, and provide safer play.
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