Risk factors associated with injuries among children below 18 years attending health facilities in Dar es salaam, Tanzania

Abstract

Background Injuries are the leading cause of death and disability among children and youth worldwide. Approximately 950,000 children die every year as a result of injuries and violence. WHO identifies burns, falls, Road Traffic Injuries (RTIs), poisoning and drowning as the major causes of injuries in Children. In Tanzania 2.5% and 4.3% person were reported to have been injured during the previous one year in urban and rural areas respectively. Among these, 37% were below 14 years. The risk factors for injuries that have been documented elsewhere include socioeconomic status, maternal education, maternal age, marital status, number of children in the house, and overcrowding. However, there is limited data on factors associated with injuries among children in our setting. Objective To determine risk factors associated with injuries among children below 18 years seen at various health facilities in Dar es Salaam, Tanzania Materials and Methods A hospital based case control study was conducted from August 2011 to October 2011 in six selected health facilities in Dar es Salaam. Data were collected using a structured questionnaire. Cases were children below 18 years who had suffered injuries. Controls were children below 18 years who had visited the same health facilities with other problems apart from injury. Recruitment was done at the outpatient department. Parents/guardians of selected cases and controls were interviewed by trained research assistants. Data analysis was performed using SPSS version 17. Univariate, and multivariate analyses were done for both child and parental/guardian factors. Logistic regression models were built to identify independent determinants of injuries. Both unadjusted and adjusted odds ratio with corresponding 95% confidence intervals were reported. All the analyses were two-tailed and significance was set at 5% level.Results A total of 492 cases and 492 controls were included in the study. Younger parents/guardians {Adjusted odds ratio (AOR)= 0.95; 95% CI (0.92-0.97)}, more than six people in the same house {AOR= 1.8; 95% CI (1.3-2.6)}, more than three children in the house {AOR= 1.6; 95% CI (1.1-2.2)}, absence of parent/guardian at time of injury occurrence {AOR= 1.6; 95% CI (1.1-2.3)} middle {AOR=1.5; 95%CI (1.0-2.1)} and low socio-economic status {AOR= 1.6; 95% CI (1.1–2.4)} were independent risk factors for injury. Falls (32%), burns (26%), Road Traffic Injuries (14%) and cuts (10%) were the major types of injuries identified. More than two thirds of these injuries occurred at home. Conclusion and Recommendations Inadequate supervision, overcrowding, having more than 3 children in the house, lower socio-economic status and low maternal age were significant risk factors. Falls, burns, RTIs and cuts were the main types of injuries in Dar es Salaam. Local programmes for injury prevention need to take into account improved household, child supervision and other identified risk factors to be able to curb the childhood injuries. Schools should also teach students on road safety. Further community studies are needed to identify magnitude of injuries for proper planning of interventions.