Developing a framework for prevention of childhood falls in rural Bangladesh : implication for low-income countries

Sammanfattning: Childhood falls and their complications are a major public health problem in Bangladesh as in other parts of the world. However, the problem was not recognized and systematically studied earlier. A holistic approach considering the socio-economic and cultural context is needed to address this problem. Adequate information about the magnitude, associated factors and community perceptions (both parents and children) about the problem is necessary in order to design a community-based intervention. This thesis attempted to determine the magnitude of the problem, epidemiological features, socio-economic and cultural associations and community perceptions about childhood falls. Finally a framework is proposed to address childhood falls in rural Bangladesh. Five studies were carried out in this dissertation. Data from the Bangladesh Health and Injury Survey (BHIS) were used for two of these studies. Two qualitative studies were also conducted in two different rural settings. The first study enabled us in calculating the magnitude of unintentional injuries among children as well as comparing the burden of injury morbidity focusing on falls with other causes of illness. Falls was the leading cause of morbidity among 5-9 years children. This study also revealed that around 57 percent of all falls occurred in the home and its surroundings. The second study determined the incidence of childhood falls and associated factors. The yearly incidence of falls among children less than 18 years was 472.9/100,000 children per year. The incidence of childhood falls was significantly higher among male children. Home and its surroundings were identified as the most common places of incidence. It was also revealed that more than half of all incidences occurred from height. The third study investigated the parents' perception as well as time, place and causes of unintentional injuries among children. This study also documented common injury prevention practices in the community by the parents. Young children were found to be the main victims and the majority of all unintentional injuries occur in the home and its surroundings. In few households it was observed that safety measures are being practiced by the parents unknowingly. Supervision and placing barriers were suggested as the main preventive measures. Using mass media and government involvement were also suggested. The fourth study aimed at obtaining views of Bangladeshi rural children about childhood falls and their prevention. It was found that boys appeared to be the main victims of falls and that the majority of these injuries occurred in and around the home. It was also documented that children mostly sustained injury when they were unsupervised. Supervision, public awareness and placing barriers at the door were suggested as the preventive measures. The fifth study describes the framework for childhood falls prevention in rural Bangladesh. The framework has been developed through series of workshops by utilizing the findings of above studies and compiling findings of similar studies following extensive literature review. In conclusion, the thesis illustrated the high incidence of childhood falls in rural Bangladesh. The thesis explored the common causes of unintentional injuries among children and the focus was on childhood falls. The thesis also documented parents' and children's perception about unintentional injuries especially falls among rural Bangladeshi children and its prevention. Based on all this information a framework for childhood falls prevention was developed for rural Bangladeshi children which could be replicated in other countries with similar socio-cultural settings.