A Mixed-Method Study on Recurrent Unintentional Injuries in Children and Adolescents in a Rural Area of Delhi

Introduction: Unintentional injuries are largely preventable causes of death and disability in children. Understanding the extent of the problem and its contributing factors will help us in addressing them and thus prevent their occurrence to a great extent. Methodology: It is a mixed-method study, which is a part of a funded research project on unintentional childhood injuries, conducted in two villages of Delhi, on 397 children and adolescents. Quantitative data for occurrence of injuries was collected over 16 months during the period 1st September 2017-31st December 2018. Outcome variables included incidence of unintentional childhood injuries, knowledge of subjects regarding injuries and their prevention, family practices for injury prevention and treatment seeking behavior as reported by subjects, safety score regarding domestic and peridomestic environment, and danger signs within the house. Subjects with three or more incidents of unintentional injuries during the entire period of data collection were considered to have recurrent injuries and were classified as belonging to high-risk group. The qualitative part of the study included in-depth interview of subjects who suffered from recurrent injuries and their guardians in their families. Total 13 children were identified as high-risk group, of which three were below 10 years of age and hence were not interviewed. Purpose of interview was to assess the perception of each adolescent subject and his/her guardian in the family, regarding possible reasons for occurrence of recurrent injuries and the ways in which injuries can be prevented in these subjects. Results: Recurrent injuries occurred in 3.28% of total population, significantly more in male subjects. Mean age of the recurrently injured subjects and mean age of their guardians were lower than the corresponding uninjured group. Rate ratio and rate difference indicated greater vulnerability of the high-risk group of subjects. KAP scores of mothers and practice of families were significantly lower in the high-risk group than the other group. The main reasons for injury occurrence mentioned by both subjects and their guardians were that children are careless, naughty, fight with other children, and since parents do not stay at home there is no one to monitor them. Work-related injuries were also stated. Other than preventing the reasons for recurrent injuries stated by both the groups, some more measures were suggested. These were to keep the community clean as one major injury had occurred due to unclean surroundings, take help from close neighbors, particularly by working mothers of nuclear families, and elder siblings to take care of their younger siblings. Conclusion: Deeper understanding of the factors associated with unintentional injuries in specific cases provides a scope for targeted interventions. Educational programs and training of the people in the community and counseling members of the concerned families, will significantly help in prevention of injuries.