|Year : 2016 | Volume
| Issue : 4 | Page : 1033-1039
Knowledge, attitude and practice of rural mothers towards home injuries among children under 5 years of age in Menouf District- Menoufia Governorate, Egypt
Mohamed A Megahed1, Nora A Khalil MD 2, Reda A Ibrahem3, Reham S El Disoki2
1 Department of Plastic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Ministry of Health, Egypt
3 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||07-Jun-2015|
|Date of Acceptance||04-Oct-2015|
|Date of Web Publication||21-Mar-2017|
Nora A Khalil
Department of Family Medicine, Faculty of Medicine, Menoufia University, 49 Zaki Shabana Street, El Bar El Sharki, Shebin El Kom, Menoufia Governorate, 32511
Source of Support: None, Conflict of Interest: None
The aim of this study was to assess rural mothers' knowledge, attitudes, and practices as regards first aid for home-related injuries among children under 5 years of age before and after implementation of educational program and to measure the prevalence of these injuries. This study was conducted to assess rural mothers' knowledge, attitudes, and practices toward home-related injuries and their first aids among children under 5 years of age before and after implementation of educational program.
Accidental injuries are a major health problem in children. They are the most common cause of death in children under 5 years of age. Every year they leave many thousands permanently disabled. Most of the children at risk from a home accident are in the 0–5 years' age group. Most of these accidents are preventable through increased awareness, improvements in the home environment, and greater product safety.
Materials and methods
This cross-sectional interventional study included 270 mothers from Bijirim village, Queisna district, Menoufia, Egypt. A predesigned questionnaire was administered to them before and after application of educational program. The first part of the questionnaire included sociodemographic and economic characteristics of the mothers. The second part included mothers' knowledge about the causes, prevention, and first aid of home injuries. The third part included mothers' practice followed toward their children in case of exposure to any type of home injuries and its occurrence.
The study result revealed that mass media were the main source of knowledge for 43.3% of the participants. There was a statistically significantly higher percent of satisfactory knowledge among highly educated mothers and those with middle and high socioeconomic level. There was a significant positive correlation between mothers' practice and either their education or their socioeconomic level. There was a significant correlation between socioeconomic level and either knowledge or attitude of mothers toward home injuries. There was a significant improvement in mothers' knowledge after intervention.
The study revealed that there was a significant improvement in mothers' knowledge and practice as regards home injuries after intervention.
Keywords: children, home injuries, under 5 years of age, unintentional
|How to cite this article:|
Megahed MA, Khalil NA, Ibrahem RA, El Disoki RS. Knowledge, attitude and practice of rural mothers towards home injuries among children under 5 years of age in Menouf District- Menoufia Governorate, Egypt. Menoufia Med J 2016;29:1033-9
|How to cite this URL:|
Megahed MA, Khalil NA, Ibrahem RA, El Disoki RS. Knowledge, attitude and practice of rural mothers towards home injuries among children under 5 years of age in Menouf District- Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2016 [cited 2018 Dec 16];29:1033-9. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1033/202506
| Introduction|| |
Injuries to children arising from home accidents are increasingly seen as a community health problem. Injuries are classified into intentional and unintentional. According to the National Safe Kids Campaign in the USA, 40% of deaths and 50% of nonfatal unintentional injuries occur in and around the home . In Egypt too it has become a public health problem . For example, in 1998 the overall rate of injuries in the indoor home environment was 72.5% among children under the age of 5 years . The incidence of home accidents among children under 6 years of age in Assiut governorate in the year 2003 as perceived by their mothers was 50.3%. The most common injuries include drowning, falls, fires or burns, poisoning, suffocation, and transportation-related injuries . Moreover, findings from selected Arab countries between 2004 and 2012 suggest increasing rates of domestic violence .
Young children are particularly vulnerable to accidents due to their innate desire to explore their world and the inability to perceive the dangers of their actions . As children learn through experience, minor injuries are inevitable, but providing a safe environment can reduce the risks, coupled with close supervision and setting the limits of safety. Parents should remember that they need to maintain a constant balance between overprotecting the child on one hand and giving him or her freedom in the process of learning the hazards of his or her environment .
Accidental injuries to infants and young children are often serious, but are largely preventable. Prevention programs that use a multidisciplinary strategy (i.e., a combination of education, environmental modification, product modification, supportive home visits, and legislation) have been shown to be particularly effective in reducing injury mortality in many high-income countries .
First aid is the provision of initial care for an illness or injury, usually by a nonexpert but trained person, until medical treatment can be accessed. Provision of immediate first aid to patients who require emergency care can make a big difference to the outcome .
In certain self-limiting illnesses or minor injuries, appropriate first aid measures may be sufficient to avoid a medical consultation. Parents' knowledge and practice about first aid is especially important, as many adverse consequences of injuries can be averted if parents know what actions to take .
The aim of our study was to assess knowledge, attitudes, and practices (KAP) of mothers toward home injuries and to identify the most common types of home injuries in the studied group and to assess the effect of a well-structured program in promoting KAP toward home injuries.
| Materials and Methods|| |
This cross-sectional interventional study was conducted from 1st of April 2014 to the end of May 2015 in Bijirim family health unit, Quewisna district, Menoufia governorate. Mothers who attended Bijirim health unit from 1 May 2014 to the end of July 2014 for any service and had children under 5 years of age were included in this study. There were 296 mothers. In all, 270 of them agreed to participate in this study, with a response rate of 91.2%.
The study was conducted on three phases:
- Phase 1 (the preintervention phase):
Data were collected from participant mothers using a structured questionnaire, which included the following four parts:
- Sociodemographic and economic data (e.g., age, education, occupation, and the El-Gilany socioeconomic scoring system) 
- Mother's knowledge toward different types of home injuries among children (causes and methods of prevention). Mothers who scored greater than 50% were considered as having satisfactory knowledge
- Attitude of participant mothers toward home injuries among children under 5 years of age. Mothers who scored greater than 50% were considered as having positive attitude
- First aid measures toward different types of home injuries (mothers who scored >50% were considered as having good practice).
- Phase 2 (the intervention phase):
An educational program was carried out for mothers by the researcher during the period from 1 May 2014 to the end of July 2014, 4 days a week, in the form of lectures, group discussion, posters, video, booklets, and real objects such as medication, cleaning substances, toys, etc.
The aim of the program was to improve the mothers' knowledge and practice as regards injury prevention and first aid for their children under 5 years of age.
The content of the program was implemented for each group in one session. Each session included ˜7–10 mothers and took ˜60 min. Its content was as follows:
- Definition of unintentional home injuries
- Types of child home injuries
- Causes of common types of child home injuries
- Prevention of different types of home injuries
- First aid for common types of child home injuries.
- Phase 3 (the postintervention phase):
Using the same questionnaire the participants were re-evaluated for KAP toward children home injuries from the first to the end of November 2014.
The data were collected, tabulated, and analyzed using SPSS (Statistical Package for Social Science) version 17.0 on IBM compatible computer (SPSS Inc., Chicago, Illinois, USA).
Two types of statistics were performed
- Descriptive statistics [e.g., percentage (%), mean, and SD].
- Analytic statistics included the following tests:
- The χ2-test, to study the association between two qualitative variables
- The Z-test, to test the proportion between two independent groups
- The t-test is a test of significance used for comparison between two groups normally distributed having quantitative variables
- Paired t-test: It measures whether means from a within-subjects test group vary over two test conditions of normally distributed data. The paired t-test is commonly used to compare a sample group's scores before and after an intervention
- The Wilcoxon signed-rank test is a nonparametric statistical hypothesis test used when comparing two related samples, matched samples, or repeated measurements on a single sample to assess whether their population mean ranks differ
- Spearman correlation test (r) is a test used to measure the association between two not normally distributed quantitative variables or one quantitative and one qualitative ordinal variable.
A P value of less than 0.05 was considered statistically significant.
| Results|| |
The mothers' ages ranged from 20 to 43 years, with a mean of 29.56 ± 5.42 years. As regards educational level, 41.9% of the participants had secondary education and 9.6% of them were illiterate. As regards the working status of mothers, 69.3% of them were housewives. As regards socioeconomic level, 53.3% of mothers were of very low and low socioeconomic level; the mean of socioeconomic score was 56.39 ± 8.81, with a range of 40–72 ([Table 1]).
|Table 1 Sociodemographic and socioeconomic criteria of the studied group|
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The most common types of home injuries in the studied group were wounds, fractures, and choking (68.9, 55.6, and 53.3%, respectively) [Figure 1].
|Figure 1: Prevalence of home injuries in children under 5 in the studied group.|
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As regards the source of mothers' knowledge about home injuries, this study revealed that the main sources of knowledge were mass media and relatives (49.0 and 49.4%, respectively) [Figure 2].
|Figure 2: The source of knowledge of studied mothers about first aid of home injuries among children.|
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The level of knowledge of our participants on home injuries was not affected by mothers' age. It also revealed that, among these demographic and economic criteria, knowledge satisfaction is significantly affected by education and socioeconomic level, being higher among those with high education (P < 0.001) and those with moderate and high socioeconomic level ([Table 2]).
|Table 2 Relationship between mothers' knowledge about home injuries and both sociodemographic and economic criteria of the studied group|
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There was a remarkable improvement in participants' level of knowledge as regards home injuries (causes, prevention, and first aid) after the program (P < 0.001) in comparison with that before the program. The mean knowledge score was statistically highly significant after the program (P < 0.001) ([Table 3]).
|Table 3 Total knowledge about home injuries among the studied mothers before and after intervention|
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There was an improvement in mothers' attitude toward home injuries after implementation of the program [Figure 3]. There was a positive correlation between mothers' socioeconomic level and both total knowledge score (+0.13) and attitude score (+0.14) [Figure 4].
|Figure 3: Correlation between socioeconomic score and both total knowledge and attitude scores.|
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|Figure 4: Correlation between socioeconomic score and both total knowledge and attitude scores.|
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There was a positive correlation between mother's practice as regards child home injuries and both education and socioeconomic level of mothers ([Table 4]).
|Table 4 Spearman correlation between level of mother education and socioeconomic status and level of practice toward different home injuries before intervention|
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There was a statistically significant improvement in mothers' practice toward first aid of child home injuries after intervention ([Table 5]).
|Table 5 Level of improvement in first aid practice for home injuries in the studied group after intervention|
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| Discussion|| |
Unintentional injuries continue to be a major cause of death, ill health, and long-term disability during childhood, but are largely preventable with appropriate information and safe practice . Young children are particularly vulnerable to accidents due to their innate desire to explore their world and the inability to perceive the dangers of their actions. As children learn through experience, minor injuries are inevitable, but providing a safe environment can reduce the risks, coupled with close supervision and setting the limits of safety .
The current study revealed that more than half of the mothers (69.3%) were housewives. This finding is in agreement with that of Eldosoky , Hossien , Abd El-Aty et al. ,and Ibrahim , who mentioned that the majority of mothers were housewives and the home accidents' rate was high among their children. However, Mohammed et al. , who conducted a study in Cairo University Specialized Pediatric Hospital and Benha University Hospital and included 100 mothers indicated that less than 60% of the mothers (59%) were working. This can be attributed to the existence of jobs in the governorate of Cairo more than any other province.
As regards types of home accidents, the present study indicated that cut wound represented the highest percentage of home injuries among the studied children (68.9%). This is in agreement with the study conducted on 600 mothers in Elwan and El-Masra villages in Assiut governorate, Egypt, by Abd El-Aty et al.  and with the study by Ibrahim  in El-Fatah district, Assiut governorate, Egypt. Moreover, this result is in line with that of Eldosoky , who measured the incidence and types of home injuries affecting rural children aged up to 12 years in the study that included 1450 rural mothers from Qalubeya governorate, Egypt. They found that cut wounds were the most common accidents among the studied children. A similar trend was obtained by Mohammed et al. , whose study was conducted in Cairo University Specialized Pediatric Hospital and Benha University Hospital. They found that the highest percent of the mothers reported that falling and cut wounds were the most common injuries experienced among their children.
This study also investigated the source of mothers' information about prevention and first aid of home injuries among children. It was revealed that 43.3% of them gained their first aid information from mass media. Similar results were obtained by other researchers. Kamel et al. , who conducted a study on 283 mothers from Damares village, El-Minia, Egypt, found that 38.5% of mothers obtained their first aid information from television. Our results are in agreement with those of Eldosoky , who showed similar results as regards the source of knowledge, in which TV and radio accounted for about 45.8%. This is in agreement with the findings of Morrison and Stone , who recorded that television and family members were considered the primary source of parents' information about their child safety measures. However, only 3% of them depend on internet to obtain information. The same trend was found in the study by Joanne et al. , who documented in their study in 14 European countries that the most frequently cited sources of parents' information on their child's safety were family and TV, followed by friends. This is contradictory to the findings of Sonavane and Kasthuri , who reported in a study in India that a higher proportion rate of the studied women had not heard about first aid (65.7%). This may be attributed to the different demographic characteristics of the populations.
The findings of this study showed that, mothers' knowledge score was higher with increased level of education, as 64.3% of mothers who had satisfactory knowledge had high education, whereas 2.9% of mothers who had satisfactory knowledge were illiterate. This result is in agreement with that reported by El-Sabely et al.  in a study that included 150 mothers from Kafr Mohsen village, Sharkia governorate, Egypt, which revealed that illiterate mothers had poor knowledge on home accidents among children. The same was obtained from the study by Ozturk , who reported that there was a meaningful relationship between mothers' educational status and knowledge and practice as regards child home injuries.
As regards mother's knowledge on causes of home injuries, the current study revealed that more than half (64.8%) of the mothers had unsatisfactory knowledge about causes of home accidents. This is in agreement with the findings of El-Sabely et al. , who reported that more than half of the mothers (55.3%) did not know anything about home accidents to which their children might be exposed, and the findings of Abd El-Aty et al. , who assessed knowledge and practice of 600 mothers in rural areas, Assiut governorate, toward home accident among children and documented that approximately three-quarter (74.5%) of mothers did not know the causes of home accident.
As regards mother's knowledge about prevention of child home injuries, our study revealed a low percentage of satisfactory knowledge about the preventive measures of common types of home injuries in the studied group. This result was similar to that of a study conducted in Baghdad city by Lafta et al. , who found that mothers' knowledge about prevention of the four types of accidents studied was clearly deficient. This is also in agreement with a study conducted in China by Wang et al. , which concluded that parental knowledge on injury prevention and safety promotion was unsatisfactory. However, these findings are in disagreement with the findings of Hatamabadi et al. , who conducted a study in Iran on 230 mothers and mentioned that 75% of participants had good knowledge on preventive measures.
This study showed that there was general improvement in mothers' knowledge on prevention of child home injuries (burn, choking, wounds, falls, electrical accidents, poisoning, and drowning) after intervention. This portrays the important role of educational programs in injury prevention. The same result was obtained by Olds et al. , who recommended that all mothers should be counseled as regards safety and injury prevention for children to prevent the occurrence of injuries and decrease child mortality. Moreover, this was emphasized by Yousef , who studied health promotion for child care at home within the first 2 years of life and found that, before the application of the health promotion program, mothers' knowledge scores on accidents and its control were inadequate, whereas after program implementation, the mean scores of all knowledge items on accidents prevention were significantly improved. Moreover, Sobhy , who conducted a study on the impact of health promotion educational program for 100 mothers as regards accident prevention and first aid for preschool children at Benha city mentioned that there was obvious improvement in mothers' knowledge about prevention of preschool children home accidents after implementation of health promotion program. Moreover, Abd El-Aty et al.  reported that prevention and control of home injuries among children has been recently a target and very important area for health promotion.
The current study revealed that there was a positive correlation between mothers' KAP and their socioeconomic level. The same result was obtained by Eldosoky , who mentioned that higher socioeconomic status was a significant predictor of better KAP among mothers. This is in agreement with the findings of Sobhy  as well, who reported that there was a general improvement in total mothers' KAP as regards home injuries with the increase in family income, with a highly statistically significant difference (P < 0.001). Increased family socioeconomic level helps mothers to gain more knowledge through mass media and enables them to apply safety measures at home.
Our study illustrated that mothers' practice of first aid as regards burn, choking, wounds, fracture, electrical accidents, poisoning, and drowning were obviously improved after intervention. The incidence of mothers who reported good practice before intervention was 48.5, 38.2, 18.8, 12.7, 26.1, 30, and 26.7%, respectively, and the incidence after intervention was 70.1, 73.3, 85.4, 96.2, 63.6, 64.7, and 70%, respectively. There was a highly statistically significant difference before and after intervention as regards mothers' practice. This finding was approved by Sobhy  and Abd El-Aty et al. , who documented that mothers' practice as regards first aid of home injuries among children under 5 years of age was highly improved after implementation of the educational program.
| Conclusion|| |
Although home-related injuries are a common problem among rural children, mothers in Bejerim district did not have enough knowledge as regards causes, prevention, and first aid of these injuries. Factors found to affect KAP scores of mothers were level of education and socioeconomic level.
It is recommended that health education programs be conducted for parents, especially new parents, on injury prevention and first aid as a routine service at MCH centers and units.
The author thanks the participating mothers for their cooperation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]