Shumona Shafinaz

Epidemiology of childhood burn: Yield of largest community based injury survey in Bangladesh

In terms of mortality, morbidity and disability, burns are emerging as a major child health problem in Bangladesh. This trend is similar to many other developing countries. To develop effective burn prevention programmes, information on its magnitude and determinants is necessary. The purpose of this study was to document the magnitude and determinant of childhood burns in Bangladesh, based on a population-based survey which was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. To facilitate data collection, face-to-face interviews were conducted. The rate of non-fatal burn among children under 18 years of age was calculated as 288.1 per 100,000 children-year. The highest incidence (782.1/100,000 children-year) was found among the 1-4 years age group. About 46% of non-fatal burn injuries occurred between 9 a.m. and 3 p.m. The incidence of childhood burn was found to be more than four times higher in rural children than urban children. Ninety percent (90%) of the childhood burns occurred at homes and the kitchen was the most common place. The rate of disability due to burn was 5.7 per 100,000 children per year. The rate of fatal burn was 0.6 per 100,000 per year among all children. The study findings confirmed that childhood burn was a major childhood illness in Bangladesh. An urgent and appropriate prevention programme is required to prevent these unwanted morbidities, disabilities and deaths due to burn.

Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries.

Objective: To determine the epidemiology of child drowning in order to propose possible interventions for Bangladesh and other similar low-income countries. Design: Population-based cross-sectional study. Setting: Rural and urban communities in Bangladesh. Subjects: About 352 000 children 0–17 years were selected from over 171 000 households, using multistage cluster sampling. Main outcome measures: Incidence of fatal drowning. Results: Drowning was the leading cause of death (28.6 per 100 000 child-years) in children aged 1–17 years. The highest incidence (86.3 per 100 000 child-years) was in children aged 1–4 years. More than two-thirds of drownings occurred in ponds and ditches. Most drownings (85%) happened in daylight. In more than one-third of cases of drowning, the child was alone. In the two-thirds of cases in which the child was accompanied, almost half were with children who were 10 years or below. Only 7% of drowned children over 4 years of age knew how to swim. Conclusions: Drowning is a major cause of childhood mortality in Bangladesh. Creating drowning-safe homes, improving supervision of children, modifying the environment, and developing water safety skills for children and the community may be effective interventions for drowning prevention.

Consequences of childhood burn: Findings from the largest community-based injury survey in Bangladesh

In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10-14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be

Perceptions of rural people about childhood burns and their prevention: A basis for developing a childhood burn prevention programme in Bangladesh

462. In this study it was found that more than 61% of the families earn less than

Socioeconomic inequality in child injury in Bangladesh – implication for developing countries

50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority.

Community perception of childhood drowning and its prevention measures in rural Bangladesh: A qualitative study

OBJECTIVES This study was conducted to gain an in-depth understanding of peoples perceptions of childhood burns and their prevention in rural areas of Bangladesh. STUDY DESIGN Qualitative study. METHODS Five focus group discussions were conducted in this study. Eight to twelve members were present in each group. Groups were composed of mothers of children under 5 years of age, adolescent male and female students in Grades IX and X, fathers and local leaders such as school teachers and religious leaders. The study was conducted in a rural community of Bangladesh in 2003. RESULTS Focus group participants were aware of the devastating consequences of childhood burn injuries. They reported that younger boys and older girls are at higher risk of burn injuries. They identified home as the most common place for childhood burn injuries, and stated that occurrence was more common in winter. They held the household members or caregivers responsible because of their lack of supervision and carelessness. The focus group participants suggested that people should supervise their children more carefully, and should take initiatives to modify their homes and premises as necessary so that children would not have access to fires and heat sources. Regarding first aid, the focus group participants reported prevailing harmful practices which are likely to make injuries worse. CONCLUSIONS A safety education programme could be an effective intervention to improve knowledge and practices of rural people in Bangladesh with regard to prevention of burns injuries in children.

Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics

BackgroundChild injury is an emerging public health issue in both developed and developing countries. It is the main cause of deaths and disabilities of children after infancy. The aim of this study was to investigate the socioeconomic inequality in injury related morbidity and mortality among 1–4 years children.Materials and methodsData used for this study derived from Bangladesh Health and Injury Survey. A multistage cluster sampling technique was conducted for this survey. In this study quintiles of socioeconomic status were calculated on the basis of assets and wealth score by using principle component analysis. The numerical measures of inequality in mortality and morbidity were assessed by the concentration index.ResultsThe poorest-richest quintile ratio of mortality due to injury was 6.0 whereas this ratio was 5.6 and 5.5 for the infectious diseases and non-communicable diseases. The values of mortality concentration indices for child mortality due to infection, non-communicable diseases and injury causes were -0.40, -0.32 and -0.26 respectively. Among the morbidity concentration indices, injury showed significantly greater inequality. All the concentration indices revealed that there were significant inequalities among the groups. The logistic regression analysis indicated that poor children were 2.8 times more likelihood to suffer from injury mortality than rich children, taking into account all the other factors.ConclusionDespite concentration indices used in this study, the analysis reflected the familys socioeconomic position in a Bangladesh context, showing a very strong statistical association with child mortality. Due to the existing socioeconomic situation in Bangladesh, the poor children were more vulnerable to injury occurrence.

Initial community response to a childhood drowning prevention programme in a rural setting in Bangladesh

OBJECTIVES To gain an in-depth understanding of peoples perception of causes and their concepts of prevention of childhood drowning in rural Bangladesh. DESIGN A qualitative study and focus group discussion (FGD) was adopted. SETTING A rural community in Bangladesh. PARTICIPANTS FGDs were conducted with mothers of children aged under 5 years, adolescent male and female students, fathers and local leaders. One FGD was conducted for each group. Out of 53 participants 25 were women. RESULTS The respondents considered that children of 5-10 years are at risk of drowning. Ponds, ditches and canals were frequently mentioned locations of drowning. Most of the drownings were reported to occur around noon. For prevention of childhood drowning the participants suggested that the children should be constantly supervised, unwanted ditches should be filled in, ponds should be fenced and drowning prevention awareness in the community be increased by community leaders. They suggested that government should organise campaigns for preventing childhood drowning, promoting swimming instruction activities for children and motivating communities to fence ponds. CONCLUSIONS People interviewed in general know the causes of childhood drowning and its preventive measures, but they do not put their knowledge into preventative actions as they fail to recognise this as a major child survival issue and they are never reached with definite actions points to change the behaviours.

The magnitude of child injuries in Bangladesh: a major child health problem

OBJECTIVE The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries. METHODS A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0-18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information. RESULTS About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children. CONCLUSION Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parents education a national burn prevention program needs to be developed to combat the devastating child injury, burn.

EXPERIENCE FROM COMMUNITY BASED CHILDHOOD BURN PREVENTION PROGRAMME IN BANGLADESH: IMPLICATION FOR LOW RESOURCE SETTING

Objectives To describe the development, community acceptability, feasibility, and sustainability of a pilot drowning prevention intervention for rural children, 1–4 years old, in Bangladesh. Methods A prevention package was formulated and piloted in four rural communities of Bangladesh for 3 months. Focus group discussions and in-depth interviews were organised with stakeholders to elicit community acceptability, feasibility, and sustainability of the proposed interventions. Results Increased supervision of children, raising awareness on water safety, and educating the community on first response skills were the three core aspects identified through workshops to include in the intervention package. During development of interventions emphasis was given to finding low-cost local resources. To increase child supervision, creation of drowning-safe homes and establishment of community crèches were identified. To create heightened water safety, formation of village committees and conduction of courtyard and social autopsy meetings with communities were considered. The community actively participated and considered that these interventions would be useful for prevention of child drowning. There was also an increasing demand for some of these interventions. Conclusion Use of low-cost local resources, community participation, and increasing demand of the interventions indicated that the package was acceptable, feasible, and sustainable to the community. To determine the effectiveness of the package demands implementation on a larger sample.