ẠI AND TRAINING OF HEALTH HAIPHONG UNIVERSITY OF MEDICINE AND PHARMACY BUI LE VI CHINH THE STATUS OF INJURY ACCIDENTS AMONG CHILDREN UNDER 15 YEARS OLD AND SOME PREVENTIONS OF CHILDR
Trang 1ẠI AND TRAINING OF HEALTH
HAIPHONG UNIVERSITY OF MEDICINE AND
PHARMACY
BUI LE VI CHINH
THE STATUS OF INJURY ACCIDENTS AMONG CHILDREN UNDER 15 YEARS OLD AND SOME PREVENTIONS OF CHILDREN DROWNING IN TWO DISTRICTS OF BINH DINH PROVINCE
Speciality: Public Health Code: 62.72.03.01
SUMMARY OF PUBLIC HEALTH PHD
DISSERTATION
ôGS.TS
Tr ängHAI PHONG - 2020
Trang 2THE DISSERTATION COMPLETED AT HAIPHONG UNIVERSITY OF MEDICINE AND PHARMACY
Academic Supervisors:
1 Assoc Prof Dinh Van Thuc
2 Assoc Prof Duong Thi Huong
Time: …… date …… month …… year 2020
The dissertation could be found at:
1 National Library
2 Library of Haiphong University of Medicine and Pharmacy
Trang 3INTRODUCTION
Injury accidents among children are a very important public health problem worldwide This is the cause of about 5 million deaths every year, accounting for 9% of total deaths worldwide and 12% of the global burden of disease Drowning is now one of the public health issues of global concern Although Tuy Phuoc is a large delta district
in the southern part of Binh Dinh province, there are quite intermittent systems of rivers and lakes, each year most affected by floods than other districts in the province, prevention of drowning in Children are interested in and focused on implementing these activities over the years However, the situation of drowning in the district in recent years has tended to increase Objectives of the study:
1 Description of epidemiological characteristics of injury and drowning accident in children under 15 years old in Tuy Phuoc and Hoai Nhon districts, Binh Dinh province in 2015
2 Describe the knowledge and practices of people and health workers about drowning prevention in children under 15 years in Tuy Phuoc district - Binh Dinh province
3 Evaluating the effectiveness of educational interventions to prevent drowning of children under 15 years old in the community of Tuy Phuoc district - Binh Dinh province
THE CONTRIBUTION OF THE THESIS
This is the first study on the situation of childhood injury and some drowning preventive intervention were conducted in two coastal districts of Binh Dinh province The study contributes to a better explanation of the reason for injury, especially child drowning, while the locality has been implementing an injury prevention program for many years The results of the study will give managers a number of recommendations and appropriate solutions to reduce the burden of drowning
Trang 4STRUCTURE OF THE THESIS
The main part of the thesis is 116 pages long, consisting of the following sections: Introduction: 2 pages; Chapter 1- Overview: 31 pages; Chapter 2- Research Object and Method: 18 pages; Chapter 3- Research Results: 31 pages; Chapter 4- Discussion: 31 pages; Conclusions and recommendations: 3 pages The thesis has 149 references, of which 68 are in Vietnamese and 81 are in English The thesis has 41 tables and 7 pictures
CHAPTER 1 OVERVIEW 1.1 Injury accident
- Accident: is an unexpected, unintended event (incidental,
unintentional) caused by an outside agent that causes physical or mental damage and injuries
- Injury: is the physical damage to the human body due to the
effects of energies (including: mechanics, heat, electricity, chemistry, radiation ) with different degrees and speeds In addition to injury, there is a shortage of essentials for life
- Consequences of injury injuries: The consequences of injuries
left to children are health effects, causing physical pain because they may be partially injured or disabled for life, even death; Mental and psychological effects such as children with inferiority complex, inferiority complex, always in a state of fear and costly treatment of trauma Since then, making children difficult to integrate into the society, and child injuries also cause more socio-economic burden for families, localities and the country
1.2 Drowning among children
Drowning is any liquid that gets into the airway and interferes with breathing Drowning leads to lack of oxygen to the brain, if it is not provided in a timely manner, the victim will lose consciousness, death or serious damage to the brain causing complications such as learning disorders, memory problems and permanent permanent loss
of function or permanent vegetative state; Factors causing drowning
in children: The development and behavior of children, age nts,
Trang 51.4 Solutions to prevent drowning in children
Health education and communication is one of the top ten contents of primary health care and the most important content to help people have the knowledge and skills to protect their own health Drowning occurs not only in lakes, rivers, canals, etc but also can occur at home, work, schools, preschools Therefore, parents, teachers, everyone needs to know how to prevent and rescue drowning emergency skills is essential Health education programs can help people gain the right knowledge and practice about drowning prevention
CHAPTER 2: METHODOLOGY 2.1 Population, location and and time frame of study
2.1.1 Study population
2.1.1.1 Study population for objective 1
- Children under 15 years old living in Tuy Phuoc and Hoai Nhon districts, Binh Dinh province Exclusion: Children with severe medical conditions such as cerebral palsy and disability
- Parents or caregivers of children under 15 years old Exclude subjects with limited communication skills who are unable to understand and answer questions or do not agree to participate in study
2.1.1.2 Study population for objective 2 and 3
- Parents or caregivers of children under 15 years old in Tuy Phuoc district; Health worker working at 13 commune health stations in Tuy Phuoc district, Binh Dinh province
Trang 62.1.2 Study location
Tuy Phuoc and Hoai Nhon districts - Binh Dinh province
2.1.3 Time frame: The study was conducted from January 2015 to
December 2018
2.2 Methods
2.2.1 Study design: The project is conducted in 2 consecutive
research designs: Cross-sectional study and controlled community intervention study
2.2.2 Sample size and sample selection
2.2.2.1 Sample size, sample selection for objective 1:
Apply the formula to calculate the sample size:
In fact, 9.335 children in 6 communes of the two districts were included
2.2.2.2 Sample size, sample selection for objective 2:
Sample size of parent / caregiver
In fact, 4,467 people were surveyed in Tuy Phuoc district
* Sample size/ sample selection of health workers: Interview all health workers working at 13 commune health stations in Tuy Phuoc district
2.2.2.3 Sample size, sample selection for objective 3: Intervention research
* Sample for community intervention:
In fact, 1689 people in the intervention area and 1451 people in the control area were included
2.3 Technical details and data collection tools
2.3.1 Collecting data for objective 1 and 2: Describe the
epidemiological characteristics of injury and drowning incidents for children under 15 years old in Tuy Phuoc and Hoai Nhon districts, Binh Dinh province in 2015
Trang 72.3.1.1 Developing a toolkit:
Developing a survey form for the community on injuries based on the guidance of the Ministry of Health's investigation, amending and supplementing a number to suit the local situation and thesis's objectives The questionnaire for interviewing knowledge and practice was designed based on the guidance of the Department of Health Environment Management and the overview of previous researches
2.3.1.2 Steps to conduct research: Select a list of children under 15 years old; Conduct investigations; Collect surveys form
2.3.2 Collecting data for objective 3:Assessment of changes in
knowledge and practice of people and health workers after 2 years of intervention in Tuy Phuoc district, Binh Dinh province
2.3.3 Criteria for evaluating knowledge about drowning prevention
- Knowledge of circumstances of drowning; emergency drowning; handling when drowning children; measures to prevent drowning;
- People's practices on preventing children from being exposed to environmental risk factors for drowning
2.4 Implementation of intervention activities
- Developing communication materials for child drowning prevention as follows Develop 01 propaganda message about child drowning prevention; Designing and developing leaflets on drowning prevention and distribution in the community Number of leaflets produced and distributed: 3,000 leaflets; painted 40 pano, propaganda posters in crowded public places Put up warning signs
in places prone to drowning
- Organizing 14 small group communication sessions for people who take care of children daily in the community 14 sessions at school; Integrating propaganda in programs such as expanded vaccination, prevention of malnutrition, mass activities ; Organized
04 swimming lessons for 120 children Organizing 03 training courses for 50 people who are health workers and commune-level child care and protection officers on drowning prevention
Trang 8communication skills; identify and manage drowning cases in children
2.6 Ethics in research
The research was carried out according to the thesis outline which was approved by the Ethical Committee of Hai Phong University of Medical and Pharmacy and approved by local leaders; Participants voluntarily participate in research;
Chapter 3 RESEARCH RESULTS
3.1 Epidemiological characteristics of injury and drowning incidents in children under 15 years in Tuy Phuoc and Hoai Nhon districts, Binh Dinh province in 2015
3.1.1 Epidemiological characteristics of injury accident of children under 15 years old
Table 3 1 Prevalence of child injuries in two districts in 2015 Commune / town
Number of children research
Children with injury
p1,2 = 0,252
- Pure farming (2)
+ Phuoc Son commune
+ Phuoc Quang commune
2 Hoai Nhon district 4868 521 10,7 p3,4 =
Comment: In Tuy Phuoc district: The rate of children injured in the
district is 11.9%; Hoai Nhon District: The rate of children injured in the district is 10.7% The rate of children injured injuries in 2 districts accounted for 11.3%
Trang 9Figure 3.1 Prevalence of injury-related children by gender (n=9335)
Comment: The rate of injuries in young boys in Tuy Phuoc district is
13.5%, Hoai Nhon is 11.8% The incidence in girls is 10.1% and 9.5%, respectively
Table 3.2 Age-related injury accidents among children in two
Trang 10Comment: Tuy Phuoc district: The highest rate of children with
injuries in farming areas is 16.6% (5-<10 years old), (p<0.001); Hoai Nhon District: The number of children with injuries in the age group (5-<10 years) accounts for the highest rate in both areas, (p <0.05)
Figure 3 2 Causes of children having injuries (n = 1052)
Comment: Falling 37.5%; Traffic accidents are 18.8%; drowning is
13.8%
Figure 3 3 Incidence of injury accident by months of the year
Comments: The percentage of children with concentrated injuries in
June, July and August
37.5
18.8
13.8 8.6 5.6 4.7 4 3.5
2.1 1.4 0
3 5.4
7.4 7.9 8.1
17.7 17.4 18.4
6.6 5.1
3 2.2 0
Trang 113.1.2 Epidemiological characteristics of drowning accidents for children under 15 years old
Table 3 3 Childhood morbidity and mortality rates
No District 3 communes of
Comment: The overall rate of children drowning in the study area of
the two districts is 15.53 ‰, the death rate due to general drowning
is 1.07 ‰
Table 3 4 Prevalence of drowning in the study area
No Characteristics n Number drowned p
Comments: The rate of drowning in male 19 ‰, higher than female
11.7 ‰ (p <0.05) The prevalence of children by age group was highest in the age group (5-<10) years (23.96 ‰), the difference was statistically significant (p <0.001)
Trang 12Table 3 5 Mortality / drowning rates (n = 145)
No Characteristics Num of
children
Number of children died from drowning
Comment: Among male drowning children, the mortality/morbidity
rate in children is 9.8%, the female mortality rate/drowning is 1.9%
Table 3 6 Infected children due to the location of the drowning
accident
No Location
Num of children drowning (n=145)
Children die from drowning (n=10)
Comments: Among drowning children, the most common place
where accidents occur is water containers (42.1%); 26.9% of lakes / ponds / rivers / canals
Trang 13%
Figure 3 4 Time of child drowning (n = 10)
Comment: There are 04 cases (40%) occurring in the period of 14-17
hours, 03 cases (30%) of deaths occurred in the 11-13 hour period, 20% occurred during the time period 18-20 hours
3.2 Knowledge and practice of people and health workers about drowning prevention in children under 15 years in Tuy Phuoc
3.2.1 Knowledge and practice of people on drowning prevention in children
Table 3 7 Right knowledge of people on emergency measures
for drowning (n = 4,467)
Pinched the heart outside the chest 1.029 23,0
Comments: The rate including all 3 drowning emergency operations
is 22.9%
Table 3 8 People's knowledge about drowning prevention
1 Do not let children play near ponds, lakes 2.211 49,5
2 Fencing, building walls surrounding ponds
5 Teach children to practice swimming under
Trang 14Comments: 49.5% of parents answered “do not let children play near
lakes”; 45% said that it was necessary to make fences and build walls around ponds and lakes
Table 3 9 People's practices on preventing children from being exposed to environmental risk factors for drowning (n = 4,467)
Comment: In households, tanks, barrels, jars of water with lids
66.3%; building walls and fencing around ponds and lakes 58.4%; only 17.1% participated in the training course
3.2.2 Knowledge and practice of health workers on drowning prevention in children
Table 3 10 Knowledge of health workers on drowning prevention measures for children (n = 245)
Comments: Health workers have adequate knowledge about
drowning prevention 40.4%
Trang 15Table 3 11 Knowledge of health workers on emergency of
drowning children
No Knowledge of first aid for drowning children n %
6 Move to the nearest nearest health facility 168 68,6
Comment: The percentage of health workers with the right
knowledge was 66.9%
Table 3 12 Practicing emergency drowning of health staffs
No Practice emergency of drowning children n %
1 Number of health workers who have given first
2 Number of health workers who have given first
Comment: There were 57.6% of health workers who had given first
aid to drowning children
3.3 Effective intervention interventions to prevent drowning of children under 15 years old in the community of Tuy Phuoc - Binh Dinh District
3.3.1 Knowledge - practice of the people after the intervention
Table 3 13 Knowledge of people on emergency drowning measures
Knowledge
General rate before intervention
Region of intervention (n=1689) 1
Region comparison (n=1451) 2 p 1,2