Injuries at home constitute a significant number of childhood injuries, as children spend longer period of time in the home and also due to the many hazards that may be present [1,2]. The common injuries for younger children typically occurring at home are burns [3], falls [4] and poisoning [2,3,5,6].

After clearance from the institutional ethical committee, a cluster randomized controlled trial was conducted to assess the effectiveness of HSSP in 10 villages in Udupi district, Karnataka.

Cluster randomization technique was used, wherein villages were considered as clusters and houses in the village as cluster units. A random allocation was carried out at the level of selection of villages to the intervention and control group. Individual houses or selection of cluster units were done by an external person who was not involved in the study. Selection of the villages was done using probability proportional to size. In EPI methodo-logy, which is carried out after creating a cumulative list of community population and selecting systematic sample of clusters with a random start [11]. After identifying the villages, a randomization process was done to select the villages to the experimental and control group. This was done using tossing of coin. The villages were randomized into intervention group (5 cluster) and control group (5 cluster). From each cluster, 13 cluster units (houses) consisting of children between the age group of 2 to 5 years were selected. Home safety supervisory program was administered to intervention group cluster and the control group received teaching on child care. Fig. 1 shows the consort flow chart of participant selection.

Fig. 1 CONSORT flow chart of the study.

The sample size in the RCT is based on comparison of means which was calculated on the basis of pilot study finding. A total of 130 families were included in the study (65 each in intervention and control group) who met the following inclusion criteria: Houses consisting of at least one child belonging to the age group of 2 to 5 years, care-givers’ of children (2 to 5 years) who can read, write and understand English or Kannada (local language) and care-givers’ who care for the children for at least 6-8 hours a day.

A demographic proforma was used to collect basic information about the child and caregiver, age and gender of the child, birth order, and type of family. Risk behavior assessment questionnaire is a self-prepared 20-item questionnaire to collect information from the caregivers regarding events of injury in the past three months among their children.

A home hazard assessment self-report questionnaire was in the local language used to assess the presence of home injury hazards as reported by caregivers during a personal interview. This questionnaire was prepared by the researcher and established validity and reliability. It consisted of 27 items categorized under following areas: burns, cut/injury, fall, drowning, suffocation/chocking and poisoning. A higher score indicates more hazards at home that can cause injury to the child. Observed home hazard (OHH) inventory was used by the researcher to personally observe the home hazards in the house which was researcher developed instrument based on the practices in the local area. Caregiver supervisory attitudes (CSA) is a five-point Likert scale 25-item questionnaire to assess the caregiver’s child supervision practices. All the instruments underwent validity and reliability studies. The tools were later translated to local language and retranslation was done to make sure the accuracy. The schematic representation of the study is shown in Fig. 2.

Fig. 2 Schematic representation of the study description.

The home safety supervisory program for caregivers (HSSP) is the intervention developed for caregivers of children aged 2 to 5 years in intervention group. The program consisted of a video on ‘Safe home; Safe child,’ a poster on ‘Safe home; Safe child’ and an individual home visit. Health teaching on care of children between 2 to 5 years of age was administered to the caregivers in the control group. The contents of the health teaching included nutritional needs, hygienic needs, safety needs and normal growth and development.

Many published studies reported that the majority of injures occurs for children between the age of one to four years [12,13]. In this study the mean age of children experiencing home injuries was 3.3 years.

Interventions for caregivers are very effective in reducing the injuries among children [14]. There are two different strategies in interventions. They are active and passive. One of the active strategy is training [15-16]. Injuries among children at home can be maximally reduced by giving training or education for caregivers [17]. The results of the present study revealed that such an intervention had a significant reduction in the overall injury status of children.

An educational program in combination with the distribution of a barrier or playpen was found to have a significant decrease in burns injury among children post intervention [18]. There is evidence that caregiver super-vision may reduce the risk and severity of childhood injuries [19] and protect children who have injury risk factors [9].

An educational intervention was found to have improved the home safety practices of families with young children with significant increase in the percentage of homes deemed ‘safe’ after the fall intervention counseling [16,20]. The findings of a systematic review reported that parenting interventions, provided within the home using multi-faceted interventions may be effective in reducing child injury [21,22].

As the injury history in the study was collected retrospectively, there might be varations while reporting by the caregivers. There could be observer bias in the present study as the observed home hazard safety practices was assessed by the researcher.

The external validity of the study can be improved by increasing the sample size and representation of sample. A follow up of one year will make sure the retention of practices.

The intervention in the study aimed at increasing the caregivers awareness about home injuries and various home safety practices, which inturn contributes to the overall health and wellbeing of the children. Further the study emphasizes that the intervention should be directed towards the caregivers to have the change in the behaviour of children and themselves and also to improve the home environment. Surveillance of childhood injury and caregiver awareness would help to bring down the unintentional injuries among children.

Ethics clearance: Institutional Ethics Committee of Kasturba Medical College and Kasturba Hospital, Manipal; No. IEC193/2018, dated March, 2018.

Contributors: AG: concept and design development, data collection, writing the first draft and consecutive revisions of the manuscript; RG: concept and design development, development of the instruments, preparation and consecutive revisions of the manuscript; SS: data collection, data analysis and preparation and consecutive revisions of the manuscript. All authors approved the final version of manuscript, and are accountable for all aspects related to the study.

Funding: Indian Council for Medical Research (ICMR), New Delhi; Competing interest: None stated.

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