Knowledge, attitude, and factors associated with household chemical safety practices among caregivers of children in Kampala; a mixed methods study

doi:10.21203/rs.3.rs-4616008/v1

Download PDF

Article

Knowledge, attitude, and factors associated with household chemical safety practices among caregivers of children in Kampala; a mixed methods study

https://doi.org/10.21203/rs.3.rs-4616008/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

To date, there is widespread use of household chemical products. However, more about caregiver knowledge, attitudes, and chemical safety practices needs to be known, as they are primarily responsible for children's safety, health, and well-being. This study used a qualitative descriptive approach embedded in a mixed-methods sequential explanatory study design to explore knowledge, attitude, and chemical safety practices among caregivers of children. Over 67.8% (261/385) of caregivers exhibited poor chemical safety practices. Poor chemical safety practices were associated with being aged 25–35 years (APR: 1.22, 95% CI: (1.00-1.50), p = 0.048), awareness of the practices that increase the risk of exposure to HCPs (APR: 0.83, 95%CI: (0.71–0.96), p = 0.017), knowing whether chemical poisoning could be prevented or not (APR: 0.81, 95%CI: (0.67–0.97), p = 0.027), agreeing to usually checking product labels for warnings and instructions before using HCPs (APR: 0.83, 95% CI: (0.73–0.95), p = 0.009), agreeing that proper ventilation was necessary when using household chemicals (APR: 0.83, 95% CI: (0.73–0.95), p = 0.009), and feeling confident that one can respond effectively in case of a chemical poisoning emergency (APR: 0.82, 95%CI: (0.72–0.93), p = 0.003). Overall, caregivers of children exhibited poor chemical safety practices. There is a need for enhanced investment in health education training programs on chemical safety.

Health sciences/Signs and symptoms/Digestive signs and symptoms

Health sciences/Signs and symptoms/Nausea

Health sciences/Signs and symptoms/Neurological manifestations

Health sciences/Signs and symptoms/Skin manifestations

Health sciences/Signs and symptoms/Vomiting

Chemical safety

Household

caregiver

chemical poisoning

Chemical safety is a significant global public health concern [1, 2]. For decades, household chemical products (HCPs) have been hazardous to both human health and the environment [3]. Although limited, available data indicate that chemical poisoning caused the loss of two million lives and 53 million disability-adjusted life-years in 2019 [4]. Although harmful HCPs have been banned by the European Union [3], these are still prevalent and not appropriately regulated in Low and Middle-income countries (LMICs), including Uganda [3]. As a result, the burden of chemical poisoning in LMICs remains high [5]. The limited number of Poison Centers (PCs) causes an underestimation of the burden of chemical poisoning in Africa [6]. Indeed, only 20% of African countries have PCs [6]. Nevertheless, the WHO estimates that chemical poisoning causes the loss of 39,800 lives and nearly 28 million disability-adjusted life-years in the African region [6]. Over the years, Uganda has experienced increased importation, manufacture, and use of chemicals in the industry, agricultural and health sectors and at the household level [7]. Available evidence indicates that these chemicals account for 20% of all poisoning cases in Uganda [8].

Chemical safety entails activities aimed at protecting humans and the environment from the detrimental effects of chemicals [9, 10]. These activities include keeping medicines, cosmetics, cleaning products, and other household chemicals out of sight and out of reach of children, storing paints, solvents, gasoline, fuels, varnishes and other products that may release harmful fumes or catch fire outside homes, regularly checking containers for leaks or damage, not mixing chemicals, keeping products in their original containers, and reading safety precautions [11, 12]. Failure to implement chemical safety practices increases incidents of chemical poisoning in households [13]. Chemical poisoning occurs when a toxic chemical exposure overwhelms the body's ability to detoxify it [14]. In LMICS, like in Uganda, chemical poisoning is one of the significant causes of emergency attendance at hospitals since it is a time-dependent emergency that requires a specialist for diagnosis and treatment [15].

Unsafe chemical safety practices are associated with a multitude of environmental and health impacts, which include lung cancer, respiratory diseases such as pneumonia, and neurotoxic effects such as chronic solvent-induced encephalopathy [16]. In addition to acute toxicity, household chemicals such as air fresheners, insecticides, cosmetics, detergents, and pesticides are corrosive and flammable, which could lead to burns and scalds, especially in children [17]. Given their risk-taking behaviour, such as crawling on the ground and putting anything they touch into their mouths (oral sensory seeking behaviour or mouthing), children are most vulnerable to chemical poisoning [18].

Several strategies have been implemented at national and international levels to mitigate the burden of chemical safety. The WHO advocated establishing and strengthening PCs in member states to achieve chemical safety. In 2021, WHO published Guidelines for establishing PCs as an update of the 1997 guidelines for poison control [15]. These centres play a crucial role in identifying and assessing toxic risks within a population and collecting data to improve knowledge about the effects of chemicals on human health. Although Uganda has not established a PC, the Ministry of Health developed the Uganda Clinical Guidelines (UCG) to guide health workers in detecting, managing, and treating common health conditions, including chemical poisoning [19]. Despite strategies/ interventions at the national and international levels, more needs to be known about knowledge, attitude and chemical safety practices, especially among caregivers of children since they are responsible for the children's well-being, safety, health, and day-to-day lifestyle [20, 21]. This study used the Knowledge, Attitudes, and Practices (KAP) model to examine caregivers' knowledge, attitudes, and practices regarding household chemical safety. The KAP model is instrumental in establishing a baseline for future assessments, suggesting intervention strategies tailored to local circumstances, and identifying potential barriers to behaviour change [22]. This model was previously used to understand the relationship between knowledge, attitude and household chemical product poisoning [23].

Study setting

This study was conducted in the informal settlements of Katanga, Kanyogoga, Kiyaaye and Kifampa, located in Kampala City in Uganda. Kampala City is administratively divided into five urban divisions, namely: Kawempe, Nakawa, Rubaga, Central, and Makindye division. Kampala City is the most populated urban centre in the country with a projected population of 1,680,600 persons [24]. Kampala is encircled by Wakiso district and borders Mukono to the East. It is estimated that over 60% of Kampala's population lives in informal settlements [25, 26]. Informal settlements are characterised by congestion, leading to a lack of space for the proper storage of HCPs. Kampala has a total of 1458 health care facilities which include 22 general hospitals, 2 National Referral hospitals, and 3 referral hospitals [27].

Study design

A mixed-methods sequential explanatory study design was used to collect data from caregivers of children. A mixed-methods sequential explanatory study design is a research approach conducted in two distinct phases. In the first phase, quantitative data is collected and analysed. The results from this phase guide the collection and analysis of qualitative data in the second phase, providing deeper insights and explanations for the quantitative findings [28]. In the second phase, the qualitative descriptive design was employed as the qualitative component of explanatory mixed methods studies, as it does not necessarily require a deep theoretical foundation [29–31].

Eligibility criteria, sample size determination and sampling procedures

The study included all household caregivers aged 18 years and above. Households were eligible if they had at least one child aged five years or younger. Participants were excluded if they were under 18 years old or if they declined to provide consent.

For the quantitative phase, Kish Leslie's formula for cross-sectional surveys was used to determine the required sample size [32]. Considering a 50.0% proportion of chemical safety practices (due to limited evidence) [33], a z score of 1.96 corresponding to the 95% level of confidence, and a margin of error of 5%, a minimum sample size of 385 was determined.

A multistage sampling technique was employed to select study participants. In Stage I, all five divisions of Kampala city were purposively selected to ensure geographic representation. In Stage II, all wards within these divisions were assigned unique identifiers, and one ward per division was randomly selected using the Microsoft Excel random number generator. Stage III involved assigning unique identifiers to all cells within the selected wards and randomly selecting one cell per ward using the Microsoft Excel randomiser. In Stage IV, a Village Health Team (VHT) member, assigned by the chairperson, assisted research assistants in identifying households for interviews. Each household received a unique identifier, and simple random sampling without replacement was conducted using the Microsoft Excel random number generator until the desired sample size of 77 households per cell was achieved. In Stage V, eligible caregivers within the selected households were identified, and the research assistants invited the primary caregiver, who most often cared for the child or children, to participate in the study upon obtaining informed consent.

For the qualitative phase, a total of five Focus Group Discussions (FGDs) were conducted, one from each division in Kampala City, corresponding to the cells initially sampled in the quantitative phase. Each FGD comprised 8 participants. Caregivers who could provide rich and diverse perspectives related to the research questions were purposively selected to participate in the FGDs.

Study variables and measurement

Dependent Variables

Chemical safety practices

A total of 8 questions were used to determine the caregiver's chemical safety practices. The participants were asked if they stored household chemical products out of reach of children, read product labels for warnings and instructions before using household chemical products, using personal protective equipment (gloves, mask) when handling harmful household chemical products, educated children in their care about the dangers of household chemical products, had a designated and secure storage area for household chemical products, attended training or sought information on child-safe practices related to household chemical products, had a plan in place for responding to chemical poisoning emergencies, had a first aid kit at home, regularly checked and updated the first aid kit in their home, provided strict supervision to prevent children's exposure to HCPs. The total score for chemical safety practices was obtained by summing up scores obtained from each question. The maximum score a caregiver attained was 8.0, while the minimum score was 0. Respondents who scored 6 or above, which was the median score, were considered to have good chemical safety practices. Those who scored below 6 were classified as having poor chemical safety practices.

Independent Variables

The independent variables included the age category, sex of the respondent, religion, education level, marital status, employment status, and sources of information on chemical poisoning. Attitude was established by rating the extent of agreement with the following statements; 1) children are at a high risk of poisoning due to household chemicals, 2) it is essential to store household chemical products out of reach of children, 3) it is important to usually check product labels for warnings and instructions before using household chemicals, 4) proper ventilation is important when using household chemicals, 5) it is necessary to educate children about the danger of household chemicals, 6) I feel confident in my ability to respond effectively in case of a chemical poisoning emergency/incident, 7) taking safety precautions with household chemicals is an important part of childcare, 8) seeking professional medical help is crucial if a child is exposed to a harmful chemical, and 9) caregivers should undergo regular training on child-safe practices related to household chemicals.

Knowledge variables included awareness of; 1) products that cause chemical poisoning in homes (e.g., fuels, detergents and soap, bleach, pesticides, medications, disinfectants, paints and paint thinners, insecticides, drain cleaners, swimming pool chemicals, air fresheners, weed killers, personal care products, and rodent poisons), 2) steps to take when a child gets exposed to household chemical products (e.g., giving the child milk, seeking help from family or community members, taking the child to the nearest healthcare facility, keeping any packaging or containers of the poisonous substance for reference, and contacting the local authority for assistance), 3) practices that increase the risk of chemical poisoning due to HCPS (e.g., mixing different chemical products, storing chemicals in areas accessible to children, using chemicals in poorly ventilated spaces, failing to read and follow instructions on the product label, and using uncertified chemical products), 4) signs and symptoms of chemical poisoning (e.g., nausea, vomiting, difficulty in breathing, eye irritation, skin irritation, seizures, diarrhea, abdominal pain, muscle weakness, headache, wheezing, dizziness, loss of consciousness, fever, excessive tearing, blurred vision, chest pain, and coughing), 5) whether chemical poisoning is preventable (Yes/No), 6) whether chemical poisoning is treatable (Yes/No), 7) individuals at increased risk of exposure to HCPS (e.g., children, elderly, and individuals with pre-existing condition), and 8) routes of exposure to HCPs (e.g. inhalation, ingestion, and body/skin contact).

The knowledge variables included in the model to identify factors associated with poor household chemical safety practices were: 1) participants' knowledge of practices that increase the risk of poisoning from household chemical products, and 2) their awareness of whether chemical poisoning can be prevented. Participants who mentioned at least one correct response were classified as knowledgeable and scored 1, while those who did not provide any correct response were classified as not knowledgeable and scored 0. This binary scoring system enabled us to analyse the relationship between knowledge and household chemical safety practices.

Data collection, management, and analysis

Quantitative ata were collected using the KoboCollect mobile application and later exported to STATA 14.0 for statistical analysis. Before analysis, data cleaning was performed to minimise any errors. Practices were classified as poor if the participant scored below the median mark or good if the participant scored the median and above. The prevalence of the outcomes was above 10%, and therefore, prevalence ratios generated by a generalised linear 'modified Poisson' regression model were used to measure the strength of association between the independent and the dependent variables [34]. For all dependent variables, bivariable analysis was first conducted using a 'modified Poisson' regression model, and variables with a p-value less than 0.2 at bivariable analysis were then included in the multivariable model [35]. Although age and sex were not significant in the bivariable analysis, these variables were included in the multivariable model because they are known to be important confounders [36].

During the qualitative phase, data were collected through FGDs, each consisting of about eight participants, using a guide with open-ended questions. The guiding questions focused on participants' knowledge, attitudes, and practices regarding household chemical safety. These interviews were conducted face-to-face, with the moderator facilitating the conversation and creating a positive environment for participants to share their opinions and experiences. A note-taker recorded critical points and verbatim quotes using a coding matrix, observed the participants' non-verbal cues [37], and each session was audio-recorded. The audio recordings were labeled by date, time, and location, and later transcribed. Transcripts were analysed with the aid of Nvivo 14.0.

Although qualitative descriptive analyses are not typically based on pre-existing theoretical approaches or models [38], we used the KAP (Knowledge, Attitudes, and Practices) model to further guide our integration of respondents' perspectives on household chemical safety, including its benefits and impacts. Following the recommendations of Doyle, McCabe [39], and colleagues, qualitative data were analysed using a content analysis approach.

Quality control and assurance

Research assistants with a minimum background of bachelor's in any health-related course were recruited. Research assistants underwent a two-day training to familiarise themselves with the data collection tool and understand the ethical practices, research qualities, and procedures. We used an electronic data collection application (KoboCollect) to collect quantitative data. The electronic data collection application was designed with the relevant checks and must-enter commands to avoid missing data. The questionnaire was pre-tested among households in Kasangati town council, Wakiso district, an urbanised neighborhood with characteristics similar to those of Kampala City. The research assistants uploaded collected data to the server daily while all audio files were uploaded to the Google Drive server. End-of-day debriefs were conducted to discuss the challenges and strategies to improve the quality of data collection. The Principal Investigator closely supervised the research assistants to ensure quality data collection. All data were stored in password-protected computers and only accessed by the principal investigator, who continually monitored the data on the servers and provided daily feedback to the team.

Socio-demographic characteristics of the participants in the quantitative component

A total of 385 caregivers participated in the study. Of these, nearly half, 49.1% (189/385) were aged between 25–35 years, 37.1% (143/385) had attained primary level education, 78.7% (303/385) had nuclear families, and 92.5% (356/385) were female (Table 1).

Table 1

Socio-demographic characteristics of caregivers in the quantitative component
Variable	Category	Frequency (N = 385)	Percentage (%)
Age-category (Years)	18–24	81	21.0
	25–35	189	49.1
	above 35	115	29.9
Religion	Anglican	79	20.5
	Born again	94	24.4
	Catholic	125	32.5
	Moslem	74	19.2
	SDA	13	3.4
Sex	Female	356	92.5
Sex	Male	29	7.5
Level of education	No formal education	66	17.2
	Primary	143	37.1
	Secondary	138	35.8
	Tertiary	38	9.9
Marital status	Divorced	53	13.8
	Married	237	61.5
	Single	80	20.8
	Widowed	15	3.9
Employment status	Employed by someone or an entity	108	28.1
	Self-employed	189	49.0
	Unemployed	88	22.9
Type of family	Extended	82	21.3
Type of family	Nuclear	303	78.7

Socio-demographic characteristics of participants in the qualitative component

Of the 45 caregivers, 93.3% (42/45) were female, 42.2% (19/45) were aged between 25 to 35 years, and 35.6% (16/45) were catholic. Almost half of the caregivers, 48.9% (22/45) were married, and 40% (18/45) had attained primary-level education (Table 2).

Table 2

Socio-demographic characteristics of the FGD participants
Variable	Category	Frequency (N = 45)	Percentage (%)
Age	18–24	7	15.6
	25–35	19	42.2
	Above 35	19	42.2
Sex	Female	42	93.3
Sex	Male	3	6.7
Education level	No formal education	10	22.2
	Primary	18	40.0
	Secondary	16	35.6
	Tertiary	1	2.2
Marital status	Married	22	48.9
	Separated	22	48.9
	Widowed	1	2.2
Religion	Catholic	16	35.6
	Anglican	7	15.6
	Muslim	6	13.3
	Born again	16	35.6

Sources of information on household chemical safety

More than half, 51.7% (199/385) mentioned having obtained information on chemical safety from radios or Televisions (TVs), 18.7% (72/385) obtained information from neighbors, 9.6% obtained information from friends and peers, 8.1% (31/385) obtained information from healthcare staff, 7.5% (29/385) obtained information from family members, 3.9% (15/385) obtained information from newspapers, 27.5% (106/385) reported never having obtained information on chemical safety and 4.2% (16/385) obtained information from other sources such as the internet. Healthcare personnel were key sources, offering guidance during visits to healthcare facilities and sometimes through community outreach. The elderly in the community, neighbors, parents and labels on HCPs packaging were also sources of safety information.

"My child started having bloody diarrhoea recurrently, even after treatment and I didn't know the cause until my neighbour hinted that it might be because my child always drinks soapy water whenever I'm washing clothes. That's when I realised the cause and stopped my child. He never had bloody diarrhoea ever again" (FGD participant)

Caregivers faced several challenges in accessing information about chemical safety. Some lacked televisions and radios, making it difficult to receive vital information. Health education sessions were infrequent in their communities, leading to forgetfulness of the safety practices taught. Additionally, caregivers encountered contradicting messages in mass media, which created confusion about which information was accurate and trustworthy.

"Many participants have talked about wanting to obtain information from radios and TVs, but some of us do not have TVs or radios and neither can we afford them. You do not expect me to go to my neighbour's place on a daily wanting to watch TV or radio" (FGD participant)

Caregivers preferred to obtain information on chemical safety from TVs, radio, and newspapers. Healthcare personnel were also preferred as a source of information due to their ability to provide valuable chemical safety guidance during healthcare facility visits and community outreaches. The elderly in the community were regarded as knowledgeable sources of information, while instructions and labels on HCP packaging provided guidance on safe usage. Neighbors also played a crucial role in disseminating chemical safety information. Caregivers preferred routine physical health education sessions, emphasising their importance for those without access to media. They mentioned that these sessions helped reinforce critical safety information, promoting knowledge retention. Additionally, many caregivers highlighted the role of parents in passing down chemical safety information across generations, ensuring sustained awareness and practices.

"We learn a lot from our parents. As children, we grow up in families and we are told by our parents what is harmful and not. Then when we grow up and become parents, we do the same to our children and the children will do the same for their children and the cycle will continue" (FGD participant)

Knowledge of Chemical Safety

More than half, 55.6% (214/385) of the caregivers were aware that soaps and detergents could cause chemical poisoning and 73.5% (283/385) mentioned that they would take a child to the nearest health facility in case of chemical poisoning (Table 3).

Table 3

Knowledge of chemical safety among caregivers of children in Kampala, Uganda
Variable	Category	Frequency (N = 385)	Percentage (%)
Products that cause chemical poisoning in homes	Drain cleaners	1	0.3
	Swimming pool chemicals	1	0.3
	Disinfectants	10	2.6
	Weed killers	10	2.6
	Paints and paint thinners	15	3.9
	Air fresheners	15	3.9
	Other	25	6.5
	Bleach	34	8.83
	Pesticides	36	9.4
	Don't know	56	14.6
	Rodent poisons	70	18.2
	Personal care products e.g hair dye, lotions, etc	98	25.5
	Medications	101	26.2
	Insecticides	47	12.2
	Fuels such as kerosene	166	43.1
	Detergents and soap	214	55.6
Steps to take when a child gets exposed to household chemical products	Give the child milk	154	40.0
	Seek help from community members	46	12.0
	Take the child to the nearest health facility	283	73.5
	Keep any packaging or containers of the poisonous substance for reference	2	0.5
	Seek help from family members	3	0.8
	Contact local authority for assistance	34	8.8
	Other	16	4.2
	Don't know	3	0.8
Practices that increase the risk of chemical poisoning due to HCPs	Mixing different chemical products	49	12.7
	Storing chemicals in areas accessible to children	301	78.2
	Using chemicals in poorly ventilated spaces	21	5.5
	Failing to read and follow instructions on the product label	14	3.6
	Using uncertified chemical products	10	2.6
	Other	19	4.9
	Don't know	44	11.4
Known signs and symptoms of chemical poisoning	Nausea	40	10.4
	Vomiting	266	69.1
	Difficulty in breathing	42	10.9
	Eye irritation	49	12.7
	Skin irritation	78	20.3
	Seizures	15	3.9
	Diarrhea	156	40.5
	Abdominal pain	68	17.7
	Muscle weakness	42	10.9
	Headache	17	4.4
	Wheezing	10	2.6
	Dizziness	18	4.7
	Loss of consciousness	17	4.4
	Fever	54	14.0
	Excessive tearing	60	15.6
	Blurred vision	3	0.8
	Chest pain	8	2.1
	Coughing	32	8.3
	Don't know	18	4.7
	Other	32	8.3
Chemical poisoning is preventable	Yes	317	82.3
	No	52	13.5
	Don't know	16	4.2
Chemical poisoning is treatable	Yes	359	93.3
	No	10	2.6
	Don't know	16	4.2

Populations at risk of household chemical poisoning

The majority, 95.3% (367/385) of the respondents identified children as being at a higher risk of exposure to chemical poisoning, 8.3% (32/385) identified the elderly and 2.9% (11/385) identified individuals with pre-existing conditions as being the higher risk population. About 4.2% (16/385) of the respondents reported that they did not know while 0.8% (3/385) mentioned others. Children were particularly vulnerable due to their hand-to-mouth behavior, lack of discernment, and explorative tendencies, further exacerbated by their underdeveloped and weaker body organs. Women faced risks from chemical exposure through the use of HCPs, such as uncertified or expired beauty products, which could be absorbed through the skin and cause irritations. Individuals under the influence of alcohol were also at risk, as their impaired judgment could lead to accidental exposure to hazardous substances like kerosene. The elderly were also reported to have a heightened risk due to weakened body systems. Additionally, individuals with underlying diseases and mental illnesses were more susceptible due to compromised immune systems and difficulty in discerning harmful substances.

"We women we see a lot of things that look good not knowing if they are harmful or not and we don't ask to find out the effects. You go and buy make-up and apply it to your whole body and lips, then later in the day, you find that it is finished, later finding out that it has been eaten by the child. You can even consume the lipstick while eating food yet it is not supposed to be eaten" (FGD participant)

"Most especially women, I can see someone who has used make-up products and they look good, I'll also believe that if I use the same, I might also look good, on applying I could get allergic reactions and skin rash" (FGD participant)

"I was once poisoned by kerosene. I came back home drunk and I put my bottle of Waragi on the bed-side. Coincidentally, a bottle with kerosene was also kept at the same location. When I woke up, I grabbed the Kerosene bottle and drank the contents, ending up in hospital" (FGD participant)

Route of exposure

More than three-quarters, 88.8% (342/385), of the respondents mentioned ingestion as the most common route of exposure to household chemical poisons. Close to three quarters, 29.4% (113/385) of the respondents mentioned inhalation, 17.7% (68/385) mentioned skin contact, 8.6% (33/385) mentioned eye contact, and 4.9% (19/385) did not know. FGD participants stated that chemical poisoning often resulted from the ingestion of household chemical products, particularly in children, who frequently exhibit hand-to-mouth behaviors. This made ingestion the most common route of exposure.

"What I see as dangerous is soap, my child found soap on the table and ate it, he later had sores in the mouth and we treated them, a week later we realised that the sores were spread to the stomach all. The child almost died but what helped me was herbal medicine" (FGD participant)

"I am going to talk about paraffin, I had a kerosene stove at home. One day I had gone to the market to buy something, when I came back, I found when both my children had poured paraffin on themselves and had drunk the paraffin as well. I took them to the hospital and they were treated" (FGD participant)

Knowledge of chemical safety procedures

The majority, 84.9% (327/385) of the caregivers were aware of the practice of keeping HCPs out of children's reach, about 12.5% (48/385) were aware of reading product labels before use as a chemical safety procedure, and 9.1% (35/385) did not know of any chemical safety procedure. About 7.0% (27/385) of the respondents were aware of other chemical safety procedures such as keeping HCPs in their original packaging and 2.3% (9/385) were aware of the chemical safety procedure of using appropriate PPE while using HCPs. Caregivers acknowledged their role in safeguarding children, who were not able to identify harmful chemicals themselves. They recognised that chemical poisoning often results from the ingestion of HCPs, illustrated by a case where a child suffered severe health issues after consuming soap. Additionally, they noted that carelessness, such as neglecting safety measures, significantly increased the risk of chemical poisoning in children.

"You have to threaten the child and show them that this is bad and you should not touch it. This is done such that it is implanted in the child's mind that a certain thing is bad and shouldn't be touched. You can keep these chemicals away from children in your household, but they will go to the neighbor's place and find them there but if it is in the child's mind, they will not touch it" (FGD participant)

"Things like paraffin, as a parent might be careless about such products, not knowing that it would expose my children to danger but during this discussion, I have gotten to know that I need to keep these products far away" (FGD participant)

Attitude towards chemical safety

About 66% (254/385) of the respondents strongly agreed that children were at a high risk of poisoning due to HCPs, 79.7% (307/385) strongly agreed that it was essential to store household chemical products out of reach of children and more than half, and 53.7% (207/385) strongly agreed to usually check product labels for warnings and instructions before using HCPs. More than half, 52.0% (200/385) of the caregivers strongly agreed with the importance of proper ventilation during the usage of HCPs, 68.8% (265/385) strongly agreed that it's necessary to educate children about the danger of household chemicals, and 47.5% (188/385) strongly agreed that they felt confident in their ability to respond effectively in case of a chemical poisoning emergency. About 68.1% (262/365) of the caregivers strongly agreed that taking safety precautions with household chemicals was an important part of childcare, 73.8% (284/385) strongly agreed that seeking professional medical help is crucial if a child is exposed to harmful chemicals and 67.5% (259/385) strongly agreed that caregivers should undergo regular training on child-safe practices related to household chemicals (Table 4).

Table 4

Attitude on chemical safety among caregivers of children in Kampala city
Variable	Category	Frequency (N = 385)	Percentage (%)
Children are at a high risk of poisoning due to household chemicals	Strongly agree	254	66.0
	Agree	118	30.6
	Disagree	13	3.4
It is essential to store household chemical products out of reach of children	Strongly agree	307	79.7
	Agree	75	19.5
	Disagree	3	0.8
I usually check product labels for warnings and instructions before using household chemicals	Strongly agree	207	53.7
	Agree	124	32.2
	Disagree	51	13.3
	Strongly disagree	3	0.8
Proper ventilation is important when using household chemicals	Strongly agree	200	52.0
	Agree	126	32.7
	Disagree	56	14.6
	Strongly disagree	3	0.8
It is necessary to educate children about the danger of household chemicals	Strongly agree	265	68.8
	Agree	110	28.6
	Disagree	9	2.3
	Strongly disagree	1	0.3
I feel confident in my ability to respond effectively in case of a chemical poisoning emergency	Strongly agree	183	47.5
	Agree	138	35.8
	Disagree	61	15.8
	Strongly disagree	3	0.8
Taking safety precautions with household chemicals is an important part of childcare	Strongly agree	262	68.1
	Agree	109	28.3
	Disagree	12	3.1
	Strongly disagree	2	0.5
Seeking professional medical help is crucial if a child is exposed to a harmful chemical	Strongly agree	284	73.8
	Agree	86	22.3
	Disagree	15	3.9
Caregivers should undergo regular training on child-safe practices related to household chemicals	Strongly agree	259	67.5
	Agree	99	25.8
	Disagree	25	6.5
	strongly disagree	1	0.3

Chemical safety practices

About 67.8% (261/385) of the respondents exhibited poor chemical safety practices. The majority, 85.2% (328/385) of the caregivers reported having stored HCPs out of reach of children, 70.4% (271/385) reported having read product labels for warnings and instructions before using HCPs, 43.9% reported having used PPE while using HCPs, and 47% attended training or sought information on child-safe practices related to HCPs (Table 5). Caregivers were motivated to promote chemical safety due to several reasons. Parents who had experienced chemical poisoning were driven to prevent similar incidents. The need to protect children from harm, avoid medical expenses related to poverty, and prevent deaths and disabilities were significant motivators. Additionally, caregivers recognised their parental responsibility and the expectation that children would care for them in old age, prompting them to prioritise their children's safety.

"I am motivated to prioritise chemical safety because we do not have enough money to take care of the children and therefore it is very hard for us to afford medical expenses in case a child is poisoned" (FGD participant)

"Ever since my child drank JIK, I keep dangerous products in a lockable compartment in my cupboard and I am the only one with access to the keys, I can't put my children's life in danger again" (FGD participant)

Table 5

Chemical safety practices among caregivers of children in Kampala city
Variable	Category	Frequency (N = 385)	Percentage (%)
Store household chemical products out of reach of children	Yes	328	85.2
	No	55	14.3
	Don't know	2	0.5
Read product labels for warnings and instructions before using household chemical products	Yes	271	70.4
	No	112	29.1
	Don't know	2	0.5
Use personal protective equipment (gloves, mask) when handling harmful household chemical products	Yes	169	43.9
	No	214	55.9
	Don't know	2	0.5
Educate children in my care about the dangers of household chemical products	Yes	316	82.1
	No	69	17.9
Have a designated and secure storage area for household chemical products	Yes	301	78.2
	No	84	21.8
Attend training or seek information on child-safe practices related to household chemical products	Yes	181	47.0
	No	200	52.0
	Don't know	4	1.0
Have a plan in place for responding to chemical poisoning emergencies	Yes	221	57.4
	No	162	42.1
	Don't know	2	0.5
Have a first aid kit at home	Yes	78	20.3
Have a first aid kit at home	No	307	79.7
Regularly check and update the first aid kit in my home	Yes	74	19.2
Regularly check and update the first aid kit in my home	No	311	80.8
Provide strict supervision to prevent children's exposure to HCPs	Yes	305	79.2
	No	79	20.5
	Don't know	1	0.3

Benefits, strategies and barriers to chemical safety in households

Caregivers highlighted multiple benefits of chemical safety. They stated that ensuring chemical safety minimises quarrels within families, promotes peace, and reduces child mortality by preventing fatal poisonings. It also alleviates stress for parents, helping to prevent stress-related non-communicable diseases like hypertension. By avoiding the costs associated with treating chemical poisoning, families can save money. Furthermore, chemical safety reduces gender-based violence, as it prevents situations where husbands might blame and physically abuse their wives for perceived negligence.

"Our husbands always blame us when something bad happens to the child. Sometimes we end up being beaten or chased away from home. That's why we are careful and try to keep these products away from children" (FGD participant)

Caregivers employed several strategies to prevent chemical poisoning among children. They kept HCPs out of children's reach by storing them in elevated compartments such as cupboards. Maintaining clean and organised homes helped in designating proper storage areas for HCPs and quickly identifying misplaced items. Many caregivers resorted to threatening and punishing children if they were found holding, eating or applying HCPs to their skins. This was done to instil a sense of danger, preventing similar incidences. Strict supervision of children during daily activities was prioritised despite various challenges such as lack of time caused by distractions and other household responsibilities to be taken care of. Additionally, caregivers educated children aged three and above about the dangers of HCPs to foster awareness and caution.

"We keep them in the cupboard or raised place they can't reach and we store them there" (FGD participant)

"You have to threaten the child and show them that this is bad and you should touch it. So that it is rooted in their minds and even when they go to the neighbour's place and find them there, they'll not touch them" (FGD participant)

Caregivers face several challenges in promoting chemical safety. Congested living spaces, lack proper storage for hazardous chemicals, making them easily accessible to children. Uncooperative neighbourhoods and poor waste disposal practices increase children's exposure to harmful chemicals. Poverty limits access to effective medical treatment for poisoning, often leading caregivers to rely on inadequate over-the-counter solutions. Additionally, the exclusion of men from health education sessions impedes the implementation of safety measures, as women often lack decision-making power. The imbalance between work and child supervision, coupled with the distrust of the house due to reported incidents of harm, complicates efforts to ensure children's safety.

"We sleep in congested single rooms, lacking space to store these chemicals. In this community, 3 people can rent one room to cut down rent expenses. So, we end up congested and those without children in the room do not care about chemical safety" (FGD participant)

"I can personally try my best at home, to protect my child from exposure to these chemical products but my neighbour does not, this means my child will gain access to them at a certain point in time. That discourages me" (FGD participant)

"I almost lost my son when he ate soap. He originally only had sores in the mouth so we treated those at the clinic in the neighborhood. Because we didn't have money, we did not take him for a check-up at the hospital. After a week, he became severely ill, and upon taking him to the hospital, we realised the sores were spread all through his stomach and to his anus. It cost us a lot that we had to borrow money to foot the medical bill" (FGD participant)

Factors associated with poor chemical safety practices

After adjusting for potential confounders, the age of the respondent, knowledge of practices that increase the risk of chemical poisoning due to household chemical products, whether chemical poisoning could be prevented, awareness that proper ventilation was important when using household chemical products, and feeling confident with the ability to respond effectively in case of a chemical poisoning emergency were significantly associated with poor chemical safety practices.

Respondents aged 25–35 years had a 22% higher prevalence of poor chemical safety practices compared to those aged 18–24 years (APR: 1.22, 95% CI: (1.00-1.50), p = 0.048). The prevalence of poor chemical safety practices was 17% lower among caregivers knowledgeable of practices that increase the risk of exposure to chemical poisons (APR: 0.83, 95%CI: (0.71–0.96), p = 0.017) than those who were not. The prevalence of poor chemical practices was 19% lower among caregivers who knew whether chemical poisoning could be prevented (APR: 0.81, 95%CI: (0.67–0.97), p = 0.027) compared to those who did not. The prevalence of poor chemical safety practices was 17% lower among caregivers who usually checked product labels for warnings and instructions before using HCPs than those who did not (APR: 0.83, 95% CI: (0.73–0.95), p = 0.009). The prevalence of poor chemical practices was 21% lower (APR: 0.79, 95%CI (0.70–0.89), p < 0.001) among caregivers who agreed that proper ventilation was important when using household chemicals compared to those who disagreed. The prevalence of poor chemical practices was 18% lower (APR: 0.82, 95%CI: (0.72–0.93), p = 0.003) among caregivers who felt confident that they were able to respond effectively in case of a chemical poisoning emergency compared to those who did not. (Table 6).

Table 6

Factors associated with poor chemical safety practices among caregivers in Kampala City
Variable	Category	n	Practice level		Crude PR (95% CI)	Adjusted PR (95% CI)	P-value
Variable	Category	n	Good	Poor	Crude PR (95% CI)	Adjusted PR (95% CI)	P-value
Age category (Years)	18–24	81	35 (43.2)	46 (56.8)	1
	25–35	189	51 (27.0)	138 (73.0)	1.28 (1.04–1.58)	1.22 (1.00-1.50)	0.048
	> 35	115	38 (33.0)	77 (67.0)	1.17 (0.93–1.48)	1.14 (0.90–1.45)
Sex	Female	356	118 (33.1)	238 (66.9)	1
Sex	Male	29	6 (20.7)	23 (79.3)	1.18 (0.97–1.44)	1.11 (0.92–1.34)	0.243
Employment status	Employed by someone or an entity	108	31 (28.7)	77 (71.3)	1
	Self-employed	189	59 (312)	130 (68.8)	0.96 (0.82–1.12)	0.93 (0.80–1.09)	0.436
	Unemployed	88	34 (38.6)	54 (61.4)	0.86 (0.70–1.05)	0.87 (0.72–1.07)	0.204
Type of family	Extended	82	19 (23.2)	63 (76.8)	1
Type of family	Nuclear	303	105 (34.7)	198 (65.3)	0.84 (0.73–0.98)	0.94 (0.81–1.09)	0.436
Chemical poisoning is preventable	Don't know	16	4 (25.0)	12 (75.0)
	No	52	24 (46.2)	28 (53.8)	0.71 (0.49–1.04)	0.87 (0.59–1.29)	0.505
	Yes	317	96 (30.3)	221 (69.7)	1	1.16 (0.84–1.60)	0.365
Knowledgeable of individuals at an increased risk of exposure to HH chemical poisons	No	15	2 (13.3)	13 (86.7)	1
	Yes	370	122 (33.0)	248 (67.0)	0.77 (0.62–0.95)	1.04 (0.74–1.46)	0.794
Knowledgeable of common ways in which children in households are exposed to household chemical products	No	20	3 (15.0)	17 (85.0)	1
	Yes	365	121 (33.2)	244 (66.8)	0.78 (0.64–0.95)	1.00 (0.75–1.34)	0.960
Know practices that increase the risk of exposure to chemical poisons	No	52	5 (9.6)	47 (90.4)	1
	Yes	333	119 (35.7)	214 (64.3)	0.71 (0.63–0.80)	0.83 (0.71–0.96)	0.017
Know the common signs and symptoms of chemical poisoning	No	27	5 (18.5)	22 (81.5)	1
Know the common signs and symptoms of chemical poisoning	Yes	358	119 (33.2)	239 (66.8)	0.81 (0.67–0.99)	0.98 (0.78–1.25)	0.926
Know whether chemical poisoning could be prevented	No	48	6 (12.5)	42 (87.5)	1
Know whether chemical poisoning could be prevented	Yes	337	118 (35.0)	219 (65.0)	0.74 (0.65–0.84)	0.81 (0.67–0.97)	0.027
I usually check product labels for warnings and instructions before using household chemical Products	Disagree	51	2 (3.9)	49 (96.1)	1
	Agree	334	122 (36.5)	212 (63.5)	0.66 (0.59–0.72)	0.83 (0.73–0.95)	0.009
Proper ventilation is important when using household chemicals	Disagree	59	1 (1.7)	58 (98.3)	1
	Agree	326	123 (37.7)	203 (62.3)	0.63 (0.57–0.69)	0.79 (0.70–0.89)	< 0.001
It is necessary to educate children about the danger of household chemicals	Disagree	10	1 (10.0)	9 (90.0)	1
	Agree	375	123 (32.8)	252 (67.2)	1.74 (0.60–0.92)	1.14 (0.85–1.54)	0.359
I feel confident in my ability to respond effectively in case of a chemical poisoning emergency	Disagree	64	4 (6.3)	60 (93.8)	1
	Agree	321	120 (37.4)	201 (62.6)	0.66 (0.60–0.74)	0.82 (0.72–0.93)	0.003
Seeking professional medical help is crucial if a child is exposed to a harmful chemical	Disagree	15	3 (20.0)	12 (80.0)	1
	Agree	370	121 (32.7)	249 (67.3)	0.84 (0.64–1.09)	1.09 (0.77–1.52)	0.612
Caregivers should undergo regular training on child-safe practices related to household chemicals	Disagree	27	5 (18.5)	22 (81.5)	1
	Agree	358	119 (33.2)	239 (66.8)	0.81 (0.67–0.99)	0.91 (0.71–1.16)	0.479
* PR: Prevalence Ratio

The study assessed knowledge, attitude, and chemical safety practices among caregivers of children in Kampala City, Uganda. While our study found that a significant proportion of caregivers had a high level of knowledge and positive attitudes, the majority exhibited poor chemical safety practices. Factors associated with chemical safety practices included the caregiver's age and their knowledge and attitudes related to chemical safety.

We found that a significant proportion of caregivers had a high knowledge level of chemical safety. They were particularly aware of the household products that can cause poisoning, the steps to take when a child is exposed, the practices that increase the risk of exposure, and the signs and symptoms of exposure. Despite this knowledge, the majority of the respondents identified ingestion as the primary route of exposure, with significantly fewer recognising inhalation, skin contact, and eye contact as potential routes. This indicates a substantial gap in knowledge regarding other exposure routes, which has implications for household chemical safety. The high recognition of ingestion can be attributed to caregivers' understanding of children's behaviours, such as hand-to-mouth activities, based on previous experiences of chemical poisoning, as reported by the FGD participants.

Furthermore, previous studies have documented ingestion as the most common route of exposure to HCPs among children [40, 41]. Our findings highlight the need for broader health education strategies on other exposure routes, including inhalation, skin contact, and eye contact to ensure thorough implementation of preventive measures. The study also revealed that 14.6% of respondents did not know which products could cause poisoning. This lack of knowledge could be attributed to the limited access to information in informal settlements, where topics such as chemical safety are often under-represented. This finding implies a need for targeted educational interventions and improved information dissemination strategies to bridge this knowledge gap.

The study revealed a high prevalence of positive attitudes toward chemical safety among caregivers of under-fives. For instance, more than three-quarters of participants strongly agreed on the importance of storing household chemical products out of children's reach, taking safety precautions with household chemicals as a crucial part of childcare, and seeking professional medical help if a child is exposed to harmful chemicals. Additionally, about two-thirds of participants strongly agreed that caregivers should undergo regular training on child-safe practices related to household chemicals. These findings indicate that caregivers recognise the critical role of safety measures in preventing chemical poisoning and are supportive of ongoing education to enhance their ability to protect children. The positive attitudes towards chemical safety suggest a readiness among caregivers to take up safety practices, which is crucial for effective preventive measures. Our findings corroborate those reported in previous studies conducted in Sub-Saharan Africa [42, 43].

Despite the high knowledge and positive attitudes among caregivers in this study, two-thirds exhibited poor chemical safety practices. This discrepancy between knowledge, attitudes, and actual practices highlights that knowledge and positive attitudes alone may not ensure the adoption of chemical safety practices. This highlights the need for behaviour change communication strategies that address other constraints that could prevent caregivers from adopting good chemical safety practices. These findings concur with those in a cross-sectional study conducted in Egypt, which showed that two-thirds of the mothers had unsatisfactory practices about poisoning [42].

Our study found that caregivers aged 25–35 years had a higher prevalence of poor chemical safety practices than those aged 18–24. This discrepancy may be attributed to younger caregivers perceiving a higher risk associated with household chemicals, possibly due to exposure to information, unlike older caregivers. Moreover, older caregivers might feel more confident and assume they know enough based on past experiences. Research in other contexts has shown age-related differences in safety practices [44, 45]. These findings reveal a need for interventions that consider variations in practices by age, consequently ensuring that younger and older caregivers receive the appropriate support and education to improve household chemical safety.

This study revealed that the prevalence of poor chemical safety practices was significantly lower among knowledgeable caregivers than those who were not. For instance, caregivers who were knowledgeable of practices that increase the risk of exposure to chemical poisons had a lower prevalence of chemical practices than those who were not. Knowledge about the factors that increase the risk of exposure to chemical poisons empowers caregivers to take preventive actions that mitigate these risks. For example, caregivers who understand the dangers of storing chemicals within reach of children, mixing different chemical products, or using chemicals in poorly ventilated spaces are more likely to take up safer practices, such as using child-proof storage, reading labels, and ensuring proper ventilation. Furthermore, the study found that caregivers who were aware that chemical poisoning could be prevented had a significantly lower prevalence of poor chemical practices compared to those who did not. Previous studies in other settings have also shown that knowledge about chemical safety is associated with better safety practices [42, 46].

We also found that caregiver attitudes determined chemical safety practices. Specifically, respondents agreed that proper ventilation is important when using household chemicals, and those who agreed that they usually check product labels for warnings and instructions before using HCPs had a lower prevalence of poor chemical practices than those who disagreed. This finding shows the role of attitudes in shaping behaviour, particularly related to chemical safety. Caregivers who recognise the importance of proper ventilation and the necessity of reading product labels are likely more cautious about safety and, consequently, engage in safer practices. Research in other contexts has similarly shown that caregiver's attitudes toward safety significantly influence their behavior [42, 46, 47]. For example, studies on poisoning have found that mothers with a positive attitude were more likely to engage in better behaviours [42, 46].

The study also revealed that caregivers who felt confident they could respond effectively in a chemical poisoning emergency had better chemical practices. This finding suggests that self-efficacy or belief in one's ability to manage situations effectively plays a role in the uptake of safe practices. Caregivers confident in their emergency response skills are likely to take prevention measures to avoid such emergencies in the first place. This confidence could be explained by previous exposure to information and past chemical accidents. For instance, caregivers who have encountered chemical emergencies and learned from those experiences are more likely to understand the importance of prevention and are better prepared to handle such situations. Our findings concur with those reported in another cross-sectional study in Iran, which found that the caregiver's self-efficacy was a predictor for preventing poisoning among children under the age of five [46]. Therefore, there is a need for public health interventions targeted at improving caregiver self-efficacy to ensure the uptake of chemical safety practices.

In households where using HCPs is inevitable, ensuring safety practices among caregivers is vital. The study assessed the knowledge, attitudes, and chemical safety practices among caregivers of children in Kampala City, Uganda. While a significant proportion of caregivers demonstrated high levels of knowledge and positive attitudes towards chemical safety, the majority still exhibited poor chemical safety practices. The findings also highlighted gaps in knowledge regarding exposure routes such as inhalation, skin contact, and eye contact. The prevalence of poor chemical practices was significantly lower among younger caregivers, those with a high knowledge level and those with positive attitudes regarding chemical safety. Our study reveals a need for interventions targeted at older caregivers with low knowledge and negative attitudes regarding chemical safety to improve practices.

Strengths and limitations

This study was prone to socio-desirability bias and recall bias. However, research assistants in the study were trained in probing techniques to minimise this.

Ethical Considerations

This study followed the Declaration of Helsinki. The study obtained ethical approval from the Makerere University School of Public Health Research Ethics Committee and administrative clearance from each selected cell's Kampala City Health Office and the Local Council chairpersons. Research assistants obtained written informed consent from all the study participants. Participation in this study was voluntary, and principles of respect, beneficence, and justice were observed during the selection of participants.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Funding

There was no specific funding for this particular work

Author contributions

AT, TS, and AN conceptualised this study. DN JG, WMJ, NBT, JN, WK, RKM, and JBI supported data collection, management, and analysis and participated in drafting, reviewing, and editing the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We want to thank all respondents for taking part in this study. Special thanks also go to all the research assistants who participated in collecting the data.

World Health Organisation, W. Prevention and management of cases of poisoning. 2023 11/25/2023]; Available from: https://www.who.int/teams/environment-climate-change-and-health/chemical-safety-and-health/incidents-poisonings/prevention-and-management-of-cases-of-poisoning.
Wang, Z., Y. Liu, and T. Liu, An Empirical Study on Hazardous Chemicals Risk of Urban Residents in China: Analysis of Mediating Effect and Channel Preference of Response Action Decision Model. Int J Environ Res Public Health, 2021. 18(20).
Khalil, M., et al., Chapter 11 - Household chemicals and their impact, in Environmental Micropollutants, MZ. Hashmi, S. Wang, and Z. Ahmed, Editors. 2022, Elsevier. p. 201-232.
World Health Organisation, W. Chemical Safety and Health. 2023 [cited 2023 11/25/2023]; Available from: https://www.who.int/teams/environment-climate-change-and-health/chemical-safety-and-health/health-impacts/burden-of-disease-from-chemicals.
Jors Erik, N.D., ondon Leslie, Pesticide Poisonings in Low- and Middle-Income Countries. Environmental health insights, 2018. 12.
Chelkeba, L., et al., Patterns and epidemiology of acute poisoning in Ethiopia: systematic review of observational studies. Arch Public Health, 2018. 76: p. 34.
PROBICOU, P.-b.C.i.U., PESTICIDES USE AND AGRICULTURE IN UGANDA, in PESTICIDES USE AND AGRICULTURE IN UGANDA. 2013, SINGA CREATIVE DESIGNS - Uganda. p. 20.
Ssemugabo, C., et al., Prevalence, Circumstances, and Management of Acute Pesticide Poisoning in Hospitals in Kampala City, Uganda. Environ Health Insights, 2017. 11: p. 1178630217728924.
Okebukola, P.A., et al., Investigating chemical safety awareness and practices in Nigerian Schools. Journal of Chemical Education, 2020. 98(1): p. 105-112.
WHO. Chemical safety. 2024 [cited 2024 13-June]; Available from: https://www.who.int/health-topics/chemical-safety#tab=tab_1.
Health Canada. Home safety. 2024 [cited 2024 13-June]; Available from: https://www.canada.ca/en/health-canada/services/home-safety/household-chemical-safety.html.
EPA. Household chemicals. 2024 [cited 2024 13-June]; Available from: https://www.epa.govt.nz/everyday-environment/household-chemicals/.
Lee, M. and M. You, Safety Behaviors to Reduce Risk of Using Chemical Household Products: An Application of the Risk Perception Attitude Framework. International Journal of Environmental Research and Public Health, 2020. 17(5): p. 1528.
Althobaiti, B.M., et al., Patterns of acute poisoning for children during an outbreak of Corona virus in Makkah region Saudi Arabia. Frontiers in Pediatrics, 2023. 11.
World Health Organisation, W. Guidelines for establishing a poison centre. 2021; Available from: https://www.who.int/publications/i/item/9789240009523.
International Labour Organisation, S.H.f.A., Exposure to hazardous chemicals at work and resulting health impacts: A global review. 2021. p. 95.
Buchmuller, K., A. Bearth, and M. Siegrist, Consumers' perceptions of chemical household products and the associated risks. Food Chem Toxicol, 2020. 143: p. 111511.
Bearth, A., et al., Household chemicals and pre-schoolers: Caretakers' beliefs and perspectives on risks and responsibilities. Safety Science, 2022. 154.
Ministry of Health, M. Uganda Clinical Guidelines 2023. 2023 [cited 2024 03-01-2024]; Available from: https://www.health.go.ug/cause/uganda-clinical-guidelines-2023/.
Omidire, M.F., D. AnnaMosia, and M.R. Mampane, Perceptions of the roles and responsibilities of caregivers in children's homes in South Africa. Revista de Asistenta Sociala, 2015(2): p. 113.
Kajungu, D., et al., Factors associated with caretakers' knowledge, attitude, and practices in the management of pneumonia for children aged five years and below in rural Uganda. BMC Health Services Research, 2023. 23(1): p. 700.
Monde, M.d. The KAP Survey Model. Knowledge Attitude and Practices. Steps and Rules for the Preparation and Implementation of Quantitative Surveys. Médecins du Monde. 2012 6/11/2023]; Available from: https://www.susana.org/en/knowledge-hub/resources-and-publications/library/details/4609#.
Rahman, I.B.A., A Knowledge, Attitude, And Practice (Kap) Study Of Household Chemical Products Poisoning In Pulau Pinang. 2021: Malaysian Theses Online.
Uganda Bureau Of Statistics, U., World population day celebrations Saturday, July 11, 2020. 2020, UBOS.
Brown, A.M. Uganda's emerging urban policy environment: Implications for urban food security and urban migrants. in Urban Forum. 2014. Springer.
Ssekamatte, T., et al., Predictors of consistent condom use among young psychoactive substance users in Kampala's informal settlements, Uganda. Dialogues in Health, 2022. 1: p. 100080.
Ministry of Health, KU. National health facility master list 2018. A complete list of all healthfacilities in Uganda. Kampala, Uganda. 2018 [cited 2023 26-12-2023]; Available from: http://library.health.go.ug/publications/health-facility-inventory/national-health-facility-master-facility-list-2018.
Wipulanusat, W., et al. Applying mixed methods sequential explanatory design to innovation management. in The 10th International Conference on Engineering, Project, and Production Management. 2020. Springer.
Doyle, L., et al., An overview of the qualitative descriptive design within nursing research. Journal of research in nursing, 2020. 25(5): p. 443-455.
Kim, H., J.S. Sefcik, and C. Bradway, Characteristics of qualitative descriptive studies: A systematic review. Research in nursing & health, 2017. 40(1): p. 23-42.
Baillie, J., Commentary: An overview of the qualitative descriptive design within nursing research. J Res Nurs, 2020. 25(5): p. 458-459.
Leslie Kish, Survey Sampling. By Leslie Kish. (New York: John Wiley & Sons, Inc., 1965. Pp. xvi, 643. $10.95.). American Political Science Review, 1965. 59(4): p. 1025-1025.
Ssekamatte, T., et al., prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda. BMC Public Health, 2023. 23(1): p. 801.
Martinez, B.A.F., et al., Odds ratio or prevalence ratio? An overview of reported statistical methods and appropriateness of interpretations in cross-sectional studies with dichotomous outcomes in veterinary medicine. Frontiers in veterinary science, 2017. 4: p. 193.
Gulilat, K. and G. Tiruneh, Assessment of knowledge, attitude and practice of health care workers on infection prevention in health institution Bahir Dar city administration. Science journal of public health, 2014. 7(1): p. 384-393.
Pourhoseingholi, M.A., A.R. Baghestani, and M. Vahedi, How to control confounding effects by statistical analysis. Gastroenterol Hepatol Bed Bench, 2012. 5(2): p. 79-83.
Jain, N. What is a Focus Group? Definition, Questions, Examples and Best Practices. 2023 [cited 2024 04-01-2024]; Available from: https://ideascale.com/blog/what-is-a-focus-group/#toc_Top_8_Best_Practices_for_Conducting_Focus_Groups.
Lambert, V.A. and C.E. Lambert, Qualitative descriptive research: An acceptable design. Pacific Rim international journal of nursing research, 2012. 16(4): p. 255-256.
Doyle, L., et al., An overview of the qualitative descriptive design within nursing research. J Res Nurs, 2020. 25(5): p. 443-455.
Peshin, S.S. and Y.K. Gupta, Poisoning due to household products: A ten years retrospective analysis of telephone calls to the National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi, India. Journal of Forensic and Legal Medicine, 2018. 58: p. 205-211.
Perveen, F., et al., Parental knowledge attitude and practices about chemical and medicinal poisons: A hospital based study from Karachi, Pakistan. Injury, 2023. 54: p. 110481.
Mohammed, A.E.S., D. Mohamed Sobhy, and B. Mohamed Abd Elrahman, Mothers perception regarding poisoning among their preschool children. Journal of nursing science Benha University, 2021. 2(2): p. 1-15.
Shehata, S.A., et al., Knowledge, Attitude and Practice of Mothers towards Household Child Toxicity and Unused Medications: Ismailia, Egypt. Egyptian Society of Clinical Toxicology Journal, 2023. 11(2): p. 10-23.
Green, E.J. and P.L. Knechtges, Food safety knowledge and practices of young adults. Journal of Environmental Health, 2015. 77(10): p. 18-25.
Papadopoli, R., et al., Chemical risk and safety awareness, perception, and practices among research laboratories workers in Italy. J Occup Med Toxicol, 2020. 15: p. 17.
Shahkolai, F.R., et al., The factors related to mother's beliefs and behaviors concerning the prevention of poisoning among children under the age of five, using the Health Belief Model. Turkish journal of pediatrics, 2019. 61(5).
Zailani, B.M., M. Abubakar, and Y. Ibrahim. The role of safety attitude in changing safety behavior and hazard recognition capability of construction workers. in West Africa Built Environment Research (WABER) Conference. Accra, Ghana. 2021.

No competing interests reported.

Download PDF

Reviews received at journal
10 Sep, 2024
Reviewers agreed at journal
05 Sep, 2024
Reviewers agreed at journal
05 Sep, 2024
Reviewers agreed at journal
05 Sep, 2024
Reviewers agreed at journal
05 Sep, 2024
Reviewers agreed at journal
04 Sep, 2024
Reviewers agreed at journal
04 Sep, 2024
Reviewers agreed at journal
04 Sep, 2024
Reviewers agreed at journal
04 Sep, 2024
Reviews received at journal
03 Sep, 2024
Reviewers agreed at journal
03 Sep, 2024
Reviewers agreed at journal
03 Sep, 2024
Reviewers invited by journal
03 Sep, 2024
Editor assigned by journal
03 Sep, 2024
Editor invited by journal
24 Jun, 2024
Submission checks completed at journal
24 Jun, 2024
First submitted to journal
21 Jun, 2024

You are reading this latest preprint version

Knowledge, attitude, and factors associated with household chemical safety practices among caregivers of children in Kampala; a mixed methods study

Status:

Version 1

Abstract

INTRODUCTION

METHODS

Study setting

Study design

Eligibility criteria, sample size determination and sampling procedures

Study variables and measurement

Dependent Variables

Independent Variables

Data collection, management, and analysis

Quality control and assurance

RESULTS

Socio-demographic characteristics of the participants in the quantitative component

Socio-demographic characteristics of participants in the qualitative component

Sources of information on household chemical safety

Knowledge of Chemical Safety

Populations at risk of household chemical poisoning

Route of exposure

Knowledge of chemical safety procedures

Attitude towards chemical safety

Chemical safety practices

Benefits, strategies and barriers to chemical safety in households

Factors associated with poor chemical safety practices

DISCUSSION

CONCLUSIONS

Strengths and limitations

Declarations

References

Additional Declarations

Status:

Version 1