Health-Seeking Behavior Following Injuries in Rural Children at a Sub-District of Bangladesh

doi:10.21203/rs.3.rs-4995938/v1

Download PDF

Research Article

Health-Seeking Behavior Following Injuries in Rural Children at a Sub-District of Bangladesh

https://doi.org/10.21203/rs.3.rs-4995938/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objectives

Knowing health-seeking behavior of family or caregiver is necessary to identify and include scopes of intervention in any injury prevention program, though Bangladesh lacks in recent information. Therefore, this cross-sectional study aimed to provide an updated understanding of health-seeking behavior of family or caregiver following major and minor injuries in rural children.

Methods

It was conducted between May-June 2018 in children (< 18-years) from a selected sub-district following probability sampling. A non-fatal injury occurring within previous three months and hampering regular activities < 30 days was minor, and one occurring within last year and hampering regular activities ≥ 30 days was major. Health-seeking responses for injured children were descriptively analyzed.

Results

Of enrolled 918 children, prevalence of major and minor injuries were 2.4% and 7.4% respectively. Except one child, all other sought for some sort of treatment after an injury. After a major injury (n = 22), 17 children received first aid, mainly provided by relatives (47%) and doctors/trained Health Care Workers (HCWs) (41%). Further treatment was pursued in 64% (n = 22) children; 50% (n = 16) adhered to treatment of doctors/trained HCWs. Median (IQR) suffering was 35 (30–75) days and 18% (n = 22) were hospitalized. After a minor injury (n = 68), 59 children received first aid, mainly provided by relatives (54%) and non-qualified HCWs (25.5%). Further treatment was pursued in 60% (n = 68) children; 71% (n = 49) adhered to treatment of non-qualified HCWs. Median (IQR) suffering was 7 (4–15) days and 3% (n = 68) were hospitalized. Family or caregiver often applied different substances (oil, water, toothpaste, ointment, leaves) over injured part as first aid irrespective of injury pattern and type, though substances varied.

Conclusion

The study identifies nearly similar first aid practices as seen earlier with a treatment adherence more towards non-qualified HCWs. A qualitative study is recommended for in-depth understanding of such behavior before designing targeted interventions, policies, and educational campaigns.

Preventive Medicine

Child injury

Bangladesh

first aid

health-seeking behavior

major injuries

minor injuries

Injury is a global public health problem causing nearly 8% of global mortality annually and 10% of all years lived with disability ¹, though it is relatively neglected, particularly in developing countries ^{2, 3}. Millions of deaths caused are the tip of iceberg having gradually wider layers for hospitalizations, emergency encounters, doctor’s appointments, home treatment and first aid practices at the base giving relative numbers of fatal, non-fatal treated injury, untreated injuries the shape of a pyramid, which vary from country to country ^{2, 4}. The once-sustained injury often lead to short-term, long-term or permanent disabilities, as well as increased risk of mental illness, suicides, substance abuse, and chronic diseases especially for a child injury, requiring long standing physical and mental health care and rehabilitation ^{1, 4}.

Child injury, of all injuries, is a significant public health concern, contributing substantially to the global disease burden ^5–7. In accordance with the 2016 Global Burden of Disease report, 1900 children and adolescents die every day as a result of an injury ⁸. Injury and violence pose a formidable threat to children worldwide, leading to approximately 950,000 fatalities in individuals under the age of 18 each year ⁵; with the Low and Middle-Income Countries (LMIC) bearing the greater burden as evident by five times higher child-injury deaths in these countries than in high-income countries ^{9, 10}. As an LMIC, Bangladesh is no exception. In densely populated Bangladesh, child injury presents a formidable challenge ¹¹ and great disease burden. The child injury mortality increases with age; drowning (25.7/100,000) and suicides (16.8/100,000) being the two leading causes. For injury related morbidity, children aged 5–9 years is the second in rank (13,442.5/100,000) in the whole population ¹²; incidences are higher in rural children than urban ¹³.

As these injuries, not only have immediate implications for children's well-being but can also result in enduring physical and psychological consequences due to poor or inappropriate treatment, understanding the health seeking behavior of caregivers and families after their children sustain injuries is crucial to improve outcomes as well as a secondary preventive measure. Nevertheless, despite global progress in child injury prevention and management, there is paucity of necessary recent information for decades, except for drowning ^{14, 15}, rendering the need to know the current behavior and whether there is any change in it over time to identify scopes of intervention. This cross-sectional study aims to bridge this knowledge gap by examining the health-seeking behavior of caregivers and families at a rural sub-district of Bangladesh in 2018, concerning children with major and minor injuries.

A complete outline of the methods followed in this study was described in a previous study ¹⁶. In summary, this cross-sectional study was conducted in children living at a purposively sampled rural sub-district (Belabo), which was around 80 kilometers northeast from the capital. In 2011, the sub-district contained eight Unions, 100 Villages, 42,377 households, and 73,086 children ^{16, 17}. There was a 31-bedded government owned Upazilla Health Complex, which has been upgraded to a 50-bedded one awaiting to be fully functioning. Besides, government ran seven Union Health Centers, one Union Health sub-Centers, seven Union Health & Family Welfare Centers, 23 Community Clinics (one community clinic for nearly 6,000 people) though majority demands for repair, and many private diagnostic centers and hospitals ¹⁸.

Probability sampling technique was followed all through and data were collected during May-June 2018 with prior verbal assent of the child (> 7 years) and informed written consent of the guardian in a face-to-face interview with the mother using a pre-tested semi-structured questionnaire. All children < 18 years who resided in this rural community for the last six months were eligible for this study. The sample size of 1002 was calculated using the standard formula of n = z²pq/d², with a prevalence of 0.12 ¹² for injuries in general, a precision of 0.03, a design effect of 2 for cluster sampling, and a response rate of 90%. For this study, each village was considered a cluster. Villages in the sub-district were stratified according to its administrative authorities and out of 100 villages, 25 were selected randomly and proportionally ensuring representation from each authority. A total of 41 households were selected from each village, and then, one randomly selected child from one household were interviewed. The ethical approval for the study was obtained from the Institutional Review Board (IRB) of Institute of Epidemiology Disease Control and Research, Bangladesh (IEDCR).

Data on the child’s demography, socio-economic status of the family, and injury type and other related events of the selected child were collected. For both categories, data on the non-fatal injury of alive children regarding fall, cut, burn, transport, and other injuries (injury from a blunt object, animal source, near-drowning, electrocution, and other patterns) were recorded. For children with either a major or a minor injury, data related to health seeking behavior were looked for. The questionnaire was used to collect information on whether first aid was provided immediately after the injury, the details of the first aid and about the person providing the first aid. The questions related to health seeking behavior collected the details of the seeking treatment after the first aid, its continuation, information on the requirement of hospitalization, and outcome at time of data collection. The first aid practice after a particular type of injury was summarized according to the injury pattern. Besides, overall health seeking behavior after having any major or minor injury was enumerated in proportions. All the statistical analysis in this study was performed using STATA version 14.2 (College Station, TX, USA).

Injuries were categorized ‘major’ and ‘minor’ based on how many days it hampered regular activities- as used in studies in Tanzania, Ghana, and Bangladesh ^19–21. An injury was considered ‘minor’ when regular activities were hampered less than 30 days and ‘major’ when regular activities were hampered 30 or more days. A minor injury must have occurred in the previous three months and a major injury in the previous one year because the recall time is longer for major injuries ²². A ‘health-seeking behavior’ was defined as any household member who sought first aid treatment or any type of surgical or medical intervention either from trained health care provider or untrained provider ²³. A ‘first aid’ was defined as emergency care or treatment provided before regular medical aid could be obtained ²⁴. An MBBS (Bachelor of Medicine and Bachelor of Surgery) doctor or a doctor with specialization in a particular field or trained government Health Care Workers (HCW) were defined as a ‘Doctor/trained HCW’, whereas a pharmacy person or a village doctor or a traditional healer were referred as a non-qualified HCW.

The socio-demographic characteristics and injury prevalence of the children interviewed have been partially outlined in a previous publication ¹⁶. In brief, out of 1025 households visited, a non-response rate of 9% was observed, and the target sample size of 918 was achieved. In 90% of cases, the mother of the child served as the respondent. The surveyed children, totaling 918, had a mean age of 8.0 years (SD 5.0), with the majority (29%, n = 915) falling within the 5-9-years age group. Gender distribution among the children was nearly equal. Approximately 60% of families (n = 904) reported an average monthly household expense of 10,001–20,000 Bangladeshi Taka (BDT) (Table 1). Major injuries were observed in 22 children, yielding a prevalence of 2.4 (95% CI 1.5–3.6), while minor injuries were reported in 68 children, resulting in a prevalence of 7.4 (95% CI 5.8–9.3). Two children suffered from both major and minor type of injuries. Fall injuries were the highest reported pattern for both types.

Table 1

Socio-demographic characteristics of the children
Sociodemographic characteristics	Categories	Total
Sociodemographic characteristics	Categories	f	%
Age (Years) (n = 915)	Infant	45	4.9
	1–4	235	25.7
	5–9	268	29.3
	10–14	249	27.2
	15–17	118	12.9
Sex (n = 917)	Female	458	49.9
Sex (n = 917)	Male	459	50.1
Birth order (n = 918)	≤ 2	629	68.5
Birth order (n = 918)	> 2	289	31.5
Father's age (years) (n = 888)	≤ 40	576	64.9
Father's age (years) (n = 888)	> 40	312	35.1
Father's education (n = 890)	Primary or below	506	56.9
Father's education (n = 890)	Secondary and above	384	43.1
Father's occupation (n = 890)	Farmer	248	27.9
	Businessman	205	23.0
	Others	437	49.1
Mother's age (Years) (n = 900)	≤ 30	478	53.1
Mother's age (Years) (n = 900)	> 30	422	46.9
Mother's education (n = 911)	Primary or below	411	45.1
Mother's education (n = 911)	Secondary and above	500	54.9
Mother's occupation (n = 911)	Housewife	828	90.9
Mother's occupation (n = 911)	Other than housewife	83	9.1
Household members (n = 918)	≤ 5	659	71.8
Household members (n = 918)	> 5	259	28.2
Total children in household (n = 918)	< 3	668	72.8
Total children in household (n = 918)	≥ 3	250	27.2
Number of existing siblings (n = 917)	< 3	723	78.8
Number of existing siblings (n = 917)	≥ 3	194	21.2
Living status of child (n = 915)	With father	8	0.9
	With mother	157	17.1
	With both	710	77.7
	With others	40	4.3
Monthly Expenditure (BDT) (n = 904)	≤ 10,000	235	26.0
	10,001–20,000	546	60.4
	≥ 20,001	123	13.6

Regarding the father's background, 65% (n = 888) of the children had a father aged ≤ 40 years, 57% (n = 890) fathers had an educational level equal to or below primary, and 28% fathers were farmers and 23% businessman (n = 890). Concerning the mother's background, 53% (n = 900) of the children had a mother aged ≤ 30 years, 45% (n = 911) mothers had an educational level equal to or below primary, and 91% (n = 911) mothers were housewives. Nearly 78% (n = 915) of the children lived with both parents, and the majority (72%, n = 918) had ≤ 5 family members in the household. There were ≥ 3 total children in only 27% (n = 918) households, and ≥ 3 existing siblings of the interviewed child in 21% (n = 917) households. Almost one-third (31.5%, n = 918) of interviewed children held a birth order greater than two (see Table 1).

Among children with major injuries, 77% (n = 22) promptly took measures after the event, while a higher proportion, 90% (n = 68) did so for minor injuries (Table 3). After occurrence of two major and three minor fall injury events, the injured children did not receive any first-aid care. Of all the injuries observed during data collection, one female child aged 13 years with a minor transport injury did not receive any sort of treatment. Her both parents were illiterate, had a monthly household expense below 10,000 BDT per month and > 5 household members. She suffered for five days due to the injury.

Table 3

Sequelae of health seeking behaviour after a child gets injured with major or minor injuries
Attributes		Major injuries f (%)	Minor injuries f (%)
First aid measures after injury	Yes	17 (77.3)	61 (89.7)
	No	2 (9.1)	4 (5.9)
	Don’t know	3 (13.6)	3 (4.4)
	Total	22 (100)	68 (100)
Type of first aid care provider	Relatives	8 (47.1)	32 (54.2)
	Doctor/ Trained HCW	7 (41.2)	9 (15.3)
	Traditional healer/ village doctor	1 (5.9)	8 (13.6)
	Pharmacy-person	1 (5.9)	7 (11.9)
	others	-	3 (5.1)
	Total	17 (100)	59 (100)
Practices after getting first aid measures from a doctor/ trained HCW	seeking other treatment	3 (42.9)	2 (22.2)
	no other treatment	4 (57.1)	7 (77.8)
	Total	7 (100)	9 (100)
Practice after getting first aid measures from persons other than a doctor/ trained HCW	seeking other treatment	5 (55.6)	25 (50)
	no other treatment	4 (44.4)	25 (50)
	Total	9 (100)	50 (100)
Other treatment apart from first aid measures	Yes	14 (63.6)	41 (60.3)
	No	8 (36.4)	27 (39.7)
	Total	22 (100)	68 (100)
Requirement of hospitalization	Yes	4 (18.2)	2 (2.9)
	No	18 (81.8)	66 (97.0)
	Total	22 (100)	68 (100)
Duration of illness (days)	Median (IQR)	35 (30–75)	7 (4–15)
Outcome	Recovery	22 (100)	68 (100)
Outcome	Total	22 (100)	68 (100)

Out of total 78 injuries where first aid measures were taken, 37% were related to fall injuries. Cut, burn, transport injury, blunt injury, animal source injury, and near drowning constituted 20.5%, 14%, 11.5%, 10%, 4%, and 1%, respectively. A diverse range of practices in seeking treatment or providing first aid care after a specific type of injury was observed. For first aid treatment after any type of injury (excluding transport injury and drowning), the use of various substances was a prevalent practice, albeit with variations in the substances used. In 19% of instances, the child was promptly taken to a doctor or trained Health Care Worker (HCW) after an injury, and in 13% of cases, to a non-qualified HCW (such as a pharmacy person, village doctor, traditional healer, etc.) (Table 2).

Table 2

First aid practice of immediate care provider after occurrence of a particular type of injury in a child
Pattern of injury	Major injury (n = 17) f (%)	Minor injury (n = 61) f (%)	Total injury (n = 78) f (%)	First aid practice of immediate care provider
Pattern of injury	Major injury (n = 17) f (%)	Minor injury (n = 61) f (%)	Total injury (n = 78) f (%)	Practices	f (%)
Fall	5 (29.4)	24 (32.8)	29 (37.2)	Use of different substances without massage (oil/water/ointment/leaves)	10 (34.5)
				Visit a doctor/trained HCW^*	6 (20.7)
				Massage with different substance (oil/water/kerosene/ointment)	4 (13.8)
				Visit an non-qualified HCW (traditional healer)	3 (10.3)
				Use wet cloth to cover injured part	2 (6.9)
				Use antiseptic	1 (3.4)
				Unknown	3 (10.3)
Cut	5 (29.4)	11 (18)	16 (20.5)	Use different substances (tooth paste/wet cloth/non-specific ointment)	5 (31.3)
				Visit an non-qualified HCW (pharmacy person/village doctor)	4 (25)
				Visit a doctor/trained HCW	3 (18.8)
				Use antiseptic	3 (18.8)
				Unknown	1 (6.3)
Burn	3 (17.6)	8 (13.1)	11 (14.1)	Use different substances (engine oil/coconut oil/toothpaste)	4 (36.4)
				Visit an non-qualified HCW	2 (18.2)
				Use ice in water	2 (18.2)
				Wash with running water	1 (9.1)
				Use non-specific home remedy	1 (9.1)
				Unknown	1 (9.1)
Transport	2 (11.8)	7 (11.5)	9 (11.5)	Visit a doctor/trained HCW	4 (44.4)
				Use antiseptic	2 (22.2)
				Apply bandage	1 (11.1)
				Unknown	2 (22.2)
Blunt	2 (11.8)	6 (9.8)	8 (10.3)	Use different substances (water/wet cloth/non-specific ointment/coconut oil)	5 (62.5)
				Visit a doctor	1 (12.5)
				Visit a non-qualified HCW	1 (12.5)
				Use antiseptic	1 (12.5)
Animal source	-	3 (4.5)	3 (3.8)	Use different substances (lime, holistically treated salt)	2 (66.6)
Animal source	-	3 (4.5)	3 (3.8)	Visit a doctor	1 (33.3)
Near drowning	-	1 (1.6)	1 (1.3)	Twirling overhead	1 (100)
^*HCW (Health Care Worker)

After a child suffered from a fall injury (n = 29), diverse substances such as oil, water, leaves, and ointment were applied over the injured area, either with massage (14%) or without (34.5%), and approximately 21% of children were taken to a doctor or trained HCW. In the case of a cut injury (n = 16), apart from using various substances (31%) over the affected area, 19% of children were treated with antiseptic creams. Regarding burn injuries (n = 11), only one child had the burnt area washed with water, while the rest were treated with engine oil, coconut oil, toothpaste, ice and water, or non-specific home remedies. Following a transport injury (n = 9), the predominant practice was taking children to a doctor or trained HCW (44%). For blunt and animal source injuries, the common approach involved applying different substances over the injured area. In the only recorded event of near-drowning, the child was twirled overhead (Table 2).

Following the occurrence of an injury, the majority of individuals received first aid measures, and in most cases, the initial treatment or care was administered by relatives of the injured child (47%, n = 17 for major injuries and 54%, n = 59 for minor injuries). For children with major injuries, more than one-third (41%) were first treated by a doctor/trained HCW, whereas for children with minor injuries, a non-qualified HCW (pharmacy person, village doctor, traditional healer, etc.) was the primary caregiver in one-fourth (25.5%) of cases.

The study analyzed practices of seeking additional treatment for both major and minor injuries beyond first aid care (Table 3). In the case of major injuries, when first aid measures were provided by a doctor/trained HCW (n = 7), 43% sought additional treatment from specialist doctor, traditional healer or both for injured children. When relatives (n = 7) provided first aid, 71% sought additional treatment from either only doctors and traditional healers, or in combination along with village doctors. However, no additional treatment was sought after getting first aid from pharmacy and traditional healer (n = 2). Regarding minor injuries, when first aid measures were taken by a doctor/trained HCW (n = 9), 22% looked for additional treatment from other doctors. When relatives or others (n = 35) provided first aid, 69% sought additional treatment from either only doctors/trained HCWs, pharmacy persons, village doctors, and traditional healers, or in combination. Half of those getting first aids from traditional healers (n = 4) looked for pharmacy persons, but those from village doctors and pharmacy persons (n = 11) did not seek any additional treatment. Approximately 18% (n = 22) children with major injury and 3% (n = 68) children with minor injury required hospitalization. Median (IQR) duration of suffering for a child with major injury was 35 (30–75) days, and 7 (4–15) days for a minor injury. All children were in the recovered state at time of data collection.

Half of the family or caregiver of children with major injury (n = 16) chose to complete the treatment given by a doctor and half by a non-qualified HCW. For a minor injury (n = 49), nearly three-fourth (71%) adhered exclusively to the treatment provided by a non-qualified HCW (Fig. 1). Regarding adherence to the treatment of a child with a major injury, father’s level of education did not vary between the choices of doctor/trained HCWs and non-qualified HCWs, but that of mothers were different. Over one-third (38.5%, n = 13) mothers with educational level of secondary and above continued treatment from non-qualified HCWs. In households with monthly expenses ≤ 15000 BDT, 67% (n = 12) of those continued treatment of non-qualified HCWs, whereas no household with expenses > 15000 BDT chose non-qualified HCWs (n = 3). When the child had a minor injury, majority followed treatment of a non-qualified HCW irrespective of level of education of parents or household expenses. Nevertheless, practices were slightly different with education of a father and a mother, and higher monthly household income. Around 78% fathers (n = 18) and 88% mothers (n = 25) with education of primary or below, as well as 86% fathers (n = 28) and 79% mothers (n = 24) having education secondary and above chose to continue treatment of non-qualified HCWs (Fig. 2).

Though there are advances in injury prevention and management, there is a dearth of comprehensive, context-specific, and updated research on the health seeking behavior for injured children in Bangladesh, which should be an integral part of any prevention program. With this aim, this cross-sectional study describes the current health-seeking behavior of caregivers and families at a Bangladeshi sub-district in 2018, after a child experiences non-fatal major and minor injuries. A range of critical factors were analyzed, from the first aid measures taken after injury to the adherence to treatment by various healthcare providers, aiming to shed light on the complex landscape of pediatric injury care.

The nature and pattern of treatment seeking is very much context-specific and has wide variability. As observed in this study, at least some sort of treatment was sought for after sustaining any type of non-fatal injury, except for one case. It indicates a change in health-seeking behavior as the finding is dissimilar to the earlier studies, where nearly 80% respondents either sought some form of treatment or first aid ^{23, 25} in rural Bangladesh, and around 70% in India ²⁶. The most probable reason might be that the other studies were conducted on all age group, whereas this study focused to child injury only. As parents are highly sensitive of the well-being of their children, most of the injured children undergo some form of medical treatment.

Majority children received first aid care by a relative irrespective of major or minor type, finding similar to one study conducted in Indian children ²⁷. However, the first aid care provider as observed here is different from another study conducted in under five children in a South-Indian village, where nearly 40% of the children with injuries were treated by trained health personnel, and 29% by a family member ²⁶. Enrollment of any eligible children below 18 years in this study might be the reason of this dissimilarity. Here, after a major injury, the proportion of consulting with a doctor/trained HCW after an injury was nearly equal to the care of relatives. However, a doctor/trained HCW was consulted with in a lower proportion for that of a minor injury, and relatives or non-qualified HCWs mainly provided the first aid care. Most likely, the immediate nature of the injury compelled them to such practice, which is similar to earlier studies ^{23, 25}.

As a first aid measure after fall injury, use of different substances was observed in this study and has been practiced in rural Bangladesh for years and in neighboring countries, like India ^{15, 27, 28}. Consulting with a non-qualified HCW was also practiced in the past and is common now ¹⁵. The only notable changes from earlier days were with the ‘use of wet cloth to cover injured part’, which was practiced by urban people only; and ‘use of antiseptics’, which was not common then ¹⁵.

For cut injuries, this study found use of toothpaste, wet cloth, non-specific ointment, antiseptic cream etc. for children. In Bangladesh Health and Injury Survey 2003, most people practiced using antiseptic cream for a cut injury from caused by road-traffic accidents, but herb/grass paste, kerosene, lime on bleeding wounds caused by a fall injury ¹⁵. However, slightly different substances, e.g., coconut oil, juice of local herbs, and turmeric are used for such injuries in children in parts of India ^{27, 29}.

When a child suffered from a burn injury, the recommended practice of washing the injured part with running water was noted in only one instance. The other practices of using coconut oil, tooth paste, ice in water, non-specific home remedy have been in vogue for years ¹⁵. Application of different other substances were found in India and in other countries alongside the above-mentioned ^{27, 29}.

In this study, most children were taken to a doctor/trained HCW after sustaining a transport injury. The observed practice is dissimilar to earlier 2003 survey in Bangladesh, where the child was brought to a doctor only if fractured bones or difficulty in applying first aid was suspected ¹⁵. The finding is similar to the ‘knowledge’ for injury intervention in India ²⁸, but different from the practice ²⁷.

The first-aid practice observed in this study for a near-drowning event is similar to the earlier injury survey of 2003, but different from that in India ^{15, 27}. However, only one such event was found here, which is insufficient to make any comparative statement. The first-aid found here for treating injuries from animal sources and blunt objects was mainly by using different substances over the injured area, which is no different from the earlier studies in Bangladesh and India, though, there is variation in the type of substance used for the purpose ^{15, 27, 29, 30}.

After the first aid care following a major or a minor injury, nearly three-fifth of all children sought for further care either from a doctor/trained HCW or a non-qualified HCW. In many of the cases they consulted with more than one category of HCWs, which is a decade-long practice in people as also evident in an older study ²⁵. The type of injury, major or minor, guided the category of HCW whose suggestions were to be followed regarding the continuation of treatment. For major injury half of the injured children continued that of a doctor/trained HCW, and mothers with higher educational qualification and households with better monthly expenses chose to consult them more than the others. For minor injury, majority followed that of a non-qualified HCW, the role of educational level or monthly household expenses being minimum. This is again a similar finding prevailing over decades indicating that people consider the type of injury (major/minor) more for choosing a treatment option and their educational or economic status do not contribute much in that decision making ²⁵.

The total findings summarize the presence of the nearly same gap as observed in the earlier conducted health and injury survey in 2003 in Bangladesh ¹⁵ in first aid practices provided by family member or caregiver of an injured child for most patterns of injuries. Besides, it found a changed behavior of seeking for immediate treatment from a doctor/trained HCW after a transport injury irrespective of its severity or nature. As like earlier days, the practices are still incorrect, ineffective, and often harmful for the children implying the necessity of incorporating trainings or lessons of first-aid responses in any community-based injury intervention program to be planned. Besides, the choice of HCW for treatment continuation is heavily biased to a non-qualified one and is often dictated by the type of injury rather than the socio-economic context of the family rendering the need of implementing Behavior Change Communication program focused to it.

The strength of the study is that it was conducted at the villages under a sub-district with adequate sample size, a good precision, and with a response rate of 90% which was representative of a rural community of Bangladesh and the actual child injury prevalence. The health seeking behavior was only looked for when a selected child had a history of injury in the mentioned recall period, and therefore, the results obtained represents the current common such behavior and indicates aspects of changes from the past and status quos. Nevertheless, major limitations of the study are self-reporting of injury with following events, which may have been impacted by recall bias, non-random selection of sub-district under study, and a lack of detailed qualitative component.

Injury poses a substantial threat to a childhood well-being and to a productive adulthood if the incurred morbidity is not appropriately treated and timely managed. Any injury prevention program, as a part of secondary preventive strategies, necessitates the inclusion of disseminating appropriate first-aid response and subsequent treatment seeking responses of the family or caregiver of a child. In Bangladesh, a considerable period has passed after the last nationwide conducted injury survey that provided us with such insights and today. Hence, this study described the update on the health-seeking behavior after an injury in rural children, detailing the first aid practices, first aid care provider, as well as choice of treatment continuation and role of socio-economic factors on the choice. However, a qualitative study is recommended to delve into the in-depth understanding of such behavior to design targeted interventions, policies, and educational campaigns, empowering caregivers and communities to respond effectively to injuries, ultimately reducing the burden and enhancing the well-being of children in Bangladesh.

Source of Funding: The study has been funded by the US-Centers for Disease Control and Prevention through TEPHINET for the fellows in the Field Epidemiology Training Program, Bangladesh (FETP,B). However, they are not involved in the decision to submit the article for publication, and do not provide with publication fees.

Conflict of interests: The authors declare that they have no conflict of interests.

Ethical approval and consent to participate: The ethical approval of the study was taken from the Institutional Review board of Institute of Epidemiology, Disease Control and Research (IEDCR), the reference number being IEDCR/IRB/2018/04, dated 23/04/2018. Prior to data collection verbal assent of the child (>7 years) and informed written consent of the guardian was ensured.

Consent for publication: Not applicable

Disclosure statement: The author declares no conflict of interest. The views expressed in this article are those of the authors and do not necessarily represent the decisions, policy, or views of the US-CDC or TEPHINET or IEDCR.

Authors' contributions: NA wrote the study protocol, supervised data collection, analyzed and interpreted data and drafted the manuscript. MN contributed significantly to data analysis and interpretation, and scientific writing. MSF was a contributor to the conception of the study protocol and scientific writing. All authors have critically reviewed and approved the final draft, and are responsible for the content and similarity index of the manuscript.

Acknowledgements: We express our gratitude to the support of Institute of Epidemiology, Disease Control and Research (IEDCR), and Field Epidemiology Training Program, Bangladesh (FETP,B).

Injuries and violence: WHO (2021) [updated 19-03-2021; cited 2024 26-03-2024]. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence
Injuries and Violence the Facts (2014) publication. Geneva, Switzerland, Department for the Management of Noncommunicable Diseases D, Violence and Injury Prevention; 2014
Gosselin RA, Spiegel DA, Coughlin R, Zirkle LG (2009) Injuries: the neglected burden in developing countries. Bull World Health Organ 87(4):246–246a. 10.2471/blt.08.052290
Preventing injuries (2007) and violence: A guide for ministries of health. publication. Geneva, Switzerland
Peden M (2008) World report on child injury prevention. World Health Organization
Al-Hajj S, El Bcheraoui C, Daoud F, Khalil I, Moradi-Lakeh M, Abu-Raddad LJ et al (2020) Child and adolescent injury burden in the eastern mediterranean region: Findings from the Global Burden of Disease 1990–2017. BMC Public Health 20(1):433. 10.1186/s12889-020-08523-w
Sleet DA (2018) The Global Challenge of Child Injury Prevention. Int J Environ Res Public Health 15(9):1921
. The Lancet. 2017;390(10100):1151–1210. doi: 10.1016/S0140-6736(17)32152-9
UNICEF (2001) A league table of child deaths by injury in rich nations. Unicef Innocenti Research Center, Florence
E. P. Childhood injuries in the European Union: can epidemiology contribute to their control. Acta paediatrica (Oslo, Norway: (1992) 2000;89(10):1244–1249
Rahman F, Rahman A, Linnan M, Giersing M, Shafinaz S (2004) The magnitude of child injuries in Bangladesh: a major child health problem. Injury control Saf promotion 11(3):153–157. 10.1080/156609704/233/289634
Bangladesh health and injury survey (2016) summary report. Dhaka, Bangladesh: DGHS of MoHFW, CIPRB; 2016
Chowdhury S, Rahman A, Mashreky SR, Giashuddin S, Svanström L, Hörte L et al (2009) The horizon of unintentional injuries among children in low-income setting: an overview from Bangladesh Health and Injury Survey. Journal of environmental and public health. ;2009
Hossain MJ, Hossain MS, Bhuiyan AA, Rahman AF, Mashrelky SR, Rahman A (2020) Medical care-seeking behaviours among drowning casualties: Results from a national survey conducted in Bangladesh. J Taibah Univ Med Sci 15(5):374–379. 10.1016/j.jtumed.2020.07.008
Rahman A (2005) Bangladesh health and injury survey: report on children. Directorate General of Health Services Ministry of Health an
Afreen N, Billah MM, Flora MS (2022) Child Injury Burden and Risk Profile in a Bangladeshi Rural Community: an Age-Group Related Overview. J Aging Sci 10(2):272. 10.35248/2329-8847.22.10.272
District Statistics (2011) Narsingdi. Dhaka, Bangladesh: Bangladesh Bureau of Statistics (BBS); 2013. 123 p
Facility Registry Dhaka Bangladesh: Directorate General of Health Services; [cited 2023 31-12-2023]. http://facilityregistry.dghs.gov.bd/report_org_list.php?admin_division=1&admin_district=12&admin_upazila=278&org_agency=0&form_submit=1
Moshiro C, Heuch I, Astrom AN, Setel P, Hemed Y, Kvale G (2005) Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey. BMC Public Health 5:11. 10.1186/1471-2458-5-11
Kamal S (2010) Serious Injury and Injurious Burden in Urban Bangladesh. J Appl Sci Technol 7(2):71–79
Mock CNAF, Cummings P, Koepsell TD (1999) Incidence and outcome of injury in Ghana: a community-based survey. Bull World Health Organ 77:955–964
Moshiro C, Heuch I, Åstrøm AN, Setel P, Kvåle G (2005) Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania. Inj Prev 11(1):48–52. 10.1136/ip.2004.005645
Hoque DME, Islam MI, Sharmin Salam S, Rahman QS-u, Agrawal P, Rahman A et al (2017) Impact of First Aid on Treatment Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and Demographic Census. Int J Environ Res Public Health 14(7):762
Gyedu A, Mock C, Nakua E, Otupiri E, Donkor P, Ebel BE (2015) Pediatric First Aid Practices in Ghana: A Population-Based Survey. World J Surg 39(8):1859–1866. 10.1007/s00268-015-3061-1
Rahman F, Andersson R, Svanström L (1998) Medical help seeking behaviour of injury patients in a community in Bangladesh. Public Health 112(1):31–35
Nath A, Naik VA (2009) Minor injuries among under-fives in a South Indian village. Indian Pediatr 46(7):621–623
Pathak A, Agrawal N, Mehra L, Mathur A, Diwan V (2018) First Aid Practices and Health-Seeking Behaviors of Caregivers for Unintentional Childhood Injuries in Ujjain, India: A Community-Based Cross-Sectional Study. Child (Basel Switzerland) 5(9). 10.3390/children5090124
Pathak A, Ogunbayo A, Trushna T, Khare S, Mathur A, Atkins S et al (2022) Perceptions and Experiences of Caregivers on Child Injuries: A Qualitative Study from Central India. Journal of prevention 2022;43(4):549–565. 10.1007/s10935-022-00682-3
Kalaiselvan G, Dongre AR, Mahalakshmy T (2011) Epidemiology of injury in rural Pondicherry, India. J Inj Violence Res 3(2):62–67. 10.5249/jivr.v3i2.74
Parmeswaran GG, Kalaivani M, Gupta SK, Goswami AK, Nongkynrih B (2017) Unintentional Childhood Injuries in Urban Delhi: A Community-Based Study. Indian J community medicine: official publication Indian Association Prev Social Med 42(1):8–12. 10.4103/0970-0218.199791

The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

Health-Seeking Behavior Following Injuries in Rural Children at a Sub-District of Bangladesh

Status:

Version 1

Abstract

Objectives

Methods

Results

Conclusion

Figures

Introduction

Methods

Results

Discussion

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1