Characteristics and predictors of home injury hazards among toddlers in Wenzhou, China: a community-based cross-sectional study

Unintentional injury is the leading cause of morbidity and mortality among children under five years globally [1, 2]. Furthermore, 1/3 to over 1/2 of injuries occur at home [3, 4]. Unintentional home injuries (UHI) result in not only substantial health problems to children and negative impacts on their families, but also in large financial losses for countries [5‐8]. One key factor affecting UHI is the physical environment in the home, and is mainly composed of situations where there is a high potential for a variety of injury hazards. A number of research studies indicated that home hazards were a risk factor for home injuries among young children [9‐15].

Theoretically, home hazards are more likely to be influenced by factors in three domains: child factors, parent factors and family factors. For child factors, age and/or gender have a possible impact on home hazards. For example, boys tend to be more boisterous and mischievous than girls, which could increase their exposure to home hazards [16]. Parent factors also need to be considered since parents serve as home designers and managers. A few research findings found that parents’ low educational status and low awareness of UHI was positively associated with home hazards [17‐20]. Lastly, the family is one of the social environments in which home hazards exist. Family factors have an impact on home hazards. These factors include family demographics (i.e. number of family, family income and housing tenancy) and family functioning. In general, families with more members, low income or poor housing would be positively associated with more home hazards. However, these alternative explanations have not been adequately tested.

An increasing number of studies have paid attention to occurrence and causal etiology of unintentional injuries among children, however, few attempts have focused on home hazards and related factors [10‐14, 17‐20]. The objectives of the present study are to (1) describe the characteristics of home hazards for young children aged 24–47 months in Wenzhou, China; and (2) examine the predicted relationship between child factors, parent factors, family factors, and home hazards.

In Wenzhou city, the population of children 24-47 months is approaching 76 thousand persons [21]. The incidence rate of UHI to this aggregate (40.4%) is quite high and home hazards are a key contributing factor [6]; therefore this study would be beneficial to assist in the control of home hazards and the prevention of UHI in Wenzhou.

The current study explored the characteristics and predictors of home hazards among children aged 24–47 months (equal to 2–3 years) old in Wenzhou, Zhejiang Province, China. The average percentage of reported injury hazards (33.2%), was consistent with that for toddlers in Anhui province, China (38.5%) [20]; furthermore, 50% or more respondents’ homes contained nine injury hazards, specifically, plastic bags, coins or buttons, toys with small components and sunflower seeds. These were related to suffocation and make-up related to poisoning. Electrical sockets in a low position on the wall and uncovered sockets were related to electrical shock. A stool by a table or cabinet correlated with a fall, and finally, pencils correlated to sharp injuries. These results differ from other findings, which indicated that stoves, open buckets and pedestal fans were the main home hazards in a low-income urban setting of Pakistan [28]. The possible reason for the difference was the dissimilarity of the two countries’ home culture and economics. Overall, the result reveals that homes with the characteristics studied here were more likely to be full of injury hazards for toddlers. It is necessary for children’s healthcare providers to assess the nine home hazards and guide the families to remove home hazards.

The finding revealed that older toddlers were positively correlated with home hazards; in other words, older toddlers had a higher potential for injury from home hazards. The result was similar to an American study that showed that children over 2.5 years old were more susceptible to hazards [17]. A possible explanation could be a wider gap between children’s motor skills and their understanding of dangerous hazards as they developed from 24 to 47 months. Gross motor skills and curiosity exceed cognition as toddlers get older. These two powerful attributes can drive older toddlers to move in a larger area or climb to a higher place than they could when they were younger, thereby older ones would reach more home hazard locations [29]. On the other hand, parents of older toddlers became less vigilant compared with parents of younger ones, despite the fact that those older children were still at risk [30]. This predictor implies that it is important for the children’s health professionals to inform families with older toddlers, especially those in the age group of 36 months or older about the linkage between children’s age and home hazards, and to educate them to assess their homes for hazards and to take steps to eliminate the hazards. Future research should be aimed at developing interventions to reduce home hazards or prevent children’s access to home hazards.

Additionally, the findings show that migrant children are exposed to more home hazards compared to local children. Similarly, one study of toddlers identified that an immigration background was associated with lower use of protective safety measures (jack socket) thus allowing children easy access to injury-related hazards [31]. Several explanations were possible as to why migrant children were exposed to more hazards than local children were. Firstly, migrant children often have extended families, so there are more than three people living in one home. Their families have lower incomes and are likely to live in rental houses that tend to be small, with poor physical environments. Thus, a crowded family and a small house could lead to more home hazard opportunities. Secondly, migrant children have more siblings than local ones, so, their parents may supervise them for shorter time and less closely [30]. The houses of migrant children are characterized as containing a high density of home hazards, meanwhile parental supervision and attention were lower. These are possible explanations to show that the migrant children were more likely to be exposed to home hazards. The result implies that it is important for children’s health professionals to help migrant families with young children remove home hazards and make safe houses.

Interestingly, lower family functioning was a positive predictor of home hazards. Family functioning encompasses family cohesion and family adaptation. Lower family cohesion would bring about more family conflicts, which are more likely to distract parents from the supervisory role in a child’s activity. As a result, their children were more likely to exhibit behavior that makes them more susceptible to home hazards. A family with poorer family adaptation has lower ability to cope with family problems. This kind of family is vulnerable to family stress. High family stress would lead to a parent’s mental distraction and possibly stress or disturb a toddler’s emotional or behavioral utility [32, 33]. This parents’ distraction would influence the parent’s awareness of the importance of a safe environment and decrease the ability to cope with home hazards. Children’s behavioral states would embolden the children to touch more home hazards since children have insufficient judgment as to whether the objects are safe or not. This point also reveals that one way to decrease home hazards is to improve family functioning.

A large group of hazards existed in the home where toddlers live in Wenzhou, China, and nine hazards are especially prominent: plastic bags, coins or buttons, toys with small components and sunflower seeds, make-up, lower sockets, uncovered sockets, stools by a table or cabinet and sharp rulers or pencils. The study found that the risk factors for home hazards were older toddlers, migrant children and lower family functioning. Health professionals should pay more attention to vulnerable families with these risk factors and educate them to assess home hazards and manage or store them in safe places. Further research needs to be conducted to reduce home hazards.