Kendrick D,
Young B,
Mason-Jones AJ,
Ilyas N,
Achana FA,
Cooper NJ,
Hubbard SJ,
Sutton AJ,
Smith S,
Wynn P,
Mulvaney C,
Watson MC,
Coupland C.
Source
Division of Primary Care, University of Nottingham, Nottingham, UK. denise.kendrick@nottingham.ac.uk.
Abstract
BACKGROUND:
In
industrialised countries injuries (including burns, poisoning or
drowning) are the leading cause of childhood death and steep social
gradients exist in child injury mortality and morbidity. The majority of
injuries in pre-school children occur at home but there is little
meta-analytic evidence that child home safety interventions reduce
injury rates or improve a range of safety practices, and little evidence
on their effect by social group.
OBJECTIVES:
We
evaluated the effectiveness of home safety education, with or without
the provision of low cost, discounted or free equipment (hereafter
referred to as home safety interventions), in reducing child injury
rates or increasing home safety practices and whether the effect varied
by social group.
SEARCH METHODS:
We searched the Cochrane
Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The
Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI
Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web
of Science: Social Sciences Citation Index (SSCI), ISI Web of Science:
Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO)
and DARE (2009, Issue 2) in The Cochrane Library. We also searched
websites and conference proceedings and searched the bibliographies of
relevant studies and previously published reviews. We contacted authors
of included studies as well as relevant organisations. The most recent
search for trials was May 2009.
SELECTION CRITERIA:
Randomised
controlled trials (RCTs), non-randomised controlled trials and
controlled before and after (CBA) studies where home safety education
with or without the provision of safety equipment was provided to those
aged 19 years and under, and which reported injury, safety practices or
possession of safety equipment.
DATA COLLECTION AND ANALYSIS:
Two
authors independently assessed study quality and extracted data. We
attempted to obtain individual participant level data (IPD) for all
included studies and summary data and IPD were simultaneously combined
in meta-regressions by social and demographic variables. Pooled
incidence rate ratios (IRR) were calculated for injuries which occurred
during the studies, and pooled odds ratios were calculated for the
uptake of safety equipment or safety practices, with 95% confidence
intervals.
MAIN RESULTS:
Ninety-eight studies, involving
2,605,044 people, are included in this review. Fifty-four studies
involving 812,705 people were comparable enough to be included in at
least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen
(35%) of the studies included in the meta-analysis provided IPD.There
was a lack of evidence that home safety interventions reduced rates of
thermal injuries or poisoning. There was some evidence that
interventions may reduce injury rates after adjusting CBA studies for
baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater
reductions in injury rates were found for interventions delivered in the
home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not
providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety
interventions were effective in increasing the proportion of families
with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86),
functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape
plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI
1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out
of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or
poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39),
having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having
socket covers on unused sockets (OR 2.69, 95% CI 1.46 to
4.96).Interventions providing free, low cost or discounted safety
equipment appeared to be more effective in improving some safety
practices than those interventions not doing so. There was no consistent
evidence that interventions were less effective in families whose
children were at greater risk of injury.
AUTHORS' CONCLUSIONS:
Home
safety interventions most commonly provided as one-to-one, face-to-face
education, especially with the provision of safety equipment, are
effective in increasing a range of safety practices. There is some
evidence that such interventions may reduce injury rates, particularly
where interventions are provided at home. Conflicting findings regarding
interventions providing safety equipment on safety practices and injury
outcomes are likely to be explained by two large studies; one
clinic-based study provided equipment but did not reduce injury rates
and one school-based study did not provide equipment but did demonstrate
a significant reduction in injury rates. There was no consistent
evidence that home safety education, with or without the provision of
safety equipment, was less effective in those participants at greater
risk of injury. Further studies are still required to confirm these
findings with respect to injury rates.