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A study on prevalence of domestic accidents in a rural community

Background: Domestic accidents are worldwide health problems. Domestic accidents have not so far been recognized to the same extent as traffic and work-related injuries, largely because they have not been effectively counted. Very few studies are available regarding domestic accidents in India, and there is no study available from the rural areas. Hence the present study was undertaken with an aim to assess the prevalence of domestic accidents in a rural community. Aim & Objective: To assess the prevalence of domestic accidents in a rural community. Materials and Methods: The study was conducted in the rural field practice area of Katuri Institute of Medical Sciences, Guntur. Totally 5419 individuals were selected from 30 clusters using Cluster Sampling Technique. In each cluster, 178 individuals (some clusters had more than 178 individuals) were surveyed by house-to-house visit. Information about domestic accidents among the family members in the past one year was obtained by interviewing the head of the family or responsible adult informant using a pre-tested structured proforma. The data was compiled and analyzed. Results: Among 5419 individuals, 2748 (50.9%) were males and 2671 (49.1%) were females. Prevalence of domestic accidents in the rural community was found to be 9.6%, majority (21.8%) of domestic accidents are observed in children 1-4 years of age. Most common domestic accidents reported were falls (43.2%). Majority (44.1%) of domestic accidents occurred in the morning hours. Commonest place for occurrence of domestic accidents was kitchen (46.5%). Majority (53.6%) was treated at home and complete recovery was observed in 91.9% of domestic accident cases. Conclusion: The prevalence of domestic accidents in the rural community was 9.6 %. Falls were the most common domestic accidents.


Introduction
Accidents as a whole are making an increasing contribution to the sum total of morbidity and mortality almost everywhere in the world, with the decline in many of the major communicable diseases [1] . Accidents along with cardiovascular diseases and cancers currently form the leading causes of morbidity and mortality both in developed and developing countries. Each year, tens of thousands of accidents occur worldwide. In a World Health Organization (WHO) report, the number of deaths caused by accidents was estimated to be 3.5 million annually. This figure corresponds to an average of 10, 000 deaths per day. Accidents can take place in a wide variety of environments and there is a possibility of accidents in every sphere of human life: at home, while travelling, at play and at work [2] . In today's world, in the developed as well as the developing countries, danger prevails not only on the roads, but it also exists in the home and playgrounds [3] . Home is the most likely location for unintentional injuries [4] . The pattern of domestic accidents is complex, involving cultural, social and economic factors [5] . The rates of unintentional home related injuries are high among the elderly (over 65 years old) and youngsters (0-14 years old) [5] . The type of domestic injury is often determined by several host factors (age, sex, residence, co-morbidity, alcohol and drugs, etc.), agent factors (a number of domestic products which are commonly used by people for day-to-day activities) and environmental factors (type of housing, flooring, roofing, safety environment, etc.) [6] . Home accidents are a major cause of death and injury [2] . Every domestic accident brings a varying measure of distress to the victim as well as the family members. The consequences may be disastrous both for the individual and the society when the accident results in permanent disability, as the victim loses his earning capacity and may not be able to enjoy a normal productive life [7] . There are very few research studies done on home injury compared to road traffic and occupational injuries. Although, domestic accidents represent an important setting for unintentional injuries, most of the studies were confined only to specific types of injury, mainly in the pediatric age group and among hospital cases [8] . Studies on domestic injuries are virtually non-existent in India (underreporting!) [6] and there is no study available from the rural community. In this background the present study was conducted to assess the prevalence of domestic accidents in a rural community and this information obtained may contribute to the planners in developing appropriate preventive measures.

Aim
To assess the prevalence of domestic accidents in a rural community. The study population should be residents for a minimum of 6 months.

Operational definition
 Domestic accident is an accident which takes place in the home or in its immediate surroundings and more generally, all accidents not connected with traffic, vehicles or sport [9]  In the present study home includes a dwelling place, yard, garage and all that is personal to the household, also included are the areas, stairs and approaches to flats or rooms, so long as they are reserved for the use of tenants [1] Collection of data This study was conducted in the rural field practice area of Katuti Institute of Medical Sciences, Guntur. The study was conducted from January 2019 to December 2019. 30 clusters were selected using Cluster Sampling Technique. Information about domestic accidents among the family members in the past one year from the date of survey was obtained by interviewing the head of the family or responsible adult informant using a pre-tested structured proforma in local language (Telugu). The socioeconomic status was assessed based on the Standard of Living Index (SLI) [10] .

Statistical analysis
The data was entered in Microsoft Excel and analysis was done by using SPSS. V.11.0. Data was analyzed by using descriptive statistics viz. percentages and the inferential statistics using Z-test to test the difference between proportions. The data is presented in the form of tables and graphs wherever necessary. The difference in proportion is considered statistically significant whenever P ≤ 0.05.   In the present study majority 21.8% of the domestic accident cases were observed in the age group 1-4 years and least 2.8% was observed in the age group ≥75 years. The overall prevalence of domestic accidents was found to be 9.6%. The pevalence of domestic accidents was found to be more in females compared to males and was found to be statistically significant with P value =0.0077 (Z value = 9.09). In the present study majority 96 (21.8%) of the domestic accident cases were observed in the preschool children and least 11 (4.9%) was observed in graduates. In the present study prevalence of domestic accidents is more common among house wife's 17.1%, followed by agriculture 4.6%, labourers 3.9%, business 3.1%, professional 3.1%, self-employment 2.7%, service 1.9% and others 3.7%. Prevalence of domestic accident cases in nuclear families is 10.8%, 8.2% in joint families and 9.5% in three generation families.

Distribution of domestic accident cases according to SLI
Out of the 522 domestic accident cases, prevalence of domestic accidents was 59.2% in low socio economic status, 38.5% belonged to medium socio economic status and the remaining 2.3% individuals belonged to high socio economic status.

Distribution of domestic accident cases according to marital status
In the present study, it was observed that out of 522 domestic accident cases 251(48.1%) were married persons, 243 (46.5%) were unmarried and 28 (5.4%) widow/Widower had domestic accidents. In the present study it was observed that falls (43.2%) was the most common type of domestic accidents followed by injuries from sharp or pointed instruments (27.0%), burns (17.8%), dog bite (2.5%), electrical injury (1.1%), multiple accidents (7%) and others (1.4%).
~ 56 ~ In the present study falls 122 (73.5%) was the common domestic accidents in males. Injuries from sharp or pointed instruments 133 (37.4%), falls 103 (28.9%) and burns 78 (21.9%) were the common type of domestic accidents in females. In the present study falls was more common in children below ≤14 years i.e. maximum 159 (70.7%) and minimum in the age group of 30-44 years 12 (5.4%).  in the evening, 90 (17.2%) in the afternoon and 32 (6.1%) during the night. Majority 53.6% of domestic accident victims were treated at home, followed by 43.3% treated at OPD and 3.1% of victims treated as inpatients.
~ 57 ~ In the present study majority 74.9% of domestic accident victims had taken allopathic treatment and least 1.0% victims had taken ayurveda treatment.

Prevalence of domestic accidents
In the present study prevalence of domestic accidents in a rural community for the period of one-year for all age groups was found to be 9.6%. However, Haniff J et al. observed in their study, the prevalence of self-reported home injury for all age groups was 2.5%. for one-year [8] .
Thein MM et al. observed that the overall injury prevalence rate was 19.5% [11] and Backett EM. Had estimated about 5%-10% of the population were affected by home injury each year. For each fatal home accident, there are probably 150 "significant" non-fatal ones [1] .

Age wise distribution of domestic accidents
Prevalence of domestic accidents was found to be more common in the age group 1-4 years (21.8%). This may be attributed to the fact that they spend more time in the home. It was in accordance with a study by Neghab M et al. which showed that more than 25% of accidents occurred among children aged under 4 years [2] .

Sex wise distribution of domestic accidents
In the present study it was observed that prevalence of domestic accidents was more among females. This may be due to the fact that females spend more time in the home. This was in accordance with the findings of Haniff J et al.
where the prevalence in females was reported higher (2.7%) than males (2.3%) [8] . Bhanderi DJ et al. in their study mentioned that female gender was found to be a significant predictor of domestic accidents [7] .

Types of domestic accidents
In the present study falls (43.2%) was found to be the commonest type of domestic accidents followed by sharp cut injuries (27.0%) and burns (17.8%). This is consistent with findings of Bhanderi DJ et al. where the most common accidents reported was fall, other accidents noted were burns, scalds, electrocution, injuries and accidental poisoning [7] and also Chaurasia R et al. observed a higher proportion of falls, burns and scalds in their study [12] .

Place of occurrence of domestic accidents
In the present study kitchen was found to be the commonest place of domestic accidents (46.5%). This can probably be attributed to the fact that when they are in the kitchen they may be exposed to different tools which may cause injuries. But in a study conducted by Alptekin F et al. 30% of the injuries occurred in the living room. The kitchen was the second most common place for injuries (26.7%), and the bathroom or the toilet was the third (22.1%) [5] . Thein MM et al. in his study observed that, the commonest place at home where injuries occurred was the living room (54.7%), followed by kitchen (17.7%), bedroom (13.7%) and bathroom (9.5%) [11] .

Time of occurrence of domestic accidents
In the present study, domestic accidents occurred more commonly during the morning hours. This may be due to increased work load in the morning. It is in accordance with the findings of the study conducted by Bhanderi DJ et al.
where it was reported that majority of domestic accidents occurred during the morning and evening hours [7] .

Site of injury in domestic accident cases
In the present study it was observed that, most frequently body parts injured in domestic accidents is upper limbs (70.2%), followed by lower limbs (34.1%). This is consistent with the findings of Rossi G et.al in their study mentioned that most frequent lesions were those of the upper and lower extremities [13] .

Treatment of domestic accident cases
In the present study it was observed that, home was the place where majority of domestic accidents were managed (53.6%) followed by treatment on outpatient basis (43.3%). Among those who have received treatment, majority (74.9%) have received allopathic treatment, followed by home remedies (20.5%). This is consistent with the findings of Thein MM et al. where majority of injuries were selftreated (78%to 85%) [11] .

Outcome of domestic accident cases
In the present study it was found that most of the victims of domestic accident have recovered completely (91.9%), some were in the recovery phase (6.1%) and few victims have recovered with disability (2%). No deaths were reported due to domestic accidents. This is consistent with the results of a study by Bhanderi DJ et al. where full recovery was observed in 82.6% cases of domestic accidents, while permanent disability was found in only 2.9% subjects, while 14.5% reported chronic pain after the accident [7] .

Conclusion
The prevalence of domestic accidents in the rural community was 9.6%. Domestic accidents were most commonly seen in children 1-4 years of age. Falls was the most common type of domestic accidents. Kitchen was the commonest place for occurrence of domestic accidents. Majority of domestic accidents occurred in the morning hours. Most of the domestic accident cases were treated at home. Majority of the domestic accident cases had recovered completely.

Financial Support
Nil.