Preventing childhood injuries in Uganda - development of a child safety kit; preparation for a cluster randomised controlled trial

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Injuries are a leading cause of death among children around the world. Globally, nearly 650,000 children under the age of 15 lose their lives every year to injuries and violence. This burden is unequally distributed between low- and middle-income countries (LMIC) and high-income countries (HIC) with the mortality rate from unintentional injuries in LMICs being nearly double that of HICs. In particular, Sub-Saharan Africa has the highest proportion of under 5 deaths in the world.More than 70% of these injuries are non-transport unintentional or "accidental" injuries. Evidence shows that a large proportion of childhood unintentional injuries take place in and around the home, where children are generally believed to be well supervised. Children, especially those under 5 years, spend a significant amount of their time in and around the home which exposes them to various injury hazards e.g. stairs and windows without safety grills, access to poisonous substances and chemicals, areas of open water, access to ground level stoves.Despite an overall global reduction in child injury mortality rates over the past two decades, available data indicates that the rate of decline has been much slower in LMICs and the gap between LMICs and HICs is widening. This is due in part to higher risks, inadequate preventive measures and a lack of access to timely medical care in LMICs. The nature of household injuries among children has been well documented in HICs but much less is known in LMICs. Much of what is known about preventing child injuries in the home stems from research conducted in HICs where preventive measures have been shown to be effective e.g. safety caps, smoke alarms, stair gates coupled with education of parents/carers. What is not known is how effective these measures would be in LMICs.This study aims to test the effectiveness of a child safety kit (developed through co-design to reflect differing risk profiles, cultural appropriateness and availability/affordability) against traditional education. The study will be carried out in Jinja, Uganda and will involve two phases: Phase 1 (the focus of this development grant, conducted over 1 year) will focus on contextualizing the child injury problem and developing the child safety kit through mixed methods (a review of hospital data, focus groups with parents/carers, in-depth interviews with key informants, an affordability/availability survey and a market survey to ascertain willingness to pay for safety equipment); and Phase 2 which will measure behaviour change and reductions in injuries through a cluster Randomised Control Trial (cRCT). We will assess the reduction in child injuries in two villages (clusters) - one which will have the full child safety kit of equipment plus educational material, workshops and awareness campaign for parents versus the other cluster with only education - over 3 years.A key component of Phase 1 will be to support collaborative research between scientific researchers, policy makers and parents such that all stakeholders involved in the health of under 5's have the opportunity to be full participants from conceptualisation to communication of results. The co-design approach will result in the development of a holistic intervention to include the child safety kit, educational material, training workshops for parents and a community-based awareness campaign. Engaging the community from the beginning will result in improved knowledge and awareness through the sharing of opinions and experience and will optimise equipment usage during Phase 2. The results of Phase 1 will identify any challenges to implementing the intervention, provide accurate data on which to calculate sample sizes for the cRCT and determine the key outcomes. To our knowledge, this will be the first cRCT on child safety equipment and education conducted in Africa.