Developing an educational intervention for parents to promote preschool child safety in Nepal

伤害是尼泊尔学龄前儿童可预防的死亡和终身残疾的主要原因。儿童伤害给家庭收入带来了重大压力(由于相关的护理费用)，并影响了父母的工作能力(由于照顾受伤的儿童)。因此，这种伤害可能对个人、社区和社会产生影响。受伤被视为不可避免，而很少考虑预防，这是很常见的。与许多疾病一样，大多数无意的儿童伤害是由可预测的事件造成的，因此是可以预防的。学龄前儿童受伤通常发生在家里，父母就在附近。因此，父母和其他家庭照顾者有最大的机会保护年幼儿童的安全。目前，尼泊尔没有以研究为基础的方案来支持父母在家中保护孩子的安全。该项目将在尼泊尔Sindhupalchowk区的Sunkoshi农村市进行。我们的研究旨在开发一种干预措施，以提高尼泊尔农村父母的知识和技能，以减少他们家中和周围的伤害危险。为了探索影响父母如何做出安全决策的社会、文化和健康教育体系，我们将与对儿童健康和发展感兴趣的家庭和利益相关者合作，共同制作干预措施。这些利益攸关方包括女性社区卫生志愿者，她们是直接与父母一起工作的第一线从业人员，在当地社区改善孕产妇和儿童健康。妇幼保健机构经常提供社区卫生方案，如果被证明有效，还可以提供我们的干预措施。在尼泊尔农村，在领导人和妇幼保健机构的协助下，母亲们每月聚会一次，讨论健康问题。这些“母亲团体”在尼泊尔各地都有发生。我们将与母亲团体合作，确定学龄前儿童的父母，并探索这些团体是否是让父母参与干预的适当方式。我们将让其他社区利益相关者参与制定干预措施，其中包括卫生协调员、学校教师、保健站工作人员、地方领导人、市政府代表和区主席。一旦干预措施达成一致并准备就绪，我们将开展一个小项目，以测试在以后的更大规模的研究中评估干预措施的可能性。在这个小测试中，我们将邀请六个母亲团体和他们的母婴健康服务机构横跨两个病房。在一个项目中，将对FCHV进行培训，向母亲提供干预措施，在另一个项目中，将提供与伤害预防无关的活动。我们将探讨是否有可能提供干预和替代活动，并让家长参与完成基线和后续评估。通过这个过程，我们将了解干预和后续研究是否需要任何修改。潜在的受益者包括有权减少家庭伤害风险的父母，保护他们的孩子免受伤害，以及减少本可避免的经济困难。儿童可以通过减少接触伤害危险和减少伤害而受益。危险识别和缓解可能会改善村庄公共区域的伤害风险，并使更广泛的群体受益。FCHV可能受益于更好地了解如何支持父母，并在他们所支持的社区促进安全。由于伤害减少，医疗机构的就诊次数可能会减少，从而减轻医护人员的负担。政府当局可以就儿童安全政策做出明智的决定。研究人员有潜力为有效的儿童伤害预防战略的证据基础做出贡献。

Injuries are a leading cause of preventable death and lifelong disability among pre-school children in Nepal. Child injuries place major pressures on household income (due to associated care costs) and have implications for parents' ability to work (due to providing care for an injured child). Such injuries can therefore have an impact on individuals, communities and societies. It's common for injuries to be seen as unavoidable and prevention is rarely considered. As with many diseases, most unintentional child injuries are caused by events that are predictable, and therefore preventable. Injuries to preschool children usually happen in the home and with their parents close by. Therefore, parents and other family caregivers have the greatest opportunity to keep young children safe. Currently, there are no research-based programmes in Nepal to support parents to keep their children safe at home. This project will be conducted in Sunkoshi rural municipality, in Sindhupalchowk district of Nepal.Our study aims to develop an intervention to improve the knowledge and skills of parents in rural Nepal to reduce injury hazards in and around their homes. To explore the social, cultural and health education systems that influence how parents make decisions about safety, we will work with families and stakeholders who are interested in child health and development to co-produce the intervention. Such stakeholders include Female Community Health Volunteers (FCHVs) who are frontline practitioners working directly with parents to improve maternal and child health in their local communities. FCHVs often deliver community health programmes and could deliver our intervention if shown to be effective. In rural Nepal, groups of mothers meet monthly to discuss health issues, facilitated by leaders and FCHVs. These 'Mother's Groups' occur across Nepal. We will work with mother's groups to identify parents of preschool children and explore whether these groups are an appropriate way to engage parents in the intervention. We will involve other community stakeholders to develop the intervention including health coordinators, schoolteachers, health-post staff, local leaders, municipality representatives and ward chairs.Once the intervention has been agreed and prepared, we will run a small project to test the possibility of evaluating the intervention in a later, bigger study. In this small test, we will engage six mothers' groups and their FCHVs across two wards. In one, the FCHVs will be trained to deliver the intervention to mothers, in the other an activity not related to injury prevention will be offered. We will explore whether it is possible to deliver the intervention and the alternative activity and engage parents in completing baseline and follow-up assessments. Through this process, we will learn if any modifications are needed for the intervention and subsequent study.Potential beneficiaries include parents empowered to reduce injury risks at home, protecting their children from injury and reducing avoidable economic hardship. Children may benefit by reduced exposure to injury hazards and reduced injuries. Hazard identification and mitigation may improve injury risk in village communal areas and benefit wider groups. FCHVs may benefit by improved knowledge of how to support parents and promote safety in the communities they support. Health facilities may experience fewer visits due to reduced injuries, lessening the load on healthcare practitioners. Government authorities could make informed decisions on child safety policies. Researchers has the potential to contribute to the evidence base of effective child injury prevention strategies.