Unintentional injuries are major causes of mortality and morbidity in children, resulting in over 875,000 deaths annually in children <18 years of age [1
]. Among children <5 years of age, injuries are the leading cause of death after the first birthday. Additionally, millions of children require medical care with hospital admission for nonfatal injuries and are often left with lifelong disabilities [1
]. Although unintentional injury is a major contributor to mortality worldwide, the burden is unequally distributed between low- and middle-income countries (LMICs) and high-income countries (HICs). The mortality rate from unintentional injuries in LMIC is nearly double that in HIC (65 versus 35 per 100,000), while the rate of disability-adjusted life-years (DALYs) is three times as high in LMIC as compared with HIC (2,398 versus 774 per 100,000) [4
]. The disproportionate burden of unintentional injuries borne by LMIC is due in large part to high risks, inadequate preventive measures, and a lack of access to appropriate and timely medical care [5
A substantial proportion of childhood unintentional injuries occur in the home, as a result of the relatively long period of time young children spend in the home and the many potential sources of hazards that are present [6
]. The nature of childhood injuries occurring in the household has been well described in HICs but they are less well understood in LMICs [7
]. However, a recent study in Nigeria found that 92.5% of childhood burns occurred in a domestic setting, suggesting that the prevention of childhood injuries in the home environment is a key area for future research [9
]. Challenging living conditions such as poor housing infrastructure, lack of barriers to cooking or washing areas, inadequate recreational space, use of open fires and paraffin stoves, and a lack of safe storage for harmful substances are among the hazards that place young children in LMICs at risk for burns, poisoning, and falls [10
Despite these substantial risks, the majority of household injuries can be prevented. In developed countries, a variety of preventive approaches have been shown to be effective including legislative measures, modification of the home environment with provision of safety equipment, and focused injury prevention counseling [13
]. In addition, studies utilizing home visitation programs that include education and advice have been undertaken to gauge the impact of such interventions on injury reduction [18
]. Results suggested that home visits were flexible and acceptable to families as well as helpful in increasing household members' knowledge, attitude, and behavior regarding home safety. Additionally, a meta-analysis of home safety education and safety equipment revealed that home safety education, particularly when coupled with the provision of safety equipment, was effective in increasing a range of safety practices associated with the prevention of burns, poisoning, and fall-related injuries [16
]. These studies offer strong evidence that home visitations can reduce childhood injuries in HICs; however, additional research is needed to assess the efficacy and acceptability of childhood home safety programs in LMICs.
Preliminary evidence suggests that a home-safety education program may be possible in LMIC. A study of pediatric scalding prevention in South Africa identified categories of prevention measures that included enhancements to the safety of the home environment, changes to practice, and improvements to individual competence [20
]. In addition, a recent study of perceptions about childhood burns in rural Bangladesh suggests that a safety education program could offer an effective means of increasing knowledge and practice [21
]. However, further research is needed to establish a means for sharing known, proven hazard reduction strategies tailored to these communities.
While children are universally vulnerable to injuries, the social, political, and economic environment shapes the nature and extent of injury risk [1
]. Thus, effective solutions require that intervention materials be tailored to the local context. While a number of household injury assessment tools have been utilized in HICs, differences in the nature of household risks make the direct transfer of such tools to LMIC settings inappropriate. A well-designed tool is essential for the systematic comparison of household injury risk over time and between households [22
]. Moreover, the lack of research regarding the most effective method for dissemination of home injury risk and potential prevention information in LMIC has resulted in limited ways for health professionals to share knowledge with parents [1
]. There are no predesigned pamphlets or information sheets available in this setting, in contrast to the abundance of such materials available to practitioners in HICs.
This paper introduces a study that aims to address this research gap. The study focuses on the development of two different hazard reduction information tools—an educational pamphlet and an in-home tutorial—to explore their use in a community-based LMIC setting. It also develops a hazard mapping tool for low-income household settings. This paper is based on the preliminary phase of the study and describes the approach and development of these tools in preparation for a pilot study to test their implementation and acceptability in Pakistan.