Home safety education and provision of safety equipment for injury prevention.
BACKGROUND
In industrialised countries injuries 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 improve a range of safety practices or reduce injury rates and little evidence on their effect by social group.


OBJECTIVE
We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment in increasing home safety practices or reducing child injury rates and whether the effect varied by social group.


METHODS
We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, DARE, ASSIA, Psychinfo and Web of Science, plus a range of relevant web sites, conference proceedings and bibliographies. We contacted authors of included studies and surveyed a range of organisations.


METHODS
Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, which reported safety practices, possession of safety equipment or injury.


METHODS
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 simultaneoulsy combined in meta-regressions by social and demographic variables.


RESULTS
Eighty studies were included; 37 of which were included in at least one meta-analysis. Twenty-three (62%) were RCTs and 12 (32%) included in the meta-analysis provided IPD. Home safety education was effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.35, 95% CI 1.01 to 180), functional smoke alarms (OR 1.85, 95% CI 1.24 to 2.75), storing medicines (OR 1.58, 95% CI 1.18 to 2.13) and cleaning products (OR 1.63, 95% CI 1.22 to 2.17) out of reach, syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) and poison control centre numbers accessible (OR 3.66, 95% CI 1.84 to 7.27), fitted stair gates (1.26, 95% CI 1.05 to 1.51), socket covers on unused sockets (OR 3.73, 95% CI 1.48 to 9.39) and storing sharp objects out of reach (OR 1.52, 95% CI 1.01 to 2.29). There was a lack of evidence that interventions reduced rates of thermal injuries, poisoning or a range of injuries. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury.


CONCLUSIONS
Home safety education provided most commonly as one-to-one, face-to-face education, in a clinical setting or at home, especially with the provision of safety equipment is effective in increasing a range of safety practices. There is a lack of evidence regarding its impact on child injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment was less effective in those at greater risk of injury.
Kendrick
D
D
University of Nottingham, Division of Primary Care, Floor 13, Tower Building, University Park, Nottingham, UK, NG7 2RD. denise.kendrick@nottingham.ac.uk
Coupland
C
C
Mulvaney
C
C
Simpson
J
J
Smith
S J
SJ
Sutton
A
A
Watson
M
M
Woods
A
A
D000056:Accident Prevention / Q000295:instrumentation / Q000379:methods; D000058:Accidental Falls / Q000517:prevention & control; D000061:Accidents, Home / Q000517:prevention & control*; D002056:Burns / Q000517:prevention & control; D002058:Burns, Electric / Q000517:prevention & control; D002675:Child, Preschool; D004332:Drowning / Q000517:prevention & control; D006801:Humans; D011041:Poisoning / Q000517:prevention & control; D011482:Protective Devices; D016032:Randomized Controlled Trials as Topic; D012449:Safety