Health And Unintentional Injury Survey Among Children With Disabilities

ObjectiveA health and unintentional injury survey of children aged 1-14 with disabilities in Hubei Province in the People's Republic of China was conducted based on the biopsychosocial model of the International Classification of Functioning, Disability and Health-ICF. This study aimed to understand the main risk factors for childhood disability, compare the patterns of unintentional injuries, and explore the impact factors and risks of unintentional injury among children with different disability status.The goal of our study was to provide evidence which would support and inform injury prevention and safety education targeting Chinese children with disabilities. We also evaluated a recommended disability screening tool, the UNICEF Ten Questions (TQ) for child disability using in the large-scale field suvey.MethodsFive counties--Wuchang, Yiling, Qichun, Huangmei and Xishui, which located in Hubei Province were selected. Using the registry database of persons with disabilities in the selected five counties, all children, aged 1-14 years, with pre-existing disabilities were included in this study. For every child with disability, we matched a healthy child who had the same gender and age and lived in the same neighborhood. If the parent or legal guardian agreed to participate in our study, an interview was conducted face-to-face with the parent or guardian of the child using a questionnaire. In addition to sociodemographic information questions, this questionnaire included information about the mother's pregnancy situation, fetal or perinatal general situation, children's growth history, family history, mental health condition, disability status (cause of disability, the type and severity of disabilities as defined by the China criteria for classification of disability), and unintentional injuries occurred in the past year. Data analysis was conducted using Chi-square test,t test, logistic regression model, and Kappa coefficient for agreement calculating.Results1201 children with disabilities aged 1- to 14-year-old and 1201 healthy controls were investigated in the selected five counties.1. Socio-demographic characteristics:There were 807 boys and 394 girls in both groups of children with and without disabilities. The mean age of the study sample was 6.9±3.5 years. Qichun county had the largest number of children that were investigated, accounting for 33.6%; Huangmei county had the smallest for only 113 children were included, accounting for 9.4%.2. Distribution characteristics of children with disabilities:In the six categories of disability, there were 462 children with physical disability, accounting for 38.5%, followed by intellectual disability, accounting for 20.6%. Children with mental disabilities accounted for the least proportion among all sampled children.738 children with disabilities had a single disability, accounting for 61.4%, and 463 children had multiple disabilities, accounting for 38.6%. The more severe the disability, the greater number the children with disability. There were 258 children with cerebral palsy, accounting for 55.7% of all children with multiple disabilities.3. Disability risk factors analysis:Twenty potential factors such as parents'education, virus infection/injury during early pregnancy for mothers, prenatal care situation, parental drinking and smoking that might affect childhood disability were collected. Children with and without disabilities differed significantly with respect to 17 factors except for three factors including parental drinking and smoking, consanguineous marriage, and the family history of cancer. Multivariate logistic regression analysis results showed that the both groups differed significantly in terms of parents' education, taking chemical drugs during early pregnancy, prenatal care, exposure to pets, taking folic acid, history of chronic disease in children, consanguineous marriage, the family genetic history and situations after birth (asphyxia, birth trauma, infection, complications, severe jaundice and congenital malformations, etc.). Among them, children having asphyxia, birth trauma, infection, complications, severe jaundice and congenital malformations had the highest hazard ratio (HR) which was 31.178 (95%CI=18.053,53.843, P＜0.05). Children whose mother taking chemical drugs during their early pregnancy had the second high risk of disability, and the HR was 4.372. Mother receiving prenatal examination and taking folic acid were the protective factors for childhood disability.4. TQ screening results:The UNICEF Ten Questions (TQ) for screening child disability was compared with the Chinese disability criteria. The Kappa coefficient for overall agreement between the Chinese disability criteria and the TQ screen was high (Kappa coefficient=0.913,95%CI:0.894-0.932), indicating both that this screen is appropriate for use in China and that the Chinese criteria agree with international standards.5. Unintentional injury characteristics:Children with disabilities had substantially higher prevalence of medically-attended injury than children without a disability (10.2% vs. 4.4%,P＜.001) in the past 12 months. The two groups differed significantly in terms of number of injury episodes, injury place and activity at time of injury (P＜0.05). The disabled children were more likely to experience 3 or more times of injury than the normal healthy children (19.5% vs.3.8%). The most frequent cause of injury for both groups was falls. Children with disabilities were more frequently hurt by fire/flames/heat than children without disabilities (15.4% vs.7.5%), however, traffic-related injuries occurred more often among the nondisabled children (17.0% vs.6.5%). Most of the injury events happened inside the home for both groups. Different things were that nondisabled children were more commonly injured while attending school (18.9%), whereas those children with disabilities were more commonly sleeping or resting (11.4%). Both groups reported head/neck regions and lower extremities (leg/knee) were the most common body parts injured.6. Injury risk factors analysis:Logistic regression model was used to analyze the impacts of disability status, sociodemographic characteristics and home environment factors on medically-attended injuries. In univariate analysis, the OR for injury was 4.46 (95%CI:2.57-7.74) for children with disabilities compared with children without disabilities. The child whose parent's highest education was high school, whose family had 4 to 5 members, cat/dog(s) or opening burner/brazier was at the highest risk for injury. The multivariate OR for injury was 4.72 (95%CI:2.55-8.76) for the disabled children compared with the non-disabled children after controlling for sociodemographic and home environmental factors. Compared with children who had 6 or more family members, the OR indicated that those with 1-5 family members were over 3 times more likely to having injuries. And for those whose family raised cat/dog(s) were over 90% more likely to be injured during the last 12 months (OR=1.93; 95%CI=1.19,3.11), comparing with those whose family did not have any cat/dog.7. Disability impacts on injury:The odds of injury among children with disabilities was significantly higher than that among children without a disability, after controlling for confounding variables (OR=2.76; 95%CI=2.05,3.71; P＜.001). When the sampled children were not stratified by a single disability and multiple disabilities, compared with healthy children, children with disabling conditions had substantially higher risk of injury by each specific type of disability. Children with multiple disabilities had the highest risk of injury (OR=4.27; 95% CI=2.86,6.38; P＜.001) compared with children without a disability. Among all children with a single disability, although not statistically significant, risk of injury for children with a visual problem (OR=1.96; 95%CI=0.98,3.92; P=.057); for children with a hearing problem (OR=1.70; 95%CI=0.73,3.96; P=.216) was higher than that among children without a disability. With regard to severity of disability, after controlling for confounding factors, the OR of injury was 2.33(95%CI= 1.66,3.27) for children with a single disability and 4.36(95%CI= 2.89,6.57) for children with multiple disabilities compared with children without disability. Also, risk of injury was statistically higher across almost all categories of severity level of disability for children with a single disability and multiple disabilities than for children without a disability.ConclusionsCongenital and non-communicable factors are the major risk factor for childhood disability. However, genetic factor accounts for a small proportion among congenital factor for childhood disability, and the perinatal factors are more prominent. Therefore, for disability prevention, antenatal care and standardized prenatal examination should be strengthened, and obstetric technology should be improved. Furthermore, checking, disease screening and early intervention for infants and young children regularly are of great importance. In addition, children with disabilities face a significantly higher risk of unintentional injuries than children without disabilities. Disability status has a strong association with unintentional injury. Parents and other caretakers involved with children with disabilities should receive additional education on injury prevention. Injury prevention needs to be emphasized for the sake of reducing the excess incidence of injury among children with disabilities. Furthermore, in view of a higher proportion of residential injury, intervention strategies need to be initiated to improve the safety of children's home environments. Although every child is susceptible to unintentional injury, children with disabilities not only have specific vulnerabilities, but they are more likely to stay at home and may consequently be at higher risk of residential injury. Therefore, interventions to prevent residential injury are an important public health priority in children with disabilities. The Kappa coefficient for agreement between the Chinese disability criteria and the UNICEF TQ was very high, which indicated that TQ has good value in field screening for Chinese children with disabilities, and can be used in future large-scaled pediatric population survey.InnovationThere were three innovations in this study. First, this is the first study to use the new biopsychosocial model of the International Classification of Functioning, Disability and Health - ICF to define disability in China. Findings of this study can be compared with those elicited from the other study in the world. Second, this is the first study to describe non-fatal unintentional injuries among children with disabilities in China. Detailed characteristics of the most recent injury episode were collected, including the cause of injury, mechanism of injury, body part injured, location of injury, activity the child was taking part in when injured, and treatment after injury. Third, this study included a Chinese language version of the UNICEF Ten Questions (TQ) about limitations in daily activities for children aged 2-9 years old.