Risk factors for injury in Pakistani children.

Over 1 million child fatalities occur per year, the bulk of them in less-developed countries. There remains a need, from country to country, to identify personal and environmental risk factors correlated with this mortality. The present study focused on Pakistan, home to a sizeable pediatric population of 60 million. The study employed case-control methods (i) to identify situational risk factors and (ii) to test when children were most at risk, and whether these patterns differed for preschool versus school children. For two months the families of 300 consecutive inpatients were interviewed at Children's Hospital in Islamabad. Most children (79%) were unsupervised at the time of the injury. The casecontrol study found risk factors in the mother's level of education, size of the home, and number of children in the home (all p < 0.05). With respect to temporal patterns, the time period of greatest risk was 3-6 PM. Compared to preschoolers, school children showed elevated risk on weekends (odds ratio 4.0, p < 0.001) and reduced risk during school (odds ratio 0.2, p < 0.0001); in contrast, the risk of injury for preschool children remained constant throughout the week. The results support the conclusion that overall, poor supervision, domestic crowding, and low maternal education were risk factors for injury in our sample of Pakistani children. Based on this conclusion, we recommend further efforts to keep children off roofs, isolate them from hazards, promote supervision, educate parents, and provide safer play.