CHAPTER ONE

INTRODUCTION

1.1    BACKGROUND TO THE STUDY

Accidents are commonly regarded as intrinsically different from causal sequences that lead to disease and to any other event. As a result accident remains the only major source of morbidity and mortality which many continue to view in extra-rational terms such as ‘luck’, ‘chance’ and ‘act of God’. If accidents are of such unique nature that its causation defies human understanding, control and prediction, it might be argued that it should be analysed not only by scientists and theologians and philosophers but by astrologers and soothsayers as well. On the other hand, if the causation of accidents does not differ substantially from other events, it is important that it should be subjected to rigorous and sophisticated scientific methodology. In fact, accident research is a branch of study that has evolved out of such lack of conceptual clarity (Anderson, 2005).

An accident is a happening that is not intended, foreseen or expected that can cause an injury and sometimes death. Accidents sometimes result from negligence. Accidents and injuries are common, especially among young children aged 1 – 4 years of age. Accidents are happening that are usually unintended and unforeseen. It is therefore important that you, the health workers, are aware of these possible unpleasant and unintended happenings and should play a big role first in the prevention and secondly in their management. We shall discuss both accidental and Non-accidental injuries. Accidents are a major cause of death and disability. About 14,000 people die in the UK, most of them in England and more than 700,000 will be seriously injured in England alone. They cost the UK an estimated £150 billion every year. For children and young people, accidents are the greatest threat to life (UNICEF, 2008).

A review of literature of accident research reveals that inadequately trained professionals whose nature of work made them deal with accident phenomenon largely contributed in the early period of accident research (Anderson, 2005; Boden, 2014). Consequent to this ‘much of the accident research and theorisation are based on primitive rather than sophisticated methodology. Gradually, terms like chance, luck or act of God failed to find any mention in the accident literature and safety professionals proposed various theories and models of accident causation.

However, according to Robertson (2015), an accident is an undesirable incidental and unplanned event that could have been prevented had circumstances leading to the accident been recognized, and acted upon, prior to its occurrence. Most scientists who study unintentional injury avoid using the term “accident” and focus on factors that increase risk of severe injury and that reduce injury incidence and severity. Primary school people are most times exposed to road traffic accidents, school accidents, and home accidents. It is on record that every year more than 67,000 children experience an accident in the kitchen and 43,000 of these are aged under four. (Merrill, 2013).

There are basically two classifications of accident – physical and non-physical examples. Physical examples of accidents include unintended motor vehicle collisions or falls, being injured by touching something sharp, hot, electrical or ingesting poison. Non-physical examples are unintentionally revealing a secret or otherwise saying something incorrectly, forgetting an appointment, etc. According to the International Labour Organization (ILO, 2014), more than 337 million accidents happen on the job each year, resulting, to occupational diseases, in which more than 2.3 million deaths annually.  In contrast, leisure -related accidents are mainly sports injuries.

Predisposing factors to the causation of accidents are of two types: Environmental factors and Childhood factors. Environmental Factors are things in the child’s environment at home and outdoor that may predispose or lead the child to get an accident. For example; poorly arranged furniture in the house can make a child fall and injure his or herself, unprotected cooking place can lead to child burns. Fruit trees or ladders in homes may attract a child to climb and result in a fall. Similarly pools of water outdoor including unfilled quarry with accumulation of water may lead to drowning. A final example is the overcrowded city slums are particularly bad environment for children. Childhood factors on the order hand, are factors centred on the child. They include the normal curiosity, exploration nature and imitation of a child, a child still learning and has no experience that can land them into accidents. Boys are more explorative and get into accidents more frequently than girls. But girls are more affected by accidents in cooking place at home than boys. Abnormal factors in a child that can lead into accidents include: a child with epilepsy, a child with a handicap (Royal Society for the Prevention of Accidents, 2012).

The prevention of childhood accidents is identified as one of the key indicators in the 2013-2016 Public Health Outcomes Framework. Three published guidance documents from the National Institute for Health and Care Excellence (NICE) outline recommendations for all those with a strategic role to play in injury prevention, including clinical commissioning groups (CCGs), local authorities and their partners (Kendrick , Hayes  & Ward, 2012). Unlike safeguarding, there is currently no requirement for primary healthcare teams to undergo training in unintentional injury prevention. This is an important recommendation of the NICE guidance (NICE, 2010).

The following are some of the concepts in accident prevention:

Primary prevention: removal of circumstances causing injury – eg, traffic speed reduction, fitting stair gates for young children, reducing alcohol consumption.

Secondary prevention: reduces severity of injury should an accident occur – eg, use child safety car seats, bicycle helmets, smoke alarms.

Tertiary prevention: optimal treatment and rehabilitation following injuries – e.g. effective first aid, appropriate hospital care.

Clinical roles for health professionals in accident prevention include advice to patients: health workers are well placed to identify accident risks or medical conditions conferring risk and to advise accordingly. Accidents are one of the main causes of death among children aged 1-5 years. About 100,000 children are admitted to hospital annually in the UK and 2 million attend emergency departments. In a typical CCG with a population of 100,000, this equates to approximately 3,300 emergency departments visits and 200 hospital admissions for child injuries.

In terms of numbers of people killed or injured, this is an important area for accident prevention in Nigeria and worldwide. Although the figures are still high, statistics for Great Britain suggest that the situation is gradually improving. For the year ending June 2013:

1,730 people were killed, a 3% drop from 1,785 in the previous year.

185,540 people were injured, 7% fewer than the previous year.

Total reported child casualties (ages 0-15) fell by 12% to 15,920 for the year ending June 2013 with those killed or seriously injured down 11% to 2,080.

Common causes of these accidents included speeding, drink driving, not wearing seat belts or careless driving. Around a third involved someone driving during their work. About 10% of those killed were inexperienced drivers. Higher speed both increases the risk of collision and the risk of serious injury to the driver or others. Even a modest speed reduction helps reduce both the number and the severity of accidents, e.g. pedestrians hit at speeds below 30 mph receive mainly survivable injuries but this changes to mainly fatal injuries at speeds of between about 30 mph and 40 mph (Royal Society for the Prevention of Accidents, 2011).

Children commonly drink poisonous substances or drugs left in their reach. The more attractive colours of the substance or drug the more the risk of being taken and ingested by the curious, explorative learning children. The effect of the poisoning material depends upon the quantity drunk or ingested and the chemical nature of substance or drug. And also to some extent the size or age of the child, nutritional status and when the stomach is empty in a hungry child or a child who has some food contents in his or her stomach. Large amounts are dangerous, while an empty stomach allows easy absorption of the poison and a stomach with food delays absorption of the poisonous substance or drugs (UNICEF, 2008)

For health workers, important points when advising on child accident prevention are:

Offer practical advice, not just general education – e.g. advise about car seats or home safety equipment.

Use an evidence-based approach where possible and dispel myths – e.g. some parents wrongly believe that cooker guards and baby walkers are safe.

Promoting safety does not require overprotection (‘wrapping children in cotton wool’) – this would delay development and increase the risk of obesity.

Promote sensible precautions in line with the child’s level of development.

This work will however investigate accidents and the health of primary school pupils in Erei, Biase Local Government Area of Cross River State, Nigeria.

STATEMENT OF THE PROBLEM

Accidents constitute a major health challenge amongst primary school children. According to World Health Organization (2016), every year the lives of approximately 1.25 million people are cut short as a result of road traffic crash. Between 20 and 50 million more people suffer non-fatal injuries, with many incurring a disability as a result of their injury. Other statistics on road accident are as follows: About 1.25 million people die each year as a result of road traffic crashes; road traffic injuries are the leading cause of death among young people, aged 15–29 years; 90% of the world’s fatalities on the roads occur in low- and middle-income countries, even though these countries have approximately half of the world’s vehicles; Half of those dying on the world’s roads are “vulnerable road users”: pedestrians, cyclists and motorcyclists; without action, road traffic crashes are predicted to rise to become the 7th leading cause of death by 2030; the newly adopted 2030 Agenda for Sustainable Development’s has set an ambitious road safety target of halving the global number of deaths and injuries from road traffic crashes by 2020.

More than 90% of deaths that result from road traffic injuries occur in low- and middle-income countries. Road traffic injury death rates are highest in the low- and middle-income countries of the African region including Nigeria. Even within high-income countries, people from lower socioeconomic backgrounds are more likely to be involved in a road traffic crashes.

Over the years, efforts have been directed by individuals, communities, government and international bodies towards the prevention of accidents amongst primary school pupils. There is no prove of the contrary that all effort put in place to prevent accidents among school children is still not enough as cases of road, school and home accidents still prevail among primary school pupils.

It therefore becomes imperative to investigate deeply into the underlying causes of accidents among school pupils in order to arrive at possible solutions to the problem, thus this work on accidents and the health of primary school pupils in Erei, Biase Local Government Area of Cross River State, Nigeria.

1.4    OBJECTIVES OF THE STUDY

The major objective of the study is to examine accidents and the health of primary school pupils in Erei, Biase Local Government Area of Cross River State, Nigeria. The specific objectives of this study are:-

To examine road traffic accident and the health of primary school pupils in Erei

To ascertain school accident and the health of primary school pupils in Erei

To investigate home accident and the health of primary school pupils in Erei

1.5    SIGNIFICANCE OF THE STUDY

Findings of this study will be significant to the following group of people: Parents, mothers, children, health and health related organizations, individuals, public and private, school authority.

To parents, findings of this study will create awareness and raise critical consciousness of the people on the need to confront the occurrence of accidents among primary school children.

To individuals, especially primary school pupils, this work will provide proper information and advice on how to prevent road, school and home accidents.

Above all, to school authority, information gathered from the study will serve as a guide on policy making and training of their pupils on the three major forms of accidents and their prevention.

To other researchers and scholars, this work will provide current information on accident and the health of primary school children, thus serving as a reference material.

1.6    RESEARCH QUESTIONS

           To guide this study, the following research questions were formulated:

To what extent does road traffic accident affect the health of primary school pupils?

How does school accident affect the health of primary school pupils?

To what extent does home accident affect the health of primary school pupils?

1.7    DELIMITATION (SCOPE OF STUDY)

The study is limited in scope to accidents and the health of primary school pupils in Erei, Biase Local Government Area of Cross River State, Nigeria. It is also limited to the three sub-variables adopted for this study thus:

Road traffic accident and the health of primary school pupils in Erei

School accident and the health of primary school pupils in Erei

Home accident and the health of primary school pupils in Erei

1.8    LIMITATIONS

The following factors posed limitations to the research study:

The uncompromising attitude of some respondents in giving candid opinion set a limitation to the research study.

The project was self-sponsored and money was needed to type the questionnaire, travel to the research area and meet other needs.

Another constraint of the study was inadequate time allotted for the completion of the research study. The researcher worked under the College time framework that was not enough for a coherent research.

Difficulty in reaching respondents residing in some sampled villages within Erei Community was another challenge. The research had to cover some distance before getting in contact with her respondents.

1.9    OPERATIONAL DEFINITION OF TERMS

HEALTH: Health is a state of complete physical, mental and social well being of an individual and not merely the absence of disease or infirmity (WHO)

SCHOOL AUTHORITY: These are the board of management of a particular school who gives guidelines of expected standards of behaviour, dressing, academics integrity and attendance as well as consequences for violating those standards.

EFFECT: This refers to a strong impression, result or impact of something.

ACCIDENTS: happenings that are usually unintended and unforeseen.

ROAD TRAFFIC ACCIDENT: Accidents occurring on the road.

SCHOOL ACCIDENT: Accident involving school pupils while in school.

HOME ACCIDENT: Accidents that takes place at home.

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