Date Published: February 2, 2017
Publisher: Public Library of Science
Author(s): Homayoun Sadeghi-Bazargani, Reza Mohammadi, Erfan Ayubi, Amir Almasi-Hashiani, Reza Pakzad, Mark J. M. Sullman, Saeid Safiri, Animesh Biswas.
Burns are a common and preventable cause of injury in children. The aim of this study was to investigate child and caregiver characteristics which may predict childhood burn injuries among Iranian children and to examine whether confounding exists among these predictors.
A hospital based case-control study was conducted using 281 burn victims and 273 hospital-based controls, which were matched by age, gender and place of residence (rural/urban). The characteristics of the children and their caregivers were analyzed using crude and adjusted models to test whether these were predictors of childhood burn injuries.
The age of the caregiver was significantly lower for burn victims than for the controls (P<0.05). Further, the amount of time the caregiver spent outdoors with the child and their economic status had a significant positive association with the odds of a burn injury (P<0.05). A multivariate logistic regression found that Type A behaviour among caregivers was independently associated with the child's odds of suffering a burn injury (OR = 1.12, 95% CI: 1.04–1.21). The research also found that children with ADHD (Inattentive subscale: Crude OR = 2.14, 95% CI: 1.16–3.95, Adjusted OR = 5.65, 95% CI: 2.53–12.61; Hyperactive subscale: Crude OR = 1.73, 95% CI: 1.23–2.41, Adjusted OR = 2.53, 95% CI: 1.65–3.87) also had increased odds of suffering a burn injury. However, several variables were identified as possible negative confounder variables, as the associations were stronger in the multivariate model than in the crude models. The caregiver's characteristics which were predictors of burn injuries among Iranian children were: being younger, high socio-economic status, Type A behavioural pattern and spending more time outdoors. In addition, the relationship between a child's ADHD scores and the odds of a burn injury may be negatively confounded by the caregivers predictor variables.
Unintentional injuries are a health concern in every country around the world and result in over 5 million deaths per year, or 16,000 deaths per day . According to the World Health Organization’s Global Burden of Disease Study, unintentional injuries accounted for over 3.9 million deaths in 2004. Furthermore, five of the 15 leading causes of death among persons 15–29 years of age are accidental, including: road traffic injuries, drowning, burns, poisoning, and falls . A worldwide increase in prevention efforts and early intervention programmes have substantially reduced the burden of unintentional injuries as a public health concern . However, a systematic review has shown that burn injuries remain an important public health issue in the East Mediterranean Region (EMR)  and also in Iran [4, 5].
A case-control study was undertaken at Sina University General Hospital, which is located in the city of Tabriz. Tabriz is the capital city of the East Azerbaijan province in the northwest of Iran, and has a population of around four million people. The study was conducted over a period of 12 months, from 2009 to 2010. The Hospital receives burn injury cases from 19 districts in the province. In order to minimise bias, participants’ age, gender and place of residence (urban/rural) were frequency matched for the case and control groups.
Firstly, the 11 Type A items satisfied the entrance criteria into the PCA model. This revealed two factors with Eigenvalues ≥ 1, which accounted for 26.2% and 20.5% of the variance, respectively. CFA was then undertaken to validate this factor structure, with the fit statistics of the hypothesized models presented in Table 1. The two-factor model met fit criteria (CFI = 0.89, RMSEA = 0.08), although χ2 was significant, which is due to the large sample size. Fig 1 illustrates the hypothesized two factor model. Consequently, the two subscales (TA1 and TA2) were used for assessing Type A behaviour among caregivers .
The present study found a significant association between childhood burn injuries and caregiver characteristics, including age, time spent outdoors and Type A behaviour. These findings support previous research that has found more burns injuries occur among children with younger caregivers. For example, Shah et al.  found that the maternal age of the caregiver was significantly related to the odds of a burn injury. In particular, compared to mothers younger than 20 years old, the odds of childhood burn injury were 40% lower in mothers aged 20–39 years and 72% lower in mothers older than 40 years. In contrast, there has been one study which found that maternal age was higher in the cases than in the controls, but this finding was not statistically significant .
This study found that Type A behaviour, being younger, time spent outdoors, and high economic status were caregiver predictors of burn injuries among Iranian children. Moreover, the association between a child’s ADHD score and the odds of a burn injury may be negatively confounded by the characteristics of the caregiver and the child.