Analysis of Factors Associated with the Incidence of Injury in Children Under Five Years in Cakung East Jakarta

Fadilla Saffitriyani¹, Diah Argarini²*, Andi Julia Rifiana³

Universitas Nasional, Jakarta, Indonesia^1,2,3

Email: diah.argarini@civitas.unas.ac.id

KEYWORDS	ABSTRACT
injury factors, injury incidence, toddler age	Children of toddler age (pre-school) very often experience injuries, both minor and major. Therefore, the role of parents is important in monitoring, protecting, and providing knowledge to children about what to do and what not to do. The study aims to determine the relationship between attitude, level of knowledge, and behavior with the incidence of injury in children under five years of age in Cakung, East Jakarta. This research plan uses an analytical descriptive design with a Cross-Sectional approach. The sample in this study was 134 people, and the sampling method was non-probability sampling. In collecting data, a questionnaire sheet for parents regarding attitudes, knowledge levels, and behavior was used. The results showed that the injury cases of children under five years of age were choking (47.0%), which was dominated by boys (52.2%). Then, parents with parental attitudes were dominated by moderate attitudes (48.5%), the level of parental knowledge was less (38.1%), and parental knowledge was less (41.8%). Analysis showed a significant relationship between parental attitude (p=0.028), knowledge level (p=0.004), and behavior (p=0.017) in Cakung, East Jakarta. Therefore, it is necessary to increase parents' knowledge and awareness of the need for parental supervision in order to prevent injuries to children.
DOI: 10.58860/ijsh.v3i9.239

Corresponding Author: Diah Argarini*

Email: diah.argarini@civitas.unas.ac.id

INTRODUCTION

Children are unique individuals from the age of 0 years to under the age of 18 years who will continue to experience growth and development. According to the Ministry of Health (2022), the age classification of children consists of infancy and toddlerhood (0-5 years), childhood (5-11 years), and adolescence (10 before 18 years). In the process of growth and development, children will continue to find out and try to get to know the surrounding environment by involving various five senses that are not spared from injury to death. Injury is one of the main causes of morbidity (level of pain) and mortality (mortality rate) in children, which can actually be prevented with proper prevention (Ramis Ibrahim et al., 2018) according to the World Health Organization (WHO, 2024). Injury is a lesion of the body resulting from acute exposure to energy (mechanical, thermal, electrical, chemical, or radiation) in amounts that exceed physiological tolerance limits somebody. Injuries are very common in children, especially in children under 15 years old, with high activity, great curiosity about the environment, and imperfect motor and cognitive abilities making children more susceptible to injury. Data on the high mortality rate in children under 15 years, as many as 18,000 every year, with the main causes of death being traffic injuries, drowning, burns, falls, and poisoning (Abubakar et al., 2018).

Accidental injury is the cause of the main cause of death in children aged 1-18 years. Many of these injuries to children occur in their own homes (Jaques et al., 2018). In addition, injuries to children can occur in various environments, such as at home, at school, on the street, or at the playground. Children who are most vulnerable to injury are children who are not able to walk well or who are in the learning stage to walk (Sotiraki et al., 2022). The occurrence of injuries to children can greatly disrupt the family's income and quality of life. In low-income countries most often experience injury events, this is evidenced by a seven-fold difference between the countries with the highest and lowest injury death rates in the European Region. Apart from state revenue, One of the main risk factors for child injury is an unsafe environment. For example, children are more exposed to fast traffic, lack of safe places to play, and live in overcrowded homes with unsafe structures such as stairs without handrails or gates or windows without bars and locks (Abubakar et al., 2018).

In 2020 in Indonesia, the death rate of children under 5 years old reached 28,158 people. Of these, 20,266 children under five (71.97%) died in the neonatal period (0-28 days). A total of 5,386 toddlers (19.13%) died at the age after birth (29 days-11 months). Meanwhile, 2,506 toddlers (8.9%) died at the age of 12-59 months (Parker et al., 2021). Based on data presented by RISKESDAS, the percentage of injury incidents in DKI Jakarta Province based on grouping age: 8.2% of children aged 1-4 years were injured, and 12.1% of children aged 5-14 years were injured. The proportion of injuries experienced by men is the highest, with a percentage of 11%, while the percentage of injuries experienced by girls is 7.4%, most of the limbs are most injured, namely in the lower limbs at 67.9%, this shows that physical activities such as running, kicking, jumping and other activities involving the lower limbs are the most dominant cause of injury. In addition to lower limbs, the home environment is one of the places with the highest incidence of injuries, with a percentage of 44.7%. Data from the Cakung District Health Center related to the incidence of injuries, especially in children, in 2023-2024 shows that there are 400 cases.

In addition to economic and environmental factors, The cause of injury is basically the child's lack of ability to avoid the facilities and infrastructure that cause injury and the lack of parental supervision (Coulston et al., 2023). Education is also a factor in preventing injuries, through education, parents also get information and knowledge related to child safety. This is in line with previous research, the results were obtained that there was a significant difference between maternal knowledge after being given health education and p-value (0.000)< α (0.05), Anticipatory guidance health education is an effective method to increase maternal knowledge in an effort to prevent injuries in toddler children (Anita, 2023). Likewise, the results of a study by Keness (2022) showed that there is a relationship between knowledge and the prevention of the risk of recurrent injuries in toddlers (p-value 0.000: alpha 0.05). Then, the results of the next study obtained the result that 10-year-old children (45%) with the male sex (53.7%) suffered the most injuries with a low socioeconomic level (61.1%). The most common injury experience is fall and trip injuries (71.3%) (Coulston et al., 2023). Research conducted by (Fadmi et al., 2023) shows that there is relevance to parents' knowledge about accident prevention with the incidence of accidents in toddler-aged children (P 0.003). And there is a relationship between parental attitudes regarding accident prevention and the incidence of accidents in toddler-age children (P 0.003), parental knowledge and attitudes together (simultaneously) have an effect on the incidence of accidents in toddler children (F 33.830 and R square 0.595).

Despite these findings, there is still a gap in understanding the integrated relationship between attitudes, knowledge, and behavior of parents regarding injury prevention. While prior studies have examined these factors separately, this study aims to analyze them collectively to provide a more comprehensive understanding of how they influence injury prevention in toddlers. This novel approach could lead to more effective interventions, as it recognizes that improving only one aspect (e.g., knowledge) may not be sufficient without concurrent improvements in attitudes and behaviors. Moreover, this research addresses the specific socio-economic and cultural context of Cakung, East Jakarta, which has not been extensively explored in previous studies, making it contextually unique.

Based on the above background, the incidence of injuries in children continues to increase, with the number of deaths of around 2,500 people per day under the age of 18 years with accidental injuries that require more in-depth attention.

METHOD

This study uses an analytical descriptive design with a cross-sectional approach to collecting data at one point in time. Data collection will be carried out using questionnaires, data will be collected to analyze the factors that cause injuries in children. Descriptive research, according to Sugiyono (2018) in Adiputra (2021), is a method to analyze and describe the results of the research but is not used as a conclusion to a broader research. According to Adiputra (2021), Cross-sectional is a study in which independent variables or causal factors and dependent factors or causal factors are collected simultaneously.

According to Widodo (n.d.), population is the entire element of the research, which includes objective and subjective aspects with certain characteristics. The population used in this study is 200 children aged 24 months – 59 months in June 2024 in RW.01, Penggilingan, Cakung, East Jakarta.

The sample is part of the population taken using sampling techniques (Jafarian et al., 2022). The sampling method in this study uses the non-probability (Purposive sampling) technique, which requires certain criteria to be sampled in the study. The research sample was calculated using the Slovin formula, where the error rate was 0.05 (5%).

1) Sample Size

The determination of sample size uses the Slovin formula as follows:

𝑁

n = 1 + ( 2)

Information:

n : Number of samples

N: Number of population

d : Number of significances (p) or laxity and ineffectiveness due to sampling errors (5%)

Based on the formula above, the sample obtained as follows:

𝑁

n = 1 + ( 2)

200

N= 1 + 200(0,052 )

280

=1,7

= 133.3, so the total sample in this study is 134.

In this study, non-probability sampling is used, which requires special criteria. In the study, sample criteria are needed, including inclusion criteria and exclusion criteria, where these criteria are limitations in determining whether or not the sample can be used.

This research was conducted in the RW.001 area, Penggilingan, Cakung, East Jakarta, which was carried out in March-August 2024

RESULT AND DISCUSSION

Univariate Analysis

1) Cases of Injury in Children Under Five Years

Regarding the distribution of the frequency of injury cases in children under five years old, the results were obtained that the majority of the genders of children who were injured were boys with a percentage of 52.2% and girls with a percentage of 47.8%. The employment status of the parents is the most unemployed at 57.5%, while those who are employed are 42.5%. Most children are 48 months-59 months, with a percentage of 44%; children from 36 months to 47 months, with a percentage of 29.9%, and the least is 24 children Month-35 months 26.1%. Next is the most common type of injury experienced by children, namely choking at as much as 47.0%, falling from a height at 37.3%, poisoning at 5.2%, other injuries at 4.5%, burns at 3.0%, drowning and motor vehicles with the same percentage respectively, namely 1,5%.

There are many injuries to boys because boys have a higher sense of curiosity or curiosity than women. Then, the age of children who often experience injuries is at the age of 48 months-59 months, where at that age, the child is more independent and can do many activities, which can cause injuries. In addition, many incidents of choking injuries are experienced by children caused by parents who are negligent in supervising their children and placing small items carelessly (Kalikotay & Rijal, 2022). It is not uncommon for children to choke due to small toys such as marbles, bullets for toy guns, and food that are too large. Furthermore, many parents do not work due to the demands of their spouses to stay at home so that they can focus more on taking care of their children and only do housework.

2) Parents' Attitude

Regarding the frequency distribution of parental attitudes in RW.01, Penggiling, Cakung, East Jakarta, the results were obtained that the number of parental attitudes was sufficient 48.5%, the attitude of parents was less than 38.1%, while the attitude of good parents amounted to 13.4%. This happens because the information obtained by parents is minimal, so many parents do not care about their children to prevent injuries. Not infrequently many Parents who think that their children are fine even though they are injured can still be treated at home.

3) Parental Knowledge

Regarding the frequency distribution of the level of parental knowledge, it is not as much as 38.1%; parental knowledge is sufficient at 31.3%, while parental knowledge is good at 30.6%. This happens because of the lack of information known by parents about the prevention of injuries to children, and many parents do not know how the home environment is child-friendly, especially for children under five years old.

4) Parental Behavior

Regarding the frequency of parental behavior in RW.01, Penggiling, Cakung, East Jakarta, the results were obtained that as many as 41.8% of respondents had poor behavior, as many as 35.8% of respondents had adequate behavior and as many as 22.4% of respondents had good behavior. This is because many parents are only busy with their gadgets or enjoy chatting with their neighbors while with their children, which is why children under five need the role of parents to supervise their children and prevent injuries.

5) Bivariate Analysis

The Relationship between Parents' Attitudes and the Incidence of Injury in Children Toddler Age

Based on the results of the analysis using the Chi-square test, a p-value of 0.028 was obtained. It can be concluded that there is a significant relationship between parental attitudes and injuries in children under five years old (p-value < 0.028, α 0.05). Parents' attitudes about injury prevention in preschool children have a significant relationship with injury prevention practices carried out by parents. Jamil (2022) said, "that the absence of experience that a person has with a psychological object tends to form a negative attitude towards that object." Another theory that also supports it is Ridha (2024), which reveals that personal experiences must leave a strong impression, and the experiences experienced will also shape and influence the appreciation; a person must have experiences related to psychological objects. This shows that if a parent does not have experience in treating children about injury prevention, it will tend to form a negative attitude, on the other hand, if a parent has more than one child, he will have experience in forming a positive attitude. Then, there is the theory that states the attitude in relation to its effect and role in the formation of character and the system of relations between groups, as well as the choices that are determined based on the environment and its influence on change (Rahman & Sciara, 2022). Factors that affect attitudes towards attitude objects, including personal experience, will make attitudes easier to form if the experience occurs in a situation that involves emotional factors. The influence of others who are considered important, the influence of culture, mass media, educational institutions and religious institutions, and emotional factors (Hamid et al., 2019)

The results of this study are in line with the research conducted by Mokhtar (SHAHZAD, 2024), which obtained a relationship between parental attitudes and the practice of preventing injuries in children, namely by using the Lamda correlation test. P-value = 0.000 (p<0.05), so that H0 is rejected and Ha is accepted, so the conclusion is that there is a relationship between attitudes of parents and injury prevention practices. Which found that of 31 respondents, 70.7% had a bad attitude. According to the researcher's assumption, the attitude of parents is not good because they think their children will not be injured. The environment where children play is considered safe, so parents do not need to be responsive to triggers for injuries to children. A good attitude is important because parents feel that children need to be paid attention to, even if not specifically because the trigger for injury can occur from all directions and at any time.

Relationship of Knowledge with the Incidence of Injury in Children Toddler

Based on the results of the analysis using Chi-square regarding the relationship between parental knowledge factors and injury cases, a p-value of 0.004 was obtained. It can be concluded that there is a significant relationship between knowledge and injury in children under five years old (p-value < 0.004, α 0.05).

According to Utami (2022), There are various factors that can affect the incidence of injury in children, one of which is the characteristics of causative agents, which, apart from the many objects that can cause injury to children, also provide knowledge and understanding to children regarding what can cause injuries and what effects will occur, can minimize the incidence of injury in children. In addition, the prevention of domestic injuries is to provide knowledge and information and improve the skills of parents for the sake of their health (Jamil & Merisdawati, 2022). The higher the parents' knowledge, the lower the accident incidence (Dewi et al., n.d.)

This study is in line with research conducted by Jayanti (2022), the results of the Spearman Rank test show that the significance (2-tailed) is 0.001 < less than 0.05, then H0 is rejected, which means that there is a relationship between parental knowledge about accident prevention and accident incidence in toddlers in the Gambirsari Health Center work area. The correlation coefficient number is -0.446. The negative coefficient value indicates that the relationship between parents' knowledge about accident prevention and accident incidence is not unidirectional. Another study that is also in line with Rusdiana (2019) entitled "The relationship between mothers' knowledge and attitudes about injury prevention and the incidence of injuries in toddler children 1-3 years old in the Tambaruntung Health Center Area" shows that there is a meaningful relationship between mothers' knowledge and attitudes regarding injury prevention with an incident of injury to a toddler (1-3 years old) in the Tambaruntung Health Center Area, Tapin Regency in 2020. Where the mother's knowledge is good, as many as 16 respondents (46%), enough as many as 13 respondents (37%), less than 6 respondents (17%). Meanwhile, the attitude of mothers about the prevention of maternal injuries had a positive attitude of 20 respondents (57%) and a negative attitude of 15 respondents (43%).

According to the researcher's assumption, many respondents have poor knowledge due to the lack of information sources about injury prevention, especially in children under five years old. The information obtained is still small, so many parents do not understand how the home environment is child-friendly, and many parents pay too much attention to injuries to children. By assuming that if the child is injured, he can immediately go to a health facility. As well as many parents who have minimal experience in preventing injuries to their children.

Relationship between Behavior and Injury Incidence in Toddlers

Based on the results of the analysis of the relationship between parental behavioral factors and injury cases in children under five years old, the results of the analysis using the Chi-square test obtained a p-value of 0.017. It can be concluded that there is a significant relationship between parental behavior and injuries in children under five years old in RW.01, Penggilingan, Cakung, East Jakarta (p-value < 0.017, α 0.05). The formation of behavior can be influenced by the existence of a person's knowledge or cognition (Sawitri et al., 2015), and the presence of Knowledge will form a person's behavior, attitude, and readiness to face or solve a problem. If parents' knowledge about prevention practices against dangers that can occur to children is good, it is hoped that the prevention practices will also be better (Kusbiantoro, 2015). The main influence that can cause injury in children is that at this age, children are developing their gross motor skills, which make them move actively and continuously (Stewart et al., 2021).

This is in line the study, where the results of the univariate analysis were obtained, namely that 57.5% of parents applied democratic parenting, and 51.8% showed poor preventive behavior. The results of the bivariate analysis showed that there was a meaningful relationship between parental parenting and injury prevention in toddlers in Paseban Village RW 05, Central Jakarta (p = 0.020). It is hoped that parents can supervise children's behavior and provide good parenting in an effort to prevent injuries, such as supervising children when they play at home or outside the home. Likewise, with the research conducted by Rahmawati (2015), The contingency coefficient test was used in analyzing data; the results of the test obtained a value of p = (0.000) < (0.05) and a value of r = 0.491. There was a positive relationship between parental parenting and injuries in toddler-aged children (1-3 years) in Ngijo Village, Karangploso District, Malang Regency, with a moderate correlation strength. Democratic parenting is an appropriate parenting pattern to minimize the incidence of injury in children.

Then, there is very little difference between minor child injuries and adequate parental attitudes and insufficient parental attitudes. According to Utami (2022), there are various factors that can affect injuries, namely the characteristics of the child, the causative agent, and the environment. Meanwhile, according to Candry (2023), in his research, the results were obtained in 10-year-old children (45%) with the male sex (53.7%) and the most injuries with low social levels (61.1%). Where social and environmental levels can affect the occurrence of injuries in children.

According to the author's assumption regarding parental behavior related to the prevention of injuries to children under five in RW.01, Penggilingan, Cakung, East Jakarta, due to the large number of parents who do not pay attention to children's play areas, the outdoor environment (on the side of the main road) and the lack of parental role in assisting and supervising their children while playing, both indoors and outdoors, as well as the lack of providing information given to children which areas or toys are allowed to be used to play and which are not allowed to be used to play (such as, plugging in electricity, matches, climbing on the fence of the house and others).

6) Research Limitations

In carrying out research, there will be risks of experiencing obstacles that are not expected by researchers. However, this research does not mean that it is invalid. Some of the limitations experienced by patients include:

a) The same time for respondents who are working and respondents while taking care of children so that when filling out the questionnaire is in a hurry.

b) In filling out the questionnaire, some respondents still do not understand the filling out of the attitude questionnaire, due to the many options of check pools which make respondents confused.

c) In this study using a closed questionnaire, respondents cannot write answers other than the answers available in the questionnaire; this may be because the questionnaire filling does not fully represent the actual opinion of the respondents.

CONCLUSION

Based on the results of the research analysis, it was found that the cases of injuries experienced by toddlers, especially in the RW.01 Penggilingan area, Cakung, East Jakarta, were cases of choking (47.0%) which were dominated by boys (52.2%). Based on the results of the research analysis, it was found that the level of parental knowledge was dominated by the level of less knowledge with a percentage of (38.1%). Based on the results of the research analysis, there was a significant relationship between parental knowledge factors (38.1%) and (p=0.004), parental attitudes (52.3%) with (p=0.28), and parental behavior (41.8%) with (p=0.0017) on the incidence of injury cases in children under five years old.

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