Mothers' Knowledge Levels Related to Poisoning

SUMMARY

Objectives

This study was done to evaluate mothers’ level of knowledge regarding poisoning, to plan training for issues with an identified lack of knowledge, to collect required data regarding protection and approach issues on poisoning cases which may occur in children for various reasons.

Methods

This descriptive study was performed after obtaining permission from the County Health Department and involved mothers who applied to Family Health Centers No. 1-7 between April 1^st and May 31^st 2012, and who agreed to participate in the study (n=290). The questionnaire was composed of three parts: “Personal Information Form,” “House Poisoning Evaluation Form” and “Home Poisoning Prevention Knowledge Level Form.”

Results

Participant ages were between 16 and 50 years and the mean age was 33.09±7.10 years. The number of children ranged from 1 to 6, and 203 people had seven children under the age of six. 37.6% of the mothers were primary school graduates, while 74.5% were housewives. There was a significant relationship between the knowledge score of the mothers on poisoning and education, career, neighborhood, and social security (p<0.05).

Conclusions

Childhood poisoning is the most common cause of admission to the hospital. Protective precautions such as family education, storage of medication out of reach of children and use of secure lids are thought to be important.

Introduction

Poisoning is an emergent condition that presents with signs and symptoms specific to the causative substance. It is caused by intake of a toxic substance in an amount harmful to the body through different ways. Poisonings are types of emergency pediatric diseases with preventable causes that lead to significant morbidity and mortality.1, 2 In developed countries, accidents and poisonings represent the most significant causes of death among the 1-14 year age group. 2, 3 In developed countries 2% of child deaths are caused by poisoning, with this number being more than 5% in developing countries.^[3]

According to the American Association of Poison Control Centers Toxic Exposure Surveillance System records, 65.8% of the 2.3 million reported poisoning cases are constituted of children under the age of 19 years.^[4] Poisoning is common in 1-5 year old children. Because of curiosity and willingness to learn, investigation of children's surrounding is frequently seen in this age group, and the substances found can be taken by mouth by children which may lead to poisoning. ^[5] Since children have a lesser ability to control themselves than individuals of other ages, yet cannot distinguish possible harmful substances and hazardous situations, they are particularly vulnerable to accidents and poisonings. 6, 7 Much of the child's life up until the age of 7 is spent in a home environment; it is thus important for caregivers to understand protective precautions such as the storage of medication out of reach of children and the use of secure lids.^[8] At this point, it is clear that nurses, who today have many tasks in terms of patient care, have great responsibility in family education regarding the prevention and reduction of poisoning (which is a significant cause of mortality and morbidity in childhood).^[9]

Factors that led to poisoning may vary according to region, civic society's traditions and customs, the level of education and the season.^[10] Therefore, precautions should be taken by identifying characteristics associated with poisoning of each country and even of each region.^[11] In our country numerous studies related to childhood poisonings are performed; however, all of them contain regional characteristics.5, 6, 7, 8, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 Epidemiological data of each region are required be determined and updated for the development of appropriate protection and treatment methods, for health personnel education and raising society awareness.^[29] Therefore, this study was aimed to evaluate mothers’ knowledge level regarding poisoning, organize training about the topics in which inadequacies were detected and collect the required data about the approach and protection of poisoning events in children.

Materials and Methods

This descriptive study was applied to mothers who applied for examination and treatment to Family Health Centers No. 1-7 between April 1^st and May 31^st 2012 (1008 applied, 15-49 year old women), who have one or more children under the age of fourteen (496 people) and who agreed to participate in the study (n=290) after obtaining permission from the County Health Department. Because in the literature, rates of poisoning of children under of age seven years and younger are rapidly increasing, in this study the “Measuring information score about poisoning of mothers with children under the age of seven years and younger” was designed. However, due to difficulties in each sample group, we tried to reach mothers who had children aged fourteen and younger. Only 203 of mothers in the study were found to have children age seven and younger.

Collection of Data

The study data were collected through questionnaires completed by face to face interviews of mother and the researchers. Questions about poisoning were prepared by researchers by investigating literature data on the subject.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 Pre-treatment of the survey was performed on 10 mothers who applied for treatment to the State Hospital, and had children under the age of seven (due to poisonings being more common in this age group). After making the necessary adjustments on the questionnaire we switched to the original application, mothers who participated in the pre-treatment group were not included in study again. Collection of research data occurred via a questionnaire that queried mothers regarding their knowledge of poisoning. The questionnaire consisted of three sections. The first section was termed the “Personal Information Form” and consisted of 15 questions including the sociodemographic characteristics of the mother, while the second section was the “Home poisoning Evaluation Form” which was made up of 12 questions including where they obtain their information about poisoning, whether they encountered poisoning, and poisoning type house features and the third section included the “House Poisoning Prevention Knowledge Level Form” which consisted of 20 questions identifying the symptoms observed in various poisoning cases and what should/should not be done as an intervention.

Analysis and Evaluation of Data

In this study, knowledge scores were calculated by evaluating each of the 20 questions, determining the level of knowledge of mothers, with each question scoring a maximum of 5 points. The lowest and the highest possible survey scores were “0” and “100”.

Appropriate statistical tests were used depending on whether dependent or independent variables were being assessed. SPSS 17 statistical software package was used for the analysis of data. The “Kolmogorov-Smirnov” and “the Shapiro-Wilk” tests did not display a normal distribution of poisoning knowledge scores. According to test assumptions, for comparison of more than two groups measurements, Kruskal-Wallis H test, for comparison of two different groups of measurements, Mann-Whitney U test and for determination of level and direction of the relationship, Pearson Product Moment Correlation Coefficient Analysis were used; the significance level was determined as 0.05.

Results

Participants were between 16 and 50 years old and the mean age was 33.09±7.10 years. The number of children was between 1 and 6 persons, and 203 individuals had children under age of 7 years (Table 1).

Table 1.

Socio-demographic characteristics and knowledge score distribution

	N	%	X2	SD	P*
Age of mother
16–24 years	31	10.7	0.270	3	0.966
25–33	127	43.8
34–42 years	90	31.0
43 years and older	42	14.5
Mother education level	N	%	X2	SD	P*
Illiterate	8	2.8	46.773	5	0.000
Literate	4	1.4
Primary school graduate	109	37.6
Secondary school graduate	43	14.8
High school graduate	63	21.7
University graduate and higher	63	21.7
Mother profession	N	%	X2	SD	P*
Housewife	216	74.5	35.865	4	0.000
Civil servant	56	19.3
Employee	13	4.5
Self employed	3	1.0
2Farmer	2	0.7
Family type	N	%	X2	SD	P*
Core family	253	87.2	4.142	2	0.126
Large family	29	10.0
Separated family	8	2.8
Number of children	N	%	X2	SD	P*
1 child	84	29.0	6.769	3	0.080
2 children	111	38.3
3 children	77	26.5
4 children and more	18	6.2
Social Insurance	N	%	Mann-Whitney U	Z	P**
Have	281	96.9	947.500	−1.288	0.198
Do not have	9	3.1
Total	290	100.0

^*Kruskal-Wallis H test was used;

^**Mann-Whitney U test was used.

37.6% of mothers were primary school graduate, 74.5% of them were housewives and 19.3% were civil servants. Incomes of 39.9% of the participants were found to be between 1,000 and 1,999 TL (Table 1).

Based on the correlation analysis results of “Age-Poisoning Knowledge Score” and “Number of Children-Poisoning Knowledge Score” of mothers participating in the study; the relationship between poisoning knowledge scores and the age of the mothers was not statistically significant (r=-0.023, p=0.698). According to the number of children, a relationship in a negative direction was significant at the 0.05 error level (p<0.05) (r=-0.125, p=0.035).

50.5% of the mothers reported that they had received information on intoxication via television or internet. 34.3% of 35 individuals who indicated childhood poisoning had occurred during the last year stated that the event occurred by stove/heater, 25.7% by chemicals, 17.1% by medication; based on time 48.6% occurred in the morning, 34.3% in the afternoon; based on place, 34.3% occurred in the hall and 25.7% in the kitchen (Table 2).

Table 2.

Mothers' features related to poisoning stories

Poisoning information source	N*	%
TV / internet	146	50.5
Newspaper, magazine, book	61	21.1
Family elders	31	10.7
Health care staff	27	9.4
Other	24	8.3
Total	289	100.0
Home poisoning cases during last one year	N**	%
Stove / heater poisoning	12	34.3
Chemicals	9	25.7
Medication poisoning	6	17.1
Fungus	3	8.6
Corrosive substance	2	5.7
Food	2	5.7
Other	1	2.9
Time of home poisoning	N**	%
Noon	17	48.6
Morning	12	34.3
Night	3	8.5
Evening	2	5.7
Afternoon	1	2.9
Place of home poisoning	N**	%
Hall	12	34.3
Kitchen	9	25.7
Bedroom	5	14.3
Living room	4	11.4
Bathroom	4	11.4
Balcony	1	2.9
Total	35	100.0

^*More than one answer was given;

^**Number of poisoning occurred in the last year was considered.

As shown in Table 3, it was determined that in 7 out of 35 house poisonings no type of intervention was performed and in 22 cases an intervention was performed; 6 people did not answer this question. It was found than in 48% and in 38% of poisonings at home, first intervention was performed by the father and mother, respectively. It was defined that 40% of poisonings were brought to the hospital and that in 93.1% of poisonings, precautions after the accidents were taken. 96.8% of poisonings resulted with full recovery, with a death of one child (Table 3).

Table 3.

Conditions of mothers' intervention during poisoning cases of the past year

First aid / Intervention performed	N**	%	Mann-Whitney U	Z	P*
Yes	22	75.9	72.500	−.231	0.823
No	7	24.1
Total	29	100.0
The person who performed first intervention	N***	%	X2	SD	P*
Father	14	48.0	5.401	5	0.369
Mother	11	38.0
Older brother	1	3.5
Aunt	1	3.5
Caregivers	1	3.5
Grandmother	1	3.5
Total	29	100.0
Status of applying to hospital after being poisoned	N**	%	Mann-Whitney U	Z	P*
Yes	12	40.0	92.000	−.683	0.495
No	18	60.0
Total	30	100.0
Condition of taking precautions after poisoning	N**	%	Mann-Whitney U	Z	P*
Yes	27	93.1	25.500	−0.130	0.896
No	2	6.9
Total	29	100.0
The result of poisoning	N**	%
Full recovery	30	96.8
Death	1	3.2
Total	31	100.0

^*Mann-Whitney U test was used;

^**Incomplete answer was given;

^***More than one answer was given.

64% of mothers have water heaters in the bathroom, and 85.2% and 89% have sufficient bathroom ventilation and lighting, respectively. It was found that 61.1% of mothers had to clean the building chimney every year. 89.8% of mothers reported that they do not put materials such as pesticides or detergents into food containers, and 67.9% do not keep chemical substances such as pesticides and bleach. The percentages of mothers who keep drugs in their own containers, in the refrigerator and in the bathroom are 89.8%, 5.6% and 46% respectively (Table 4).

Table 4.

Features related to the precautions taken by mothers against poisoning

Presence of water heater in the bathroom	N*	%
Yes	181	64.0
No	102	36.0
Total	283	100.0
Sufficiency of the bathroom ventilation	N*	%
Yes	241	85.2
No	42	14.8
Total	283	100.0
Sufficiency of bathroom enlightenment	N*	%
Yes	252	89.0
No	31	11.0
Total	283	100.0
Building chimney cleanliness condition	N*	%
Yes	173	61.1
No	110	38.9
Total	283	100.0
Presence of automatic switches of the stove	N*	%
Yes	143	50.5
No	140	49.5
Total	283	100.0
Switching off tube/gas appliances from the gas valve after usage	N*	%
Yes	189	66.8
No	94	33.2
Total	283	100.0
Placing materials such as pesticide and the detergent in food containers	N*	%
Yes	29	10.2
No	254	89.8
Total	283	100.0
Keeping chemicals such as bleach, pesticides in the kitchen	N*	%
Yes	90	32.1
No	190	67.9
Total	280	100.0
Placing drugs into other containers than their own containers	N*	%
Yes	29	10.2
No	254	89.8
Total	283	100.0
Drugs storage places	N*	%
Refrigerator	152	52.6
Bathroom	133	46.0
Over the loom	3	1.0
Beneath the loom	1	0.4
Total	289	100.0
Place of buying mushrooms	N*	%
Bazaar	144	50.2
Shop	143	49.8
Total	287	100.0

^*Incomplete answer was given.

The poisoning knowledge score of the participants ranged from 5 to 65 points and the mean knowledge score was 43.34±14.84. It was found that 83.1% of the mothers gave correct answers to first aid during drug poisoning questions, 80% to non-poisoning symptom questions and 71.7% to general poisoning symptom questions. It was detected that at most, first aid to gas poisoning question (87.6%), and actions that should not be done during water heater poisoning question (84.1%) were answered wrong; in addition, the poison control center number was not known by mothers (12.1%) (Table 5)

Table 5.

Poisoning knowledge questions (n=290)^*

Questions	False		Correct		Do not know
	n	%	n	%	n	%
When you notice that your child taken medicine which of the following applications would you apply?	241	83.1	40	13.8	9	3.1
In which of the following situations you would not think that your child is poisoned?	232	80.0	47	16.7	11	3.8
Which of the following is not a symptom of the common symptoms of poisoning?	208	71.7	75	25.9	7	2.4
In which of the following situations certainly child should not be induced to vomiting?	204	70.3	74	25.6	12	4.1
Which is the wrong first aid application for unknown reasoned digestive tract poisoning?	197	67.9	80	27.6	13	4.5
What should be the first attempt to apply to a child who had drunken petroleum products?	193	66.6	84	28.9	13	4.5
What is the phone number of national poison control center?	187	64.5	68	23.4	35	12.1
What should be the first attempt to apply to a child who had taken pesticides?	185	63.8	97	33.4	8	2.8
What should be the first attempt to apply to a child who had drunken bleach?	184	63.4	102	35.2	4	1.4
Performing of which of the followings is false for poisoning through skin?	180	62.1	99	34.1	11	3.8
Imagine that you entered environment poisoned with gas which you would use to protect yourself while intervention?	179	61.7	95	32.8	16	5.5
What symptoms you would not wait to be observed primarily in a child who is conscious and know that he had eaten rotten food?	178	61.4	101	34.8	11	3.8
Which of the following information is wrong about prevention of water heater poisoning?	174	60.0	108	37.2	8	2.8
Which of the following is the correct information about the mushroom consumption?	172	59.3	92	31.7	26	9.0
In which of the following poisoning routes feeding yogurt to the child is sufficient for the first aid?	161	55.5	118	40.7	11	3.8
Which of the following provided information is the correct about mushrooms?	130	44.8	138	47.6	22	7.6
In poisoning occurred by inhalation in what position patient should be kept?	128	44.1	147	50.7	15	5.2
Which of the following are symptoms for stove poisoning?	64	22.1	214	73.8	12	4.1
Which of the following should not be performed in water heater poisoning?	29	10.0	244	84.1	17	5.9
Which of the following first aid applications should be performed to respiratory poisonings caused by gas?	27	9.3	254	87.6	9	3.1

^*Line percentage was taken.

Discussion

Advancement of technology and improvement of socioeconomic status has led to more industrial and petroleum products, drugs and bleaches in homes. The negligence of families and those who are involved in child care, ignorance about poisoning, packaging of produced drugs in attractive colors, launch of pesticides for cheapest price to the market, uninformed use of drugs, nonprescription sale of some drugs and leaving them within reach of children lead to increase in poisonings.^[27]

Our study is one of the few studies measuring the level of knowledge about the poisoning of mothers living in a town. In our study, 37.6% of the mothers were primary school graduates and an increase of poisoning knowledge scores during increase of mothers’ education level was observed (p<0.05). In the study of Coşl;kun et al about first aid knowledge level of mothers who have children aged 0-14 years, in a similar manner first aid knowledge level increases with mothers’ education level.^[15] Uskun and colleagues, in a study performed on 180 women in Aksaray, reported an increase of first aid knowledge with increased level of education. Increasing knowledge of first aid in the community and for eliminating need of training on this issue may benefit more from formal education institutions.^[23]

In our study, when we examine the socio-demographic characteristics, 74.5% of the mothers were housewives and 19.3% were civil servants. Mothers who are civil servants and who have a higher income level have greater knowledge scores; in addition, it was determined that poisoning knowledge scores changed according to the mother's profession status (p=0.000, <0.05). Similar to our study, Uskun and his friends reported that women with good economic status and a higher education level have higher level of knowledge about first aid.^[23]

In our study, a negative correlation between number of children and poisoning knowledge scores occurred (r=-0.125, p=0.035) and this correlation appeared to be significant (p<0.05). Coşl;kun and his friends in their work in Eldivan found that in a similar way average knowledge decreased with increase in children number.^[15] It was considered that a decrease in knowledge scores may be due to a possible decrease of child care caused by increased number of children.

In our study, 48.6% of the 35 people indicating intoxication indicated morning and 34.3% indicated afternoon poisonings. This may be due to housewives being busy with household chores and are unable to deal with children in the morning. Akçay and friends in their study in Denizli reported that poisonings mostly occurred in the afternoon (48.5%) and in the evening (28.4%); Yılmaz et al toxicity study conducted in the Çukurova region reported that poisoning cases occur between 09:00 and 12:00 hours (24.9%).10, 30

In the home environment there are many factors (bleach, drain openers, stove, drugs, etc.), that can easily cause poisoning in children. These substances are sold exposed and unbranded, which can be stored in water or other beverage bottles in the kitchen are within easy reach of children.5, 6, 7

In a study conducted in the past year, it was found that in 35 poisoned children, 34.3% were due to stove/heater, 25.7% were from chemicals and 17.1% were poisoned by a drug. Of poisoning cases admitted to the Child Emergency Department of İzmir Training and Research Hospital mostly medical drugs (50.6%), effective corrosive ingestion (20%) and carbon monoxide poisonings (16.6%) were found.^[31] Polat et al (2005) in his study that examined the causes of poisonings observed that food poisonings (50%) occurred most frequently, followed by drugs (33.4%) and chemical poisonings (16.6%).^[17] In a study investigating poisoning cases admitted to Trakya University Medical Faculty it was identified that in 221 cases, toxic substances were taken orally, four cases occurred by inhalation and two cases through the skin; based on complications, there were four cases with liver failure, four cases with disseminated intravascular coagulation complication (DIC), two cases with status epilepticus and two cases with renal failure (0.9%).^[11] Epidemiological studies conducted in different regions of our country and at different time intervals support our research findings.5, 6, 7, 8, 10, 15, 31, 32, 33

While mortality rates in poisoning cases vary according to region; these rates had decreased compared to previous years. In our country, the mortality rate was reported as 0.5% by Çıtak and colleagues (2002), as 0.6% by Akbay-Öntürk and Uçar and as 5.5% by Ertekin et al (2001).6, 40, 41 In our study, number of children died as a result of poisonings occurred during past year is one. The rate of mortality we obtained in our study is lower than in other regions of our country, which is pleasing. However, significant improvement is made in the treatment of poisonings, taking preventive measures is more valid method for solving this problem.

Family education about poisonings, production of childproof box and covers, sticking warning labels and increasing the number of educated individuals, will significantly decrease the number of poisoning. This will lead to a significant decrease of morbidity and mortality rates.

50.5% of the mothers get information about poisoning via TV/internet. Coşl;kun et al (2008), in his study stated that mothers mostly get knowledge on first aid from television (37.6%) and books, newspapers, magazines (18.2%).^[15] In a study performed by Örsal et al (2011), it was reported that the main resources of information on first aid used by women in home accidents was television and internet (40.4%).^[34] This result lead us to think that the number of television programs giving basic information about first aid during encountered home accidents and poisonings should be increased.

In poisoning cases, getting help form “poison information center” or by calling “112” for application of early and appropriate interventions is an important factor in reducing risks of mortality and morbidity. In a study of Coşl;kun et al (2008), it was found that 47.5% of the mothers know the Hızır Emergency phone number.^[15] A study by Örsal et al (2011) determined that almost all the women (98.8%) knew the phone number of the emergency ambulance service as “112”.^[34] In our study, only 64.5% of mothers knew the number of the poison control center; this may be due to educational level of mothers who participated in the study.

Poisoning is an important public health problem which makes a significant part of the emergency department, requires a serious approach and when early intervention is performed, it responds well to a treatment.^[18] Due to frequent accidents among children, it is important for the child's health that caregivers know what to do in cases of poisoning. In our study, poisoning knowledge score of the mothers ranged from 5 to 65 points and the mean knowledge score was 43.34±14.84. In a study conducted in Ankara - Gölbasi, mothers were found to have insufficient knowledge of first aid to children during possible home poisoning.^[35] In a study of Örsal et al (2011) in Eskisehir, women received scores regarding first aid in home accidents that ranged from 10 to 36, with an average score of 24.4±3.6.^[34] In research by Turan et al (2010) performed in Denizli within the scope of “0-6 years Prevention Group of Children Home Accidents” project, as the result of studies performed on home accidents and first aid, providing training leads to an increase in the level of knowledge of housewives and results showed a positive behavior change.^[36] As a result of our study, it has been suggested that healthcare institutions and organizations in their own region should perform protective measures and training on topics such as possible home poisonings, poisonings requiring immediate intervention, and accidents. We should remember that the future of our children is closely related to unintentional injuries during childhood.

Limitations

Limitations of this study included not being a multicenter study, including only mothers who applied to the Family Health Centers, and the collection of information based solely on the statement of mothers. Also, trying to reach to mothers with children under age of seven years during permitted dates, led to difficulties in reaching a sufficient sample group. In order to take the epidemiological generalization of mothers’ level of knowledge about poisoning further, studies with a larger sample group should be performed.

Conclusion

In conclusion, our study determined that mothers’ knowledge regarding poisoning is insufficient. Informative courses about poisoning for mothers should be planned and in the future, more correct use of visual media should be shown. Nurses who have a significant role in the development and protection of a child's health should educate families about the proper storage of substances that can cause poisoning and about applications which should be performed during material ingestion.

Conflict of Interest

The authors declare that there is no potential conflicts of interest.