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Poisoning
Community-based Education Programs
Background
Community-based educational interventions
strive for the same goals, but may involve a broader participation among the community
in their implementation. Outcomes can be in the form of poisonings from national
databases, calls to local poison control centers, changes in the number of "at-risk"
areas at home, or some combination of these items.
Review of community-based education studies:
Authors | Johnston, 2000 |
Study design and target population | Controlled study.
Preschool children. |
Intervention | Home visits by nurses as part of Head
Start Program.
Provided syrup of Ipecac and instructions for use, information about
removal of poisons. |
Outcomes | Repeat home visit 3 months later. |
Results | Intervention families were 2.2 fold
(95% CI 1.3, 3.2) more likely to remove poisonous substances form their homes
than control families. Intervention families were 4.7 fold (95% CI 3.0, 7.3)
more likely to report presence of ipecac in the home. |
Study quality and conclusions | Not an RCT. |
Authors | Bablouzian, 1997 |
Study design and target population | One group pre-test, post-test design.
Boston, low income families (n=72), identified at prenatal
care. |
Intervention | Home visits by nurses. |
Outcomes | Matched pairs analysis, n=72. |
Results | There was a 32% increase in the number of households that had
the phone number of poison center sticker on the phone and a 40% increase in
the number of homes with Ipecac. |
Study quality and conclusions | Weak study design.
No data on the effect on poisoning
incidents. |
Authors | Rey et al., 1993 |
Study design and target population | Non-equivalent control group design.
Children between 0 and 15 in the town
of Chambˇry from Oct 1988, to March 1989. |
Intervention | Community-based health education against childhood
accidents.
Questionnaire mailed to parents before and after intervention. |
Outcomes | Main comparison was change in number of calls made
to anti-poison centers between intervention and comparison towns (Annecy and
Haute-Savoie, respectively). |
Results | Tendency toward a decrease in number of calls made
to anti-poison centers among intervention families compared to control families
during study period (p=0.03).
Downward trend also seen among intervention families
in frequency of home accidents. |
Study quality and conclusions | Overall impact of intervention is small at best; no
follow-up data collected to check for decay of intervention’s effect.
Study covered wide range of ages among towns’
children; effect of intervention on children less than 5 not analyzed separately.
Study written in French. |
Authors | Cooper et al., 1988 |
Study design and target population | Non-equivalent control group design.
Families of normal infants born at
Women and Infants’ Hospital of Rhode Island between March 1985 and December
1985 (n=5264 intervention families) and all other newborns born at other Rhode
Island hopsitals during same period (n=4484 control families). |
Intervention | Nine-month educational campaign that included (for
intervention families) free, 1-ounce bottle of syrup of ipecac, with verbal
and written instructions to be followed in the event of a poisoning.
Control families received no such program. |
Outcomes | All calls between March 1986 through June 1986 made
to Rhode Island Poison Center that involved children between 3 and 16 months
of age.
Interviewer-administered questionnaire given
to 92% of callers. |
Results | No significant difference between intervention families
(n=6) and control families (n=2) in calls made to poison control center.
Significant difference in mean time (+
SD) between posioning and call for intervention families (5 + 3 minutes)
and control families (12 + 4 minutes), p < 0.01. |
Study quality and conclusions | Educational campaign and distribution of syrup of ipecac
appear to be somewhat effective in improving response time of calls to poison
center.
Difficult to ascertain clinical importance
of response time if intervention families were encouraged to report exposures
of less severity than control families.
Neither total population nor number
of calls for all ages changed during study, thus removing possibility of confounding
by these factors. |
Authors | Harris et al., 1979 |
Study design and target population | Before and after design.
Children under 15 treated for poisoning at
East Birmingham Hospital |
Intervention | 3-week educational campaign designed to collect unused
medicines. |
Outcomes | Incidence of accidental poisoning before and after
campaign. |
Results | No significant change between number of poisonings
before campaign (average of 12 per week) and after campaign (average of 10.5
per week). |
Study quality and conclusions | Ability of data presented to determine efficacy of
intervention poor.
Yield of medicines returned considered low
(11,400 containers from a population of 1.05 million).
Campaign had no immediate effect on
childhood poisoning incidence. |
Authors | O’Connor, 1982 |
Study design and target population | Before and after design.
Children 0-14 years admitted to Adelaide Children’s
Hospital with accidental poisoning March 1977 to March 1978 (n=267). |
Intervention | Poisoning Prevention Week (PPW), held in September
1977, including radio and television coverage, statewide promotion of syrup
of ipecac, and poster contests. |
Outcomes | Poisonings requiring admission to hospital before and
after intervention. |
Results | No significant difference between number of poisonings
before intervention and after intervention. This trend held for all age groups
(0-2 yrs, 2-3, 3-5, and 5-14). |
Study quality and conclusions | No effect of intervention on poisonings.
Data for less than half (48%) of poisonings admitted
during study period were collected. |
Summary of community-based education studies
There has been one randomized controlled
study examining the effect of community-based campaigns, although it showed a significant
effect only in the use of telephone stickers and cabinet locks (and not in increasing
the household prevalence of syrup of ipecac). Also, its results were drawn from
families who were aware of and used (and owned a telephone) poison control centers.
As such, its results may not be applicable to lower-income families. The remaining
studies did not show any effect of the intervention on poisonings. However, these
studies had some serious flaws in their designs.
Recommendations on community-based education programs
Although the studies reviewed to date indicate
that there may be some benefit to community-based campaigns, the data do not warrant
a recommendation for their use.
Recommendations for future research
There is a need for a rigorous
randomized controlled trial assessing the effectiveness of a narrowly-focused educational
campaign. Such a study might be modeled after the Seattle bicycle helmet education
campaign by Rivara and colleagues (see section on bicycle injuries), informing families of ways to reduce the risk of
childhood poisoning such as utilizing cabinet locks, ensuring proper closure of
child-resistant caps, and knowing what to do in the event of an emergency. The outcomes
of interest would be emergency room visits and hospital admissions for poisoning
(and depending on the area, calls to poison control centers). Such a campaign could
be repeated at regular intervals and should be tailored toward (older) children
and adults.
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