http://doi.org/10.33698/NRF0059  Rajinder K, Indarjit Walia, Baljit Kaur

 

Abstract : An operational study was carried out at village Dhanas, UT Chandigarh to describe the maintenance of first aid box by families of a rural community. Prior to data collection a door to door survey was done to enlist all the houses. Systematic Random Sampling technique was adopted for the study and 25% (93) families were selected randomly out of total 375 families of village Dhanas. The selected families were studied for socio demographic variables, available articles related to first aid box, prevalence of health problems and also the preparation, utilization and maintenance of first aid box. A total of 39 chronic health problems were identified among study families. The most common of these were hypertension and diabetes. Analgesic drugs were found to be with 43.01 % of total study families. The next most common drug found was antipyretic. Also, 21.50% of study families kept the expired drugs. Out of the total 93 study families, 58 prepared the first aid box. About 93.11 % families during first follow up and 96.55% families during second follow up used the prepared first aid box. The first aid box was used mainly for finger cuts and common cough and cold. Neighbors of some of the study families contacted the researcher to seek her help in preparing first aid box for them also, which shows that people did find the first aid box as useful.

Key words :

First aid, First aid box, Operationalisation, System, Rural families.

Correspondence at : Rajinder Kaur

National Institute of Nursing Education, PGIMER, Chandigarh -160012, India.

Introduction

Methods of First Aid have been practiced perhaps ever since the human desired to help another human in sickness or after injury. But an organized world wide effort at giving First Aid came only in the year 1877 with the formation of S1. John Ambulance Association of England. As knowledge has grown, methods of First Aid have changed and now there is universal understanding on giving first aid to people suffering from various kinds of injuries or ailments1. It has been observed that most of the time people experience minor ailments and injuries at odd hours. At that time they would feel helpless and rush to the hospital. So learning First Aid is the civic responsibility of each citizen. Obviously, the implement to give First Aid is to be simple and available almost everywhere without notice. This also requires of the first aide’s lot of innovations and versatility to use the resources available to him/her. The first aide must not mistake and over play his/her duty of doing what is not in her/his domain?2

Since the main aim of first aid box is to provide the basic articles for giving first aid in an uncomplicated, accessible manner for saving the life of individual. There are different types of first aid box according to the place. For example, first aid box in family, industries, ambulance, schools, hospitals and offices. According to size, there are three types of first aid boxes- small, medium and large. Small and medium sized first aid boxes are kept in houses, schools, vehicles and large sized ones are kept in hospitals, industries etc.3

Obviously there will be a professional or experienced persons giving first aid in schools, hospitals and industries, but when it is a home, there may not be a member who is capable enough of handling a minor injury or ailment with the sophisticated equipments. But since ages, literally everyone knows something about a certain injury or ailment, which they might have learnt by virtue of an earlier similar situation or by observing others or even by listening to others’ experiences. Thus, when talking of preparing a first aid box in the family, people need a simple first aid box, containing readily available things at home. These things/articles, though available at home, may be lying at different places, which in case of emergency are inaccessible, so as to use them immediately. Some of the precautions to be taken for maintaining a first aid box within the family are:

  • First aid box should be arranged according to the need of the
  • As far as possible, the articles of the first aid box should be simple and basic so that they can be used by everyone in the family at the time of dire
  • The first aid box should be kept away from the reach of
  • First aid box should always be kept at one place in the house for easy recognition and
  • All the used articles should be replaced as soon as
  • Keep a list of all the articles in the first aid box

A Study on evaluation of the Coca Cola Company’s travel health kit in Atlanta, revealed that the most useful items were analgesics and medications used for gastrointestinal problems. Suggestions of items to be added to the kit included vitamins, cough drops, sleep aids and eye drops. Evaluation of the travel health kit revealed it to be very useful to most corporate travellers.5

A study done in Paris (France) revealed that free delivery of prevention kit and simple counseling allow often deprived families to modify their behaviour and to arrange their apartments so as to reduce risks.6

Another study conducted at resettled slum colony in Chandigarh revealed that 66.8% of children of the age group of 0-5 years had minor injuries during the specified period. The maximum prevalence was noted in age group of 4-5 years. Prevalence of minor injury was the highest among children of illiterate mothers as compared to those of the literate ones. Almost 73% children from nuclear families had minor injuries as compared to the children living in joint families among whom this percentage was 60.7

It has been observed by the investigator while working in the community that rural people in the community are not customized and habitual to maintain and utilize the first aid box at the time of minor ailment or injuries. The present study facilitated the operationalizing and evaluating the maintenance of first aid box among study families.

Objective

Main objective of the study was to promote the maintenance of first aid box among the families of a rural community.

Materials and Methods

Union territory, Chandigarh has 24 villages in it. Dhanas is one of these villages and is situated at a distance of about 6 km to the eastern side of Chandigarh. Dhanas comprises of village Dhanas, Aman Colony, Chaman Colony, Ambedkar Colony and Milk Colony. Out of the Dhanas, village Dhanas was chosen for the study as it is adopted by National Institute of Nursing Education for providing clinical experience for the students during their posting in Community Health Nursing and thus it was convenient for the investigator. Dhanas has modern basic amenities and facilities, like tap water supply, electricity, a market, a government primary and senior secondary school and few private schools, a police station, a post office and a bank, nine Angadwaris and one Balwari.

The study was focused on all the 375 households of village Dhanas. Total population of village was 4500. Prior to data collection a door to door survey was done to enlist all the houses. Systematic Random Sampling method was adopted for the study. First house was selected by lottery method out of first four houses and thereafter every 4th house(i.e. 1+4= 5th, 5+4=9th, 9+4=11th and so on) was taken as study subject. In case there were two or more families residing in one house, the lottery method was used for the selection of the family. In case of locked house for three consecutive visits, the next family was taken as study subject. For consideration of the time and resources, it was decided to keep the sample size to 93 families which were to be selected randomly out of total families of village Dhanas.

The subjects were motivated and encouraged regarding preparing, utilizing and maintaining the first aid box within the family. The subjects were made aware of the benefits of keeping first aid box in the homes. With this, their consent was also confirmed for their involvement in the study as they were told about the expenditures to be incurred by them during the study. When they agreed to get involved in the study, firstly, the articles already available with the families were listed. Secondly, the list of the remaining articles was given to the respondents to prepare their first aid boxes. The material used for the first aid box was according to their choice and available resources. Thirdly, next meeting was fixed up with the respondents. Follow up visits were made till the first aid box was prepared. When they brought all the articles, researcher helped and guided them in the preparation of first aid box. After the preparation of the first aid box, the use of its articles was explained to the respondents and return demonstration was taken to ensure their confidence in using the first aid box. Instructions about the maintenance of the First Aid Box were given to the family. After making assurance about the competence of the subject of using the first aid articles, two visits, after 15 days and 30 days respectively, were fixed up with the subject to assess the use and maintenance of the first aid box.

Results

SOCIO DEMOGRAPHIC CHARACTERISTICS OF STUDY FAMILIES

Table 1 describes the characteristics of the study families. The study revealed that 54.8% of the families were nuclear, while the rest 45.2 percent of them were joint families. All 45.2% joint families were native inhabitant families of the village, while almost all the nuclear families were in-migrant population from various states across the country.

Most of the study families followed Hindu or Sikh religion with Hindus 48.4% and Sikhs 49.5%. No need to say that other religions were negligible with only one Muslim and one Christian family each. About 35% of the respondents reported that the per capita income of their families was less than Rs. 500 per month. Rs. 500 – 1000 per capita income category accounted for more than 41 % of the total families studied, whereas 6.45% families had a monthly per capita income of more than Rs. 2000.

Table 1 : Socio Demographic Characteristics of Study Families                              N =93

 

Characteristics f (%)
Type of family
Nuclear 51 (54.80)
Joint 42(45.80)
Religion
Sikh 46(49.48)
Hindu 45(48.38)
Muslim 1 ( 1 .07)
Christian 1( 1.07)
Per capita Income
250 14 (15.05)
250 – 500 19 (20.43) Mean = 903.58
500 – 750 14 (15.05) S.D. ± 791.414
750 -1000 25 (26.88) Range= 250 – 5000
1 000 – 1250 5 ( 5.38)
1250 – 1500 4 ( 4.30)
1500 – 1750 3 ( 3.23)
1750 – 2000 3 ( 3.23)
2000 6 ( 6.45)

Table 2 : Drugs and Articles Available in the Families Prior to the Study                N=93

 

Tablets f(%)
Analgesics 40 (43.01)
Antipyretics 16 (17.20)
Anti hypertensive Suppliments Antibiotics 14 (15.05)
Anti diabetic 13 (13.98)
Anti allergic 8 (8.60)
Antacids 6 (4.45)
Antiepileptic 6 (4.45)
Anti asthmatics 6 (4.45)
Syrups
Cough Paracetamol Phenergan Nimuslide 14 (15.05)
Anti fungal 6 (4.45)
Antiseptic 4 (4.30)
Acne 3 (3.23)

Without Label Drugs Solution Antiseptic

Dettol                                                                                3 (3.23)

Drops

Spasmic Drops                                                                 2 (2.15)

Eye Drops                                                                         2 (2.15)

Nasal Drops                                                                      2 (2.16)

Emergency Articles

Thermometer                                                                     6 (4.45)

Roller Bandage                                                                   1 (1.08)

Band Aid                                                                         1 (1.08)

Adhesive Plaster                                                                 1 (1.08)

Inhaler                                                                             1 (1.08)

ORS                                                                                 1 (1.08)

Expired Drugs                                                                      20 (21.50)

*some families had multiple drugs

PREPARATION OF FIRST AID BOX

Figure 3 identifies that out of a total of 93 families; only 58 prepared the first aid box. Remaining 35 did not prepare it. The families who did not agree to prepare the first aid box gave various reasons for not doing so. About 43% expressed that their husband did not agree with the idea of having first aid box at home, 17.14% of them regarded it as wastage of time, and 20% of them expressed their helplessness of not having required money for the purpose while 2.86% stated to live in proximity of a doctor or medical shop. Lack of awareness and a little orthodox thinking also got revealed during the study where 8.56% denied having first aid box on the ground that if they keep medicines in house they would surely be attacked by disease and evil. And therefore for them first aid box was a sign of bad omen to keep in house. About 2.86% of those who denied did not believe in allopathic medicines and they preferred to go to Ayurvedic Vaid. In one of the families, lack of confidence of the respondent in using medicines and first aid was the reason to deny as she had an experience of giving first aid to her son which caused her son to be seriously injured during the process. This family therefore expressed that it was not confident about its being competent in giving any type of medication and first aid to the family members.

TIME TAKEN FOR PREPARING FIRST AID BOX

The study families needed continuous motivation to prepare first aid box. About 20.69% of the families took 1- 5 days to prepare the first aid box and 36.20% of them took 6 – 10 days for it, where as, 22.43% families prepared their First Aid Box during 11 – 15 days. About 13.79% of them took 16- 20 days to prepare it. While 6.89% families took extremely long time, that is almost about a month to prepare their First Aid Box. (Table 3)

Table 3 : Number of days taken by the families to prepare first aid box       n1 = 58 No. of days                                                                           f (%)

1- 5 12 (20.69)
6 – 10 21 (36.20)
11 – 15 13 (22.43) Range= 3 – 24
16 – 20 8 (13.79) Mean = 13.50
21 and above 4 ( 6.89)

UTILIZATION OF THE FIRST AID BOX

Figure 5 shows the use of first aid box by the respondents during two subsequent follow up visits. Almost all those who prepared the first aid box had used it. It was observed during the first follow up that 93.11 % families used their first aid box, while 6.89% of them did not use it as they had no need to do so. During second follow up it was found that 96.55% families used the prepared first aid box while only 3.45% of them did not.

VIEWS ABOUT USE OF FIRST AID BOX AS GIVEN BY SUBJECTS

Table 4 describes various positive responses regarding utilization of first aid box. Almost all the subjects (96.55%) accepted that the first aid box was easy to use and easy to locate. It was very useful in treating children’s injuries was regarded by 46.55% of the respondents. About 39.66% respondents said that the first aid box saved their time as going to a doctor requires much time than treating minor injuries or ailments at home. The first aid box was helpful in managing injuries at odd hours. This was reported by 18.97% respondents. Some respondents (17.24%) also reported that using first aid box gave them confidence in using medicines. About 10.34% respondents said that keeping first aid box gave them oppor tunity to help others especially neighbours at the time of injuries or ailments. While that it would cost less, useful while travelling and helpful when there was no money at home was also reported by some respondents.

 

 

Table 4 : Views about use of first aid box as given by subjects n1 = 58
Responses f(%)
Easy to use 56 (96.55)
Easy to locate 56 (96.55)
Useful in treating children injuries 27 (46.55)
Saves time 23 (39.66)
Managing injuries at odd hours 11 (18.97)
Gives self confidence 10 (17.24)
Opportunity to serve neighbours 6 (10.34)
Less cost 3 ( 5.17)
Useful while travelling 3 ( 5.17)
Helpful when there is no money 1( 1.72)

USE OF FIRST AID BOX FOR DIFFERENT INJURIES AND AILMENTS

Table 5 shows the use of first aid box for various injuries and ailments. Finger cut was recorded to be the most frequent. About (43.75%) of the children got their finger cut during sharpening of a pencil or while playing with blades or sharp edged things. Foot, forehead and hand injuries accounted for 15% and 12.5% respectively. There were arm and leg injuries among 5% each. Knee injury was recorded with 3.75% of the family members.About 1.25% each of the total 80 injuries wire of ankle and shoulder injuries. In case of these injuries families used various first aid articles like bandage, band aids, dettol, adhesive plaster, scissors, betadine and burnol ointments etc. All those who used the first aid box found it very useful. According to them it was a great help especially during the odd hours and for managing the minor injuries of children or some adults. Common cough and cold was the most frequent illness among the study families. It was recorded that 67.57% of the total ill persons suffered from cough and cold. Most of these were children. Respondents expressed the usefulness of first aid box in this case as they found the tincture benzoine (medicine kept in first aid box) very effective as a cure. Also study families could use the thermometer for reading the body temperature during fever. This reduced the panic caused among families during any fever as they could now measure its severity. About 5.41 % cases suffering from diarrhoea used the ORS packets which they were advised to keep in their first aid boxes during the operationalization of the study.

Table 5 : Use of first aid box for different Injuries and Ailments.                          n1 = 58 Injuries                                                                 F(%)                            Articles uses

Finger                                            35 (43.75)

Foot                                              12 (15.00)

Forehead                                         10 (12.50)

Hand                                             10 (12.50)

Arm                                                4 ( 5.00)

legs                                                4 ( 5.00)

Knee                                                3 ( 3.75)

Ankle                                               1 ( 1.25)

Shoulder                                           1 ( 1.25)

Ailments

Fever                                              10 (27.03)

Cough & Cold                                    25 (67.57)

Diarrhoea                                           2 ( 5.40)

Discussion

The word home conjures up a place of comfort and security and most people feel safer in their own homes than anywhere else. In many cases, households do not seriously consider the matter of home safety. It is only after the accident has occurred that one hears the phrase, “I never thought…!” the tragic words when spoken after getting injury at home. There are very few days in life when people do not handle knives, scissors or other cutting implements, so cuts and lacerations are common injuries. Fortunately most of them are minor, but almost all can be treated at home for which they need a simple first aid box containing readily available things.8 Literature shows very few studies have been done on maintaining first aid box by families, but none of them had been in Indian setting. The present study was undertaken with the preview to make an assessment of available articles related to first aid box existing in the families, to help the families in preparation of first aid box and also assessment of use and maintenance of first aid box by rural families. Being an operational study, all activities were done according to Donabedian Model of quality care i.e. process, input and output.The present study was conducted in Dhanas village, UT Chandigarh among rural families. Respondents were interviewed and helped in preparation of first aid boxes. Assessment of the use and maintenance of these first aid boxes prepared by the families was made by a check list. About 53.76% of the total respondents were in the age group of 20 – 30 years. About 95.70% respondents were females because most of the time they remain at home and men go out for work and very few females were working. About one fifth of the respondents (20.43%) were illiterate and about 79.57% were literates. According to Census of India 2001, literacy rate for Dhanas is 78.9% and the literacy rate in Chandigarh is 78.73%. The socio demographic characteristics of the families of the respondents show that 54.8% families were nuclear families. About half of them (49.48%) followed Sikh religion, while 48.38% followed Hindu religion. The mean per capita monthly income of the families was Rs.903.58 though it ranged from Rs 250 to 5000. The total population of 93 study families was Children under 6 years of age were recorded 13.29% and 6 to 18 years age group was 25.88% while according to NFHS -2, these figures are 17.76% and 28.56% respectively. Adults, 18 to 60 years, were 52.19%. About 7.62% of population was over 60 years of age. According to NFHS-2 (1998-99) in India the population figures for 18-60 years and above 60 years were 49.87% and 7.6% respectively.9 The present study shows that hypertension was the most common chronic health problem as it was found in 17.20% of study families. A study done in a village in Haryana showed that prevalence of hypertension was 7/1000 of rural population. Following Hypertension was the diabetes which accounts for 8.60% of the total study families. According to WHO the prevalence of diabetes in adults was found to be 2.4% in rural and 4.0 – 11.6% in urban dwellers9. This is also to be mentioned here that all who suffered from diabetes also suffered from hypertension. Also 2.15% families were suffering with stroke. Again all the stroke cases were the cases of hypertension. A WHO collaborative study in 12 countries showed that the stroke incidence rates ranged from to 5 per thousand of population per year.9 The articles and drugs available with the study families prior to the operationalization of the present study were recorded and it was found that Analgesic drugs were found in 43.01% of total subjects families. A Study on evaluation of the Coca Cola Company travel health kit in Atlanta also revealed that the most frequent items found were analgesics.5 The next most common drug found among was antipyretic which is commonly used as a cure for fever. Anti hypertensive drugs were found to be available with 15.15% subjects. Supplements like calcium, iron etc accounted for 13.98% of the total. Antibiotic medicines were kept by 8.60%. In case of syrups especially meant for children, cough syrups and syrup paracetamol were kept by about 15% and 6.45% respectively.

While surveying it was found that people also kept the expired drugs out of ignorance. These were found in 21.50% of the total study families and included almost all kinds of medicines i.e. antibiotics, painkillers, cough syrups and Ointments. Whereas the study done on the characteristics of first-aid kits used by families in the Rekaldeberri area of the city Bilbao in Spain revealed that expired medicines were found in 52.7% of the families.10

Present study shows that only 58 families, out of a total 93, prepared the first aid box. On the other hand after the field work by the researcher was finished regarding the preparation of first aid boxes; many persons contacted the researcher for help and assistance in making their first aid box, though these included those families which were not a par t of the sample. These were the neighbors of study families and those who used the first aid box and got impressed by its utility. No study could be traced to compare the findings.

The families who did not agree to prepare the first aid box gave various reasons for not doing so. About 42.86% expressed that their husband did not agree to have a first aid box at home, 17.14% of them regarded it as wastage of time, and 8.56% of them expressed their helplessness of not having required money for the purpose. No study could be traced to compare these findings.

Various families used various containers for keeping their first aid articles. About 84.48% of the families used plastic boxes for keeping first aid articles, while about 13.17% used the card board box. The plastic containers were mostly used because of their easy availability. The main emphasis was to keep all the first aid articles at one place so that one doesn’t have to panic in the time of emergency for finding medicines. This was confirmed by every family in the follow ups.

The present study documents that study families needed continuous motivation in the preparation of first aid boxes. About 20.69% of the families took 1- 5 days to prepare the first aid box, 36.20% of them took 6 – 10 days while 22.43% families prepared their First Aid Box in 11 – 15 days. About 13.79% of them took 16 – 20 days to prepare it. While 6.89% families took extremely long time, that is almost about a month to prepare their First Aid Box. Had there been more time for the research, even more number of families could prepare first aid boxes.

All those who prepared the first aid box had also used it. It was observed during the first follow up that 93.11 % families used their first aid boxes, while 6.89% of them did not use it as they had no need to do so. During second follow up it was found that 96.55% families used the prepared first aid box while only 3.45% of them did not. Also the first aid box was used mostly for children and housewives.

The present study shows the use of first aid box by study families for various injuries and ailments. The most used articles for injuries were Bandage, Band Aids, Adhesive Plaster, Scissors, Betadine/Burnol ointment and Dettol. While for ailments, the most used articles and medicines were Thermometer, Tincture Benzoin& ORS Packet. A research done in UK on the use of medicines and first aid supplies by travellers also revealed that the items most likely to be required by travellers to developing countries are analgesics, treatments for diarrhoea, antiseptics and sticking plasters. 11

Finger cut was recorded to be the most frequent among study families and it was recorded in 43.75% families. Foot, forehead and hand injuries accounted for 15.00%, 12.50% and 12.50% respectively. Most of these injuries were found in children. Literature also shows that 82%-86% of all injuries in children are reported to occur at home 12 and a study conducted at resettled slum colony in Chandigarh revealed that maximum prevalence of minor injuries was noted in the age group of 4-5 years7. These include injuries with sharp and pointed instruments like knife, blade etc. Common cough and cold was the most frequent illness among the study families. It was recorded that 67.57% of the total families suffered from cough and cold. Most of these were children. The prevalence of cough and cold was due to the reason that the study was conducted during winters when these ailments become very prominent. Respondents expressed the usefulness of first aid box in this case as they found the tincture benzoine (medicine kept in first aid box) very effective. Study families also used the thermometer for reading the body temperature during fever. This reduced the panic caused among families during fever as they could now measure its severity. About 5.40% of the study families suffering from diarrhea used the ORS packets which they were advised to keep in their first aid boxes during the operationalization of the study. The cases of diarrhea were less in number because this is an ailment of summers whereas the study was conducted during winters .The present study describes various positive responses regarding utilization of first aid box. Almost all the subjects (96.55%) accepted that the first aid box was easy to use and easy to locate. That it was very useful in treating children’s injuries was regarded by 46.55% of the respondents. About 39.66% respondents said that the first aid box saved their time as going to a doctor requires much time than treating minor injuries or ailments at home. The first aid box was helpful in managing injuries at odd hours. This was reported by 18.97% respondents. Some respondents (17.24%) also reported that using first aid box gave them confidence in using medicines. About 10.34% respondents said that keeping first aid box gave them oppor tunity to help others especially neighbours at the time of injuries or ailments. While that it would cost less. useful while traveling and helpful when there was no money at home was also reported by some respondents.Considering the above discussion. it is concluded that the present study motivated, helped and guided the subjects for preparing the first aid box in homes. Follow up visits showed that almost all the subjects had been benefited by the first aid boxes that they had prepared themselves.

Recommendations

  • To provide continuous motivation to communities and to keep the momentum of operationalization of systems, there is a need to make more frequent visits to the
  • Similar studies should be conducted in various settings to prepare the first aid box in every
  • The primary level health professional deployed in communities should spread awareness about first aid boxes among

IMPLICATION OF THE STUDY

It is possible to help people maintain first aid boxes at their homes.

References

  1. Krapp K. First aid. [CD-ROM). Microsoft @ Encarta @ Microsoft Corporation; @ 1993-2005.
  2. John First aid to the injured. 4th ed. New Delhi: St. John Ambulance Association; 1998. p. 1-20.
  3. John, Andrew, Marsden AK. First aid 6th ed. London: Dorling Kindersley 1992. p. 1-10
  4. errence UH. First aid. [Online). August 2004; Available from: U R L: \http:// k i d s h e a l t h . o r a / p a r e n t /  firstaidsafelhomelfirstaidkit.htm13
  5. Harper LA, Bettinger J, Dismukes Kozarsky  PE.  Evaluation  of  the  coca-cola company  travel  health  kit.  [Online).  2002; Available from: URL: http://ww.ncbi.nlm.nih.aov/ entrezlauerv.fcai?db=PubMed
  6. Sznajder M, Janvrin MP, Albonico V, Bonnin MH, Baudier F, Chevallier 8. Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities. [Online]. 2003; Available from:
  7. Tiagi C, Walia I, Singh A. Prevalence of minor injuries among underfives in a Chandigarh slum. Indian Pediatrics Jouma12000; 37: 755-7.
  8. Muriel S. Emergency procedure and first aid for 2nd ed. London: Blackwell Scientific Publications; 1984. p. 222-47.
  9. Park Text book of preventive and social medicine. 18th ed. Jabalpur: Banars: Das Bhanot 2005; p. 293 – 315.
  10. Maiz I, Mandaluniz I, Gutierrez C, Mouriz C, Perez F, Arrese I. Characteristics of the family medicine  chest  in  the  Rekaldeberri-Bilbao [Online). 1995; Available from: URL:htlp:/Iwww.ncbLnlm.nih.aov/ entreziauerv.fcai?db= PubMed
  11. Goodyer L, Gibbs J. Medical supplies for travelers to developing countries. [Online). 2004; Available from: URL:http:/www.ncbLnlm.nih.aov/ entreziauerv.fcai?db=PubMed
  12. Harris MJ, Kotch JB. Unintentional infant Journal of Public Health Nurse 1994; 1 (2): 90-97