In children under the age of five, the majority of unintentional injuries occur in the home, with higher levels of injury morbidity and mortality being found among those from more deprived backgrounds. This paper presents the findings of a systematic review about the effectiveness of programmes in decreasing unintentional injury rates to children (aged up to 15 years) in the home. The effectiveness of the provision of home safety equipment with or without installation, safety education or a home risk assessment is presented by outcome: injury rates, installation of smoke alarms and installation of other home safety equipment. Analysis of the statistically significant evidence suggests that few programmes reduce injury rates in children except where home safety equipment is supplied in conjunction with a home risk assessment, although this effect was only evident in households where a child had previously suffered an unintentional injury. The distribution of smoke alarms alone is insufficient for improving installation rates; programmes containing an education component showed more success. Interventions integrated into wider health programmes, where trusting relationships with householders were cultivated and/or where specific safety issues identified by a community were responded to also showed greater success in increasing smoke alarm installation rates. The evidence of effectiveness on installation rates of other home safety equipment is highly mixed, although there is some evidence to suggest that installation rates always decrease after 6 months. Where stair gates are both supplied and installed, inequalities in rates of use may be reduced.
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