Introduction
Accident prevention among children under 5 years of age is a important concern for parents, caregivers, and health care providers [1]. Accidents can be defined as an unplanned occurrence or event. For some people, the concept of accidents is viewed as part of God’s plan. Accidents has endangered the lives of many children around the world, and is one of the main causes of death in children under 5 years of age [2, 3]. Children are prone to accidents due to the physiological limitations and special characteristics, such as tendency towards adventure seeking and risky behaviors [4], in addition to other factors such as the safety of the environment and parental monitoring and care [5]. According to the estimate of the World Health Organization (WHO), more than 6000 children die every day due to preventable accidents [6]. According to the statistics of the Forensic Organization in Iran, accidents are the second cause of death in children. Accidents in children can be seen in different forms, including poisoning, falls, electrical accidents, suffocation, burns, injuries caused by physical punishment and collisions (collision of various vehicles with each other or with pedestrians, throwing stones or other objects, etc.). According to the age of the children, a certain type of accident happens more in them [7]. >25% of injuries leading to death in children occur in low- and middle-income countries. In addition to deaths, millions of children require hospital care following some types of accidents, most of whom suffer from disabilities and long-term complications. In Iran, the infant mortality rate in 2006 reached 30 per 1000 live births and the mortality rate of children under 5 years old reached 35 per 1000 children in the same year [8]. About 10% of Iran’s population is made up of children under 5 years old. Due to the developmental and cognitive immaturity, these children do not have the ability to react quickly to the events around them and is very dependent on their parents. For this reason, parents’ behavior, attitude and prognosis regarding their children’s safety protect them from unpredictable events [8, 9]. One of the millennium development goals (MDG) of the WHO is to reduce the death of children under 5 years of age by 2028 [9].
Braga et al. examined the accidents related to children in the public hospitals of Sço Luís City in Brazil and recommended that, to reduce the accidents, preventive measures should be adopted [10]. Some preventive measures have been identified to reduce these incidents and protect children under 5 years of age from possible risks. These measures can include safety at home, safety in pediatric centers and kindergartens, use of safety equipment, and the establishment of targeted rules and regulations to improve children’s safety standards [1]. However, the lack of accurate knowledge of ways to prevent accidents in children and the belief that accidents cannot be prevented are one of the major problems of society, which can be solved to some extent by educating parents. The high global prevalence of accidents in children shows the importance of this issue and the need for parental education in this field [2, 3]. In addition, it is very necessary to identify the types of preventive measures for accidents in children under 5 years old to plan to reduce the amount of injury and death caused by accidents. The present study aims to identify these preventive interventions to reduce children’s injuries by scoping review of related studies conducted in Iran and other countries.

Materials and Methods
This is a scoping review study that was conducted in 2023. A search was first conducted in Scopus, ISI Web of Science, MEDLINE through PubMed, Embase, Proquest, Cochrane Library, Emerald, Magiran, Irandoc, MoH Thesis Database, MoH Articles Database, for studies on the interventions to prevent accidents in children under 5 years old published from 2000 to 2023 in English or Persian. The articles, theses and chapters of published books were included in the search. The studies published in other languages and those with unavailable full texts were excluded. After findings records, they were entered into EndNote software, version X9. After removing duplicates, the titles and subtracts were read and irrelevant studies were removed. Then, the full texts of studies were read and the studies related to the study objectives entered into the study.
The obtained information was analyzed using the thematic analysis method in MAXQDA software, version 20. Thematic analysis was done in six stages: Becoming familiar with the data, generating initial codes, searching for themes, reviewing themes, defining themes, and creating the report. Also, the studies were evaluated using the critical appraisal skills program (CASP) checklist for qualitative studies, which assesses the parameters such as the study method, study samples, study objectives, and data analysis methods. A score of 1-5 was assigned to each of the articles based on each of these parameters. The articles whose total scores were ≥25 were confirmed in terms of quality and the rest were deleted. In this regard, 41 studies (3 theses and 31 articles) were finally selected for the scoping review. Figure 1 shows the flowchart of the study selection process.
Results
Forty-one studies on preventive interventions against different accidents such as man-made disasters, domestic accidents, traffic accidents, burns and electrical accidents for children under five years of age with acceptable quality (moderate, good, or excellent) were reviewed in this study (Table 1).


















Most of studies were related to preventive interventions against domestic accidents (n=32). Table 2 shows the reviewed studies based on the type of accident.


Regarding the written language, 10 studies were in Persian (25%) and 31 were in English (75%). In addition, most of the studies were quasi-experimental (n=18).
We generated 807 initial codes in MAXQDA software, version 20. Considering the frequency of codes, 234 codes were produced. Also, five main themes were defined, which included interventions to prevent domestic accidents (educational, evidence-based and health belief model-based), interventions to prevent man-made disasters (collective and operational), interventions to prevent traffic accidents, interventions to prevent burns and interventions to prevent electrical accidents (Figure 2). In no study, interventions to prevent electrical accidents in children under five years old had been used separately, and less attention had been paid to this type of accidents. Of 234 codes, 45 were for man-made disasters, 157 for domestic accidents, 18 for burn and electrical accidents, and 14 for traffic accidents.

Discussion
Taking care of preschool-age children can be challenging for parents. These children have a strong desire for independence and have very poor judgment about safety and appropriate behaviors. These little explorers should be carefully monitored so that their innate curiosity does not lead them into dangerous situations [11]. Since accidents are the leading cause of death in children under 5 years old, especially in middle and low-income countries, this scoping review aimed to investigate the preventive interventions against accidents for these children. The interventions were divided into four groups of interventions to prevent domestic accidents, man-made disasters, traffic accidents, and burns & electrical accidents. Most of studies were related interventions against domestic accidents. The reason can be the high presence of children in households. As a result, the presence of unsafe objects and devices at home increases children’s exposure to accidents. These reports indicate the need to visit and check the safety status of homes. According to the statistics of the Iranian Ministry of Health and Medical Education, 64% of children’s accidents are due to domestic accidents, and airway obstruction and drowning are the most common causes of death at home in children under 5 years of age [7]. Many studies have reported unsafe home environments, low socio-economic status, and lack of knowledge and inappropriate attitude of mothers as the most important risk factors for home accidents among children [11, 12-14].
The results of this study also showed that the most affected children were from urban areas. It can be explained that due to the closed and small living area in cities and the higher level of welfare and as a result, the high number of household appliances in homes, as well as the fact that most of mothers are employed, the risk of domestic accidents among children in urban areas is higher. Other possible reasons are the existence of more vehicles in cities and the outpatient treatment of people in rural areas and the lack of referral to urban medical centers.
Educational and operational interventions were also use in many studies to prevent various accidents in children under five years of age. Al-Abidi showed that the knowledge of mothers regarding the preventive measures of accidents in children improved after attending educational sessions [13]. In other studies, continuous training also had a significant role in reducing accidents and their complications in children [15, 16]. Considering that more than 90% of injuries caused by accidents in children are predictable, education, especially for mothers as a key person in the family, is of particular importance. On the other hand, theories and behavioral models can be used to understand how to prevent accidents. One of these models proposed for education is the health belief model (HBM) [17]. This model is mainly focused on the prevention of diseases and the behaviors adopted to avoid the illnesses and diseases, and is among the important and accurate models used to determine the relationship between health beliefs and healthy behaviors [18]. Another theory is the protection motivation theory that focuses on the cognitive factors affecting protection against stressful life events [7]. Limited studies had been conducted using this theory to predict the effective factors on accident prevention behaviors of children under 5 years of age. According to the findings, performing preventive behaviors against domestic accidents is only influenced by coping appraisal, i.e. mother’s perception of the ability to cope with and avoid dangers. In the studies using the HBM, different constructs predicting the occurrence of accidents had been reported. In some studies, perceived sensitivity was the predictor of preventive behaviors, while in another study, the construct of self-efficacy was the predictor of preventive behaviors. By improving self-efficacy and removing barriers, we can create a proper understanding of the ability to cope with the risk of accidents in mothers [20, 21].
A study reported the effectiveness of the protection motivation theory in promoting the accident prevention behaviors in mothers of children under 5 years old. This model can be used in developing educational programs in health centers to change the attitudes and behaviors of mothers in the prevention of accidents in children. Since the report of accidents led to children’s injury is a suitable strategy to increase parents’ understanding of their child’s vulnerability to injury and motivate them to supervise their children more actively, healthcare workers can give these reports to mothers in their educational sessions about domestic accidents. In fact, if the negative effects and severe complications of injuries on the current and future lives of children and even their families are properly perceived by parents, many of them will be prevented. In other words, the attitude of parents or guardians of children under five years old can determine the type of preventive intervention and its effectiveness [20, 21]. 
Interventions to prevent traffic accidents identified in children under five years old included: Having correct traffic behaviors, improving the skill of crossing the street, traffic management training courses, using child safety equipment in cars, building safety barriers for pedestrians, using car seats for children in cars, wearing helmets for bicycles and motorcycles, and road traffic management. Spering et al. [22] suggested that keeping children in car seats correctly and also considering specific physiological and anatomical risks related to children’s age is necessary to prevent traffic accidents in children.
Interventions to prevent burn & electrical accidents in children under five years old included: Using smoke alarms, reducing the temperature of the water heater, parents’ non-smoking, attention to the mental health of mothers, restricting access to alcohol and tobacco, equipping a separate cooking space at home, access to clean fuels, cooking with the rear burner of the gas stove, keeping cooking utensils out of the reach, and keeping electrical appliances and combustible items out of the reach. Families should be encouraged to use the electrical appliances with high safety [23]. Most preventive interventions to prevent burn accidents in children under 5 years of age should be done at home [24], which is consistent with the results of the present study.
Maintaining the safety and health of children under 5 years of age is one of the most important and vital issues for families. Various accidents can happen to children at any time and in any place. Prevention of these accidents is very important. Teaching parents about safe behaviors in areas such as kitchen and bathroom at home can reduce the risk of injury to children. Also, teaching children about safety behaviors such as wearing seat belts in cars, keeping away from dangerous toys, and using the medicines made for children, can help reduce accidents. The use of safety devices in cars for children such as seat belts and car seats can be effective in reducing traffic accidents in children. Ensuring the child’s presence in a safe place and inaccessibility of dangerous chemicals and drugs to children should also be considered. Finally, in case of accidents, it is necessary to be prepared for timely intervention and early treatment. Training on basic treatment methods and provision of medical equipment to respond to such accidents in areas such as home, school and kindergarten can be effective in reducing the complications of these accidents. One of the limitations in conducting this study was the lack of access to the full text of some articles.

Conclusion
In this review study, the identified preventive interventions against accidents for children under 5 years of age were put in four categories of interventions to prevent domestic accidents, man-made disasters, traffic accidents, and burns & electrical accidents. Most of the studies were related to preventive interventions against domestic accidents. Mothers and family caregivers play an important role in preventing domestic accidents in children under 5 years of age. Providing education to mothers and family caregivers, can improve their knowledge and safety behaviors and reduce harm to children. Also, installing appropriate safety equipment and paying attention to children’s living environment can be effective. The need to prevent accidents in children is an important issue that requires the planning and implementation of control and protection programs in health, educational and recreational centers for children.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Isfahan University of Medical Sciences (Code: IR.MUI.RESEARCH.REC.1399.626).

Funding
This study was extracted from a master’s thesis of Parvaneh Heidari, approved by School of Management and Medical Information Sciences, Isfahan University of medical Sciences and financially was supported by Isfahan University of medical Sciences (Code: 399802).

Authors' contributions
Conceptualization: Ali Reza Rahimi; Study design and data collection: Parvaneh Heidari; Data analysis and interpretation: Golrokh Atighechian; Writing the original draft: Parvaneh Heidari and Ali Reza Rahimi; Final approval: All authors. 

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank Isfahan University of Medical Sciences.
 

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