Baby Walker: Mother’s Knowledge, Injury Prevention Behavior and Incidence of Injury among Toddler in Paseban District Jakarta 74 Baby Walker: Mother’s Knowledge, Injury Prevention Behavior and Incidence of Injury among Toddler in Paseban District Jakarta

In many countries baby walkers are linked to more injuries than any other type of nursery equipments. Most parents have the impression that a baby walker will keep the baby safely entertained while they perform other tasks or will help the baby learn to walk. The study aimed to identify relationship between mother’s knowledge and baby walker injury prevention on baby walker among toddler in Paseban district, Jakarta. A cross-sectional study based on a total sampling was employed with 83 participants aged 20-49 years old. The questionnaires composed of an individual characteristic questionnaire, knowledge of baby walker injury prevention questionnaire and baby walker injury prevention behavior. The study revealed the majority of participants were in age range of 30-39 years old (44.6%). 43 participants were work and 50 of participants had a lower level of education. 53 % of participants have a boys (53%) and 50.6 % of participants were less of knowledge. 44.6 % of participant had a negative prevention behavior with 47 % of participants reported their children had injuries. The Majority of children were fault from baby walker (66.6 %). Knowledge of mothers had significant relationship with incidence of injury (p value 0.000) and baby walker injury prevention behavior had significant relationship with incidence of injury among toddler (p value 0.000). The knowledge of mothers should be improving. Therefore, knowledge about disadvantages of baby walker should be emphasized in primary health care program to promote avoid of using baby walker among toddler.


INTRODUCTION
Parents have an important role in caring for their children. Busyness of parents especially mothers can have an impact on the lack of time of interaction and child care (8). Most parents choose to use baby walkers to replace them keeping the baby entertained while they are doing other tasks or helping babies learn to walk (7). Injury Database (IDB), nine countries in Europe in 2002 to 2007 showed that more than 90% of toddlers using baby walkers were head injuries, 31% of those affected by brain injuries, and 35% had skull injuries. Baby walkers are still widely used in Indonesia, or there are still many baby walker products sold in the market.
The results of interviews at several nursery shops in Jatinegara market, East Jakarta, obtained data that there are still 10 to 15 baby walkers sold in one month. Research conducted by Elizawarda (2010) in North Binjai shows that 85.45% of babies use baby walkers. Researchers also conducted interviews with 3 mothers who bought a baby walker found that they bought the device so the child could walk earlier, strengthen the baby's leg muscles, and the mother could put the child in the baby walker while the mother worked at home.
Baby walkers are still a matter of controversial because these tools have a positive and a negative effects for babies. People perceive that the using of baby walkers can help their children walk early, but in the real there is a high risk of injury to babies due to the use of baby walkers. Research from Barss et al (2016) at the United Arab Emirates obtained from 646 cases of injury to infants due to the use of baby walkers, 174 cases including more detail  if the parents have a good knowledge so the injury will be preventing. Therefore, this study aims to identify relationship between mother's knowledge and baby walker injury prevention on baby walker among toddler in Paseban district, Jakarta.

MATERIALS AND METHODS
A cross-sectional study was conducted in Paseban District, Jakarta. The objective of this study was to identify relationship between mother's knowledge and baby walker injury preventionon baby walker among toddler. The total sampling was employed with eighty three participants.
Questionnaires that were employed in this study were composed of an individual characteristic questionnaire, knowledge of baby walker injury prevention questionnaire with 12 items, and baby walker injury prevention on baby walker questionnaire with 13 items.   The situation showed the mother's who had a low knowledge will be increasing incidence of injury. Therefore, the mother's knowledge should be improving to reduce incidence of injury. If, mother has a good knowledge, they will aware to protect their children. This sudy accordance with study by Dewi and Indarwati (2011) found that parent's knowledge has relationship with incidence of injury on baby walker among toddler.  Table 3 showed the significant relationship between baby walker injury prevention behavior and incidence of injury among toddler (p value 0.000). That's mean mother who had positive injury presentations behavior will able to reduce incidence of injury among their children. However, in this study still found 37 participants has negative baby walker injury prevention behavior.

RESULTS AND DISCUSSION
Several studies found some rationales of parent who still using baby walker. Most parents have the impression that a baby walker will keep the baby safely entertained while they perform other tasks or will help the baby learn to walk (7).

Previous study by Badhian, Adhiani and
Yaghini (2017) found that the uses of baby walker were increasing dramatically. The most type of baby walker was entertained with toys and music. Therefore, the parents assume the children will happy with the toys. However, that study also found, 50-70 % of children (4-12 month old) who using baby walker were delayed developments.
This finding also in line with studies by Widyaningsih and Widaryati (2014) and Akenet et al (2007) that found Baby walker injury prevention behavior has relationship with injury of incidence on baby walker. Therefore, the mothers should be aware with baby walker injury prevention and avoid usingbaby walker for their children. The mothers also should able to perform their roles as mother to protect and stimulate their children not only by using baby walker.

CONCLUSIONS AND RECOMMENDATIONS
This study reached that 47% toddler were fault by using baby walker and 50.6 % of participants had a less of knowledge. However, 55.4 % of participants reported had a positive of baby walker injury prevention behavior. There were significant relationship between level of knowledge and incidence of injury (p value 0.00).
Based on findings, the knowledge of mothers should be improving. Therefore, knowledge about disadvantages of baby walker should be emphasized in primary health care program to promote avoid of using baby walker among toddler. Moreover, this study should be a reference for improving nursing knowledge and health volunteer awareness in community.