Factors associated with caregivers’ perceptions of fate in childhood injury prevention in rural Nepal: a cross-sectional study

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Background Fatalistic beliefs that preventive actions have limited ability to reduce childhood injury risk may represent a barrier to injury prevention in low- and middle-income countries, yet factors associated with such beliefs among caregivers in rural settings remain poorly understood. We aimed to identify factors associated with caregivers’ agreement with a fate-related item in rural Nepal. Methods A cross-sectional study was conducted at Chaurjahari Hospital, Rukum District, Nepal (November 2025–January 2026). Caregivers of children aged 10 years or younger (n=238) completed a structured questionnaire. The primary outcome was agreement with a fate-related item concerning childhood injury preventability and destiny, dichotomised from a 5-point Likert scale (disagreement: 1–3; agreement: 4–5). Binary logistic regression was performed with two hierarchical models adjusting for sociodemographic factors, child injury experience and major information sources. Results Overall, 121 of 237 participants (51.1%) agreed with the fate-related item. In multivariable analysis, caregivers with higher secondary education or above had significantly lower odds of agreement with the fate-related item than the illiterate group (adjusted OR 0.16, p=0.016). Caregivers of children without a past-year injury also had lower odds (adjusted OR 0.43, p=0.003). Both associations were robust in model 2. In univariable analysis, agreement with the fate-related item was inversely associated with home safety practices (OR 0.91, p=0.001). Conclusions Agreement with the fate-related item was associated with maternal educational attainment and child injury experience among caregivers in rural Nepal. These findings support the importance of literacy-sensitive injury-prevention education and post-injury counselling.