|Year : 2014 | Volume
| Issue : 1 | Page : 11-16
Burn prevention and first aid knowledge: A focus on adolescents in Zaria
Abdulrasheed Ibrahim1, Malachy Eneye Asuku1, Tukur Dahiru2
1 Department of Surgery, Division of Burns and Plastic Surgery, Ahmadu Bello University Zaria, Zaria, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria
|Date of Web Publication||26-Aug-2014|
Department of Surgery, Division of Burns and Plastic Surgery, Ahmadu Bello University Zaria, Zaria
Source of Support: None, Conflict of Interest: None
Background: Burns in developing countries accounts for significant morbidity and mortality. Despite the impressive advances in the science of injury-control and prevention, burns have remained the neglected disease of modern society and are still regarded by many as an act of fate and bad luck. The aim of this study was to determine the knowledge of burn prevention and first aid treatment in adolescents as baseline information to develop an effective burn prevention program.
Materials and Methods: A survey to ascertain the knowledge of burns prevention and first aid was conducted in 10 junior secondary schools in Zaria. It was divided into three sections; demographic, knowledge of burn prevention practices and first aid treatment at home and a self-report of radio and television viewing habits. Descriptive frequencies were used to describe the student's knowledge of burn prevention and first aid treatment. Chi-square analyses were conducted to identify any significant differences between students who had previous knowledge of burn prevention and those who did not.
Results: A total of 335 students from 10 schools took part in the survey. Their age ranged from 10 to 17 years with a mean age of 14.8 years. There were 192 males (57%) and 143 females (43%). Seventy three students (21.5%) had previous knowledge of burn prevention and first aid, compared with 262 (77.3%) who had no previous knowledge of burn prevention. Those who had previous knowledge of burn prevention and first aid for burns were more likely to select the appropriate answers to burn prevention practices and first aid treatment at home (P < 0.0001). Majority of the students indicated that information on television (94.3%) or radio (90.7%) will be helpful in preventing burn injuries.
Conclusion: Knowledge deficits exist in burn prevention and first aid knowledge among adolescents in Zaria. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.
Keywords: Adolescent, burns, electronic media, first aid, knowledge, prevention
|How to cite this article:|
Ibrahim A, Asuku ME, Dahiru T. Burn prevention and first aid knowledge: A focus on adolescents in Zaria. Afr J Trauma 2014;3:11-6
| Introduction|| |
Adolescent burns in Zaria are related to domestic and livelihood tasks.  Amongst female adolescents, household chores are assumed by 6 years of age and include cooking, carrying hot food and beverages and caring for their younger siblings. Lack of electricity mandates the use of alternative hazardous sources for domestic use, including open mouthed flames with fire wood and locally fabricated kerosene stoves.  Furthermore, the risk of ignition of clothing is higher due to the long, loose indigenous garments they wear while cooking. , Burns among males in adolescence can be explained by the changing activities as they approach the responsibilities of adulthood. They are also often responsible for lighting and tending open mouthed fires, kerosene stoves and lamps, thus increasing their vulnerability to burns.  More recently, there has been a surge in burns in male adolescents from the illegal sales and storage of premium motor spirit (PMS), use of PMS contaminated kerosene in lanterns and cooking stoves and exploding cheap PMS-using electricity generating machines. ,
The management of burns in well-equipped, modern burn units of advanced and affluent societies remains demanding and extremely expensive.  Undoubtedly, in most low resource settings including Zaria, difficulties experienced in burn management are amplified many times precluding high standards of care. , Burn care is widely known to be done in the general surgical ward without trained personnel attuned to the aggressive care of burned patients.  In addition, most patients live in the rural and semi urban areas and are not able to get to a hospital promptly.  These socio-economic patient issues also means that they are unlikely to afford timely and comprehensive care including fluid resuscitation, burn wound excision and skin grafting. , Burn management is complicated even further because parents and relatives try alternative systems of medicine that have unclear benefit or are out rightly harmful. ,, The effects of these is that patients present when complications may have developed and so plastic surgeons have to deal with advanced and complicated burns pathology in routine clinical practice. The consequences are direr for burn survivors. These include problems of re-assimilating into school, with isolation from or even abandonment by the family, social segregation, unemployment and extreme poverty.  The full psychosocial and economic long-term costs of sustaining burns remain potentially huge and difficult to quantify. ,,
Despite the impressive advances in the science of injury-control and prevention, burn injuries have remained the neglected disease of modern society and are still regarded by many as an act of fate and bad luck.  A search of the current literature found no adolescent-based prevention programs that focus on burn injuries in Zaria.  Identifying areas of knowledge deficits would be useful in developing prevention programs aimed at decreasing burn injury risk. The aim of this study was to determine the knowledge of burn prevention and first aid treatment in adolescents in Zaria as baseline information to develop an effective burn prevention program.
| Materials and Methods|| |
A survey to ascertain the knowledge of burns prevention and first aid was conducted in 10 junior secondary schools in Zaria. The schools in this study are all located within Zaria Local government area. Zaria is a major city in Kaduna State in Northern Nigeria, as well as being a Local Government Area. It is home to several institutions including Ahmadu Bello University (the premier university in northern Nigeria), Ahmadu Bello University Teaching Hospital and the Nigerian Military School. Zaria is a cosmopolitan town with a population of about 408,198 (2006 census population). The inhabitants consist of government officials, clerks, petty traders and students. Outside Zaria, the suburbs are generally rural Nigeria, an Agrarian Society with clusters of villages inhabited by peasant farmers, self-employed laborers, artisans and shopkeepers.
A 26 item questionnaire was used and it was divided into three sections; demographic, knowledge of burn prevention practices and first aid treatment at home and a self-report of radio and television viewing habits. The questionnaire included a range of open ended questions as well as closed questions with the answer options as true or false. The survey was given to the principal of each school. The principal distributed the questionnaires to the class teachers. They were completed by students during the break time. Completed questionnaires were entered into the Statistical Package for Social sciences (SPSS 17.0 version; SPSS Inc., Chicago, IL, USA). Descriptive frequencies were used to describe the student's knowledge of burn prevention and first aid treatment. Chi-square analyses were conducted to identify differences between students who had previous knowledge of burn prevention and those who did not.
| Results|| |
A total of 335 students from 10 schools took part in the survey. Their age ranged from 10 to 17 years with a mean age of 14.8 years. There were 192 males and 143 females with a male: female ratio of 1.3:1. The average house hold size is eight in 51% of respondents. 97.3% of the students routinely take care of three younger siblings.
Seventy three students (21.5%) had previous knowledge of burn prevention and first aid, compared with 262 (77.3%) who had no previous knowledge of burn prevention. The source of knowledge in those who had previous information on burn prevention and first aid treatment were school (43.2%), family members (20%), television (7.46%) and radio (6.57%) [Table 1].
In the burn prevention practices and first aid treatment at home section, more than 50% of the students did not know: Burn injuries are more frequent during the Harmattan season, stop, drop and roll when your clothes catch fire, apply cold water if hot oil spills on hand and never apply raw eggs or herbs to burn wounds [Table 2].
|Table 2: Responses to knowledge of burn prevention practices and first aid|
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In order to see if there was any significant relationship between having received information on burn prevention and first aid for burns and choosing the appropriate responses to the questions, a Chi-squared test was carried out. The result indicates that those who had previous knowledge of burn prevention and first aid for burns were more likely to select the right answers [Table 3]. 87.7% of those that had received previous information on burn prevention know that it is not safe to refill a kerosene-stove or PMS-generator while it is in use. This contrasts with 40.5% of those who did not have previous information on first aid for burns (P < 0.0001). However, only 5.5% of all respondents who had previous knowledge of fist aid treatment for burn injuries were able to provide the correct answer - never apply raw eggs or herbs to burn wounds (P < 0.0001).
|Table 3: Relationship between having received information on burn prevention and first aid for burns and choosing the correct answer|
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More than 90% of the students have a television set or radio at home. Most students in the study watch television and listen to the radio between 8.00 pm-10.00 pm (56.7%) and 4.00 pm-6.00 pm (44.7%) respectively. The most popular television program is the phone-in-program (30.1%) while the student's favorite radio program is the educational program (43.9%). Majority of the students indicated that information on television (94.3%) or radio (90.7%) will be helpful in preventing burn injuries [Table 4].
| Discussion|| |
Until a few years ago injuries were generally perceived as acts of chance. Today, injuries are not regarded as just accidents. The term "injury" instead of "accident" is used because they are predictable and preventable.  As a result of this shift in perception, burn injuries have demanded the attention of health policy decision-makers world-wide.  There is a significant body of literature in the evolution of burn care that suggests burns are preventable, irrespective of the country or culture in which they occur. ,,, Therefore, establishing strategies that increase burn prevention effectively and efficiently are warranted.  The call for a focus on adolescent burn prevention is essentially about developing these observations.
In this study, the average house hold size is eight and the majority of the students routinely take care of three younger siblings. It has been previously established that the incidence of burns is higher in the first two decades of life. ,, In addition, family patterns like large families, are associated in most studies with higher burn risk. , Adolescents are a logical target in burn prevention campaigns because they constitute a significant high-risk group subject to burn injury and they are often caregivers to their younger siblings.  Thus, by raising awareness, it may be possible to raise compliance to safe practices in the home. If adolescents are seen demonstrating appropriate burn prevention behaviors, younger children and indeed, adults may be more aware of the dangers in some behaviors that might result in a burn. 
The result of this study shows significant inadequacies in the knowledge of burn prevention and first aid treatment. This indicates a poor sense of burn safety, constituting a great educational need. , Knowledge deficits in first aid care are of concern because in clinical practice, lack of clarity and knowledge of burns first aid treatment in the community results in patients presenting with toothpaste and other domestic products applied to their burns.  Stop, drop and roll when your clothes catch fire and immediate cooling of burns with cold water as a first aid measure significantly determines burn outcome. It decreases morbidity and health care costs by limiting the degree of tissue damage. Consequently, the need for surgery and subsequent reconstruction is reduced. 
This study also shows that those who have had previous exposure to information on burn prevention are more likely to follow the correct procedure when refilling a kerosene-stove or PMS-generator, i.e. switch it off. This finding is in keeping with data from a burn prevention program carried out in Jamshedphur, India,  where a sustained education program found an increase in the use of water to cool burns from 37.8% of the study population in 1993 to 75% in 1996. This suggests that education programs in low resource settings can be effective in facilitating a positive change in the first aid treatment of burns.  Education may ultimately increase burn prevention if the message is repeated, adolescents are properly engaged and a singular and concise message is delivered. ,, The aim is to bring about a change in the knowledge that will affect behavior at the individual, family and community level. , The possibility of disfigurement, disability and death, demonstrate that burn prevention and first aid knowledge must be aggressively administered. ,
Several studies have shown the effectiveness of using the mass media for health-related prevention programs. ,,, Burn prevention is no exception. It must make use of modern information dissemination tools such as televised campaigns and audio presentations.  Based on the percentage of adolescents in this study who have access to television and radio and their television watching or radio listening habits, a television and radio campaign could be an efficient method to reach a large proportion of this population. The evening was identified as the optimal time for airing the campaign and their favorite programs were also noted in this study. A similar study of burn prevention knowledge and first aid treatment amongst school age children in Cambodia, noted that television could be used as a medium to teach children about burn safety.  They are an effective method to convey information and knowledge, especially if this fits in with a recent story or it is endorsed by an authority figure. A simple, positive, behavior-specific message targeted toward at-risk groups, is known to optimize behavioral change. 
It is critical to base media programs on cultural values, norms and socio-environmental constraints of the targeted group.  In Zaria, as in many parts of rural Africa, one of the commonest source of domestic fuel is firewood which is burned for cooking and during the cold season for warming the dwelling and the body.  It would be unwise for example, to recommend the elimination of the open mouthed flames especially among the low socio-economic families and those living outside the urban settlements. It might however be effective to demonstrate burn prevention and safety skills such as: isolation of all cooking sites with open mouthed flames, appropriate type of clothing while cooking, supervision of the very young by older siblings and the provision of a water container for first aid. , A television or radio program on fire safety and first aid in English and Hausa (the vernacular language of the community) will be most useful during the dry and cold Harmattan season of December to February.  Cyclical repetition is important to maintain public awareness. However, there is a possibility of "tolerance" to the campaign and novel strategies will be required for delivering the same message repeatedly. 
A follow-up study with the same students 6-12 months later will be necessary to evaluate the long-term efficacy of the media campaigns and determine whether there is a reduction in burn injuries after education. Furthermore, a burn safety curriculum in school could be designed to complement the electronic media program to ensure repeated and lasting messages regarding burn safety. Burn prevention is an essential part of an integrated burn management protocol globally. Focusing on burn prevention in low resource settings rather than treatment cannot be over-emphasized. It remains the major and probably the only available way of reducing the current state of burn morbidity and mortality. ,,,,
| Conclusion|| |
This study demonstrates that knowledge deficits exist in burn prevention and first aid knowledge among adolescents in Zaria. There is significant room for improvement and educational intervention may be highly efficacious. Those who had previous knowledge of burn prevention and first aid for burns were more likely to take the appropriate course of action in burn prevention and first aid treatment. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.
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[Table 1], [Table 2], [Table 3], [Table 4]