[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.

85]

ORIGINAL ARTICLE

Burn prevention and first aid knowledge:

A focus on adolescents in Zaria

Abdulrasheed Ibrahim, Malachy Eneye Asuku, Tukur Dahiru1

Abstract
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

Introduction open mouthed flames with fire wood and locally fabricated
kerosene stoves.[2] Furthermore, the risk of ignition of
Adolescent burns in Zaria are related to domestic and clothing is higher due to the long, loose indigenous
livelihood tasks.[1] Amongst female adolescents, household garments they wear while cooking.[1,3] Burns among males
chores are assumed by 6 years of age and include cooking, in adolescence can be explained by the changing activities
carrying hot food and beverages and caring for their as they approach the responsibilities of adulthood. They
younger siblings. Lack of electricity mandates the use of are also often responsible for lighting and tending open
alternative hazardous sources for domestic use, including mouthed fires, kerosene stoves and lamps, thus increasing
their vulnerability to burns.[2] More recently, there has been
Access this article online a surge in burns in male adolescents from the illegal sales
Quick Response Code: and storage of premium motor spirit (PMS), use of PMS
Website:
contaminated kerosene in lanterns and cooking stoves
www.afrjtrauma.com
and exploding cheap PMS‑using electricity generating
machines.[4,5]
DOI:
10.4103/1597-1112.139449 The management of burns in well‑equipped, modern
burn units of advanced and affluent societies remains

Departments of Surgery, Division of Burns and Plastic Surgery, 1Community Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria
Corresponding Author: Dr. Abdulrasheed Ibrahim, Department of Surgery, Division of Burns and Plastic Surgery, Ahmadu Bello University Zaria,
Zaria, Nigeria. E‑mail: shidoibrahim@yahoo.com

African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1

11
[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.85]
Ibrahim, et al.: Burn prevention and first aid knowledge
demanding and extremely expensive.[6] Undoubtedly, in
most low resource settings including Zaria, difficulties
experienced in burn management are amplified many
times precluding high standards of care.[7,8] Burn care is
widely known to be done in the general surgical ward
without trained personnel attuned to the aggressive care
of burned patients.[1] In addition, most patients live in the
rural and semi urban areas and are not able to get to a
hospital promptly.[9] 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.[7,8] Burn management
is complicated even further because parents and relatives
try alternative systems of medicine that have unclear
benefit or are out rightly harmful.[6,8,10] 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.[2] The full psychosocial and economic
long‑term costs of sustaining burns remain potentially
huge and difficult to quantify.[4,11,12]
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.[13] A search of the current literature found no
adolescent‑based prevention programs that focus on
burn injuries in Zaria.[14] 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
12
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].
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).
African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1
[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.85]

Ibrahim, et al.: Burn prevention and first aid knowledge

Table 1: Sources of burn prevention and radio program is the educational program  (43.9%).
first‑aid information Majority of the students indicated that information on
television  (94.3%) or radio  (90.7%) will be helpful in
Source Number (%) preventing burn injuries [Table 4].
School 145 (43.28)
Family members 67 (20.0) Discussion
Books 26 (7.76)
Until a few years ago injuries were generally perceived
Television 25 (7.46)
as acts of chance. Today, injuries are not regarded as
Radio 22 (6.57) just accidents. The term “injury” instead of “accident”
Internet 50 (14.93) is used because they are predictable and preventable.[12]
Total 335 (100) As a result of this shift in perception, burn injuries have
demanded the attention of health policy decision‑makers
world‑wide.[6] There is a significant body of literature
Table 2: Responses to knowledge of burn in the evolution of burn care that suggests burns are
prevention practices and first aid preventable, irrespective of the country or culture in
which they occur.[4,8,15,16] Therefore, establishing strategies
Question Responses
that increase burn prevention effectively and efficiently
True False are warranted.[16] The call for a focus on adolescent
Burn prevention burn prevention is essentially about developing these
It is not safe to refill a 170 (50.7) 165 (49.3) observations.
kerosene‑stove or premium motor
spirit‑generator while it’s in use In this study, the average house hold size is eight and
Storing petrol at home can lead 227 (67.8) 108 (32.2)
the majority of the students routinely take care of three
to fires younger siblings. It has been previously established
that the incidence of burns is higher in the first two
Burn injuries are more frequent 98 (29.3) 236 (70.7)
during the Harmattan season
decades of life.[17‑19] In addition, family patterns like
large families, are associated in most studies with
Majority of burns sustained at 199 (59.4) 136 (40.6)
higher burn risk.[6,20] Adolescents are a logical target in
home occur in the kitchen
burn prevention campaigns because they constitute a
Bush burning is a harmful 98 (29.3) 236 (70.7) significant high‑risk group subject to burn injury and
farming practice
they are often caregivers to their younger siblings.[8]
First aid knowledge Thus, by raising awareness, it may be possible to raise
Stop, drop and roll when your 81 (24.2) 254 (75.8) compliance to safe practices in the home. If adolescents
clothes catch fire are seen demonstrating appropriate burn prevention
Apply cold water if hot oil spills 114 (34.0) 221 (66.0) behaviors, younger children and indeed, adults may be
on the hand more aware of the dangers in some behaviors that might
All burn injuries must be treated 201 (60.0) 134 (40.0) result in a burn.[21]
in the hospital
The result of this study shows significant inadequacies in
Never apply raw eggs or herbs to 106 (31.6) 229 (68.4)
the knowledge of burn prevention and first aid treatment.
burn wounds
This indicates a poor sense of burn safety, constituting
Do not remove clothing sticking 114 (34.0) 221 (66.0) a great educational need.[3,8] Knowledge deficits in first
to the body following a burn
aid care are of concern because in clinical practice, lack
injury
of clarity and knowledge of burns first aid treatment
in the community results in patients presenting with
However, only 5.5% of all respondents who had previous toothpaste and other domestic products applied to their
knowledge of fist aid treatment for burn injuries were burns.[22] Stop, drop and roll when your clothes catch fire
able to provide the correct answer ‑ never apply raw eggs and immediate cooling of burns with cold water as a first
or herbs to burn wounds (P < 0.0001). aid measure significantly determines burn outcome. It
decreases morbidity and health care costs by limiting
More than 90% of the students have a television the degree of tissue damage. Consequently, the need
set or radio at home. Most students in the study for surgery and subsequent reconstruction is reduced.[23]
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%) This study also shows that those who have had previous
respectively. The most popular television program is the exposure to information on burn prevention are more
phone‑in‑program (30.1%) while the student’s favorite likely to follow the correct procedure when refilling a

African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1

13
[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.85]
Ibrahim, et al.: Burn prevention and first aid knowledge
Table 3: Relationship between having received information on burn prevention and first aid for
burns and choosing the correct answer
Question
Burn prevention
It is not safe to refill a kerosene‑stove or premium motor
spirit‑generator while it’s in use
Storing petrol at home can lead to fires
Burn injuries are more frequent during the Harmattan
season
Majority of burns sustained at home occur in the kitchen
Bush burning is a harmful farming practice
First aid knowledge
Stop, drop and roll when your clothes catch fire
Apply cold water if hot oil spills on the hand
All burn injuries must be treated in the hospital
Never apply raw eggs or herbs to burn wounds
Do not remove clothing sticking to the body following a
burn injury
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,[6] 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.[7] Education may ultimately increase
burn prevention if the message is repeated, adolescents
are properly engaged and a singular and concise message
is delivered.[8,10,22] The aim is to bring about a change in
the knowledge that will affect behavior at the individual,
family and community level. [3,7] The possibility of
disfigurement, disability and death, demonstrate that
burn prevention and first aid knowledge must be
aggressively administered.[12,23]
Several studies have shown the effectiveness of
using the mass media for health‑related prevention
programs.[4,6,23,24] Burn prevention is no exception. It must
make use of modern information dissemination tools
such as televised campaigns and audio presentations.[23]
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
14
Previous knowledge No previous knowledge P value
of burn prevention of burn prevention
64 (87.7) 106 (40.5) 0.0001
69 (94.5) 158 (60.3) 0.0001
61 (84.7) 37 (14.1) 0.0001
69 (94.5) 130 (49.6) 0.0001
61 (84.7) 37 (14.1) 0.0001
62 (84.9) 19 (7.3) 0.0001
62 (84.9) 52 (19.8) 0.0001
69 (94.5) 130 (49.6) 0.0001
4 (5.5) 102 (38.9) 0.0001
62 (84.9) 52 (19.8) 0.0001
medium to teach children about burn safety.[25] 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.[23]
It is critical to base media programs on cultural values,
norms and socio‑environmental constraints of the
targeted group.[13] 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.[1]
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.[6,13]
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.[1] 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.[23]
A follow‑up study with the same students 6‑12 months
later will be necessary to evaluate the long‑term efficacy
African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1
[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.85]

Ibrahim, et al.: Burn prevention and first aid knowledge

Table 4: Responses to television and radio likely to take the appropriate course of action in burn
viewing habits prevention and first aid treatment. The use of the
electronic media (television and radio) is suggested as
Television and radio Television Radio an effective strategy to increase awareness.
viewing habits no. (%) no. (%)
Do you have a television or radio References
set at home?
Yes 322 (96.1) 318 (94.9) 1. Mabogunje OA, Khwaja MS, Lawrie JH. Childhood burns in
Zaria, Nigeria. Burns 1987;13:298‑304.
No 13 (3.9) 17 (5.1) 2. Peck MD. Epidemiology of burns throughout the world. Part I:
What time do you usually watch Distribution and risk factors. Burns 2011;37:1087‑100.
or listen (pm) 3. Rieman MT, Kagan RJ. Pilot testing of a burn prevention
teaching tool for Amish children. J Burn Care Res
4.00‑6.00 43 (12.7) 149 (44.7) 2012;33:265‑71.
6.00‑8.00 84 (25.1) 90 (26.9) 4. Parbhoo A, Louw QA, Grimmer‑Somers K. Burn prevention
programs for children in developing countries require urgent
8.00‑10.00 190 (56.7) 50 (14.9) attention: A targeted literature review. Burns 2010;36:164‑75.
After 10.00 18 (5.4) 46 (13.7) 5. Fadeyibi IO, Mustapha IA, Ibrahim NA, Faduyile FI,
Faboya MO, Jewo PI, et al. Characteristics of paediatric burns
Average number of hours in a
seen at a tertiary centre in a low income country: A five
day watching or listening (h) year (2004‑2008) study. Burns 2011;37:528‑34.
<1 58 (17.3) 60 (17.2) 6. Atiyeh BS, Costagliola M, Hayek SN. Burn prevention
mechanisms and outcomes: Pitfalls, failures and successes.
1‑3 250 (74.6) 261 (78.0)
Burns 2009;35:181‑93.
>3 27 (8.6) 14 (4.2) 7. Hodgins P, Hodgins P, Potokar T, Price P. Comparing rich and
Favorite program poor: Burn prevention in Wales, Pakistan, India, Botswana
and Zambia. Burns 2011;37:1354‑9.
Musicals 48 (14.3) 97 (28.9) 8. Sinha I, Patel A, Kim FS, Maccorkle ML, Watkins JF. Comic
Drama 67 (20.0) 57 (17.0) books can educate children about burn safety in developing
countries. J Burn Care Res 2011;32:e112‑7.
Phone‑in‑program 101 (30.1) 19 (5.7) 9. Iregbulem LM, Nnabuko BE. Epidemiology of childhood
Educational program 94 (28.1) 117 (43.9) thermal injuries in Enugu, Nigeria. Burns 1993;19:223‑6.
10. Archibong AE, Antia UE, Udosen J. Childhood burns in south
Religious program 25 (7.4) 45 (13.4) eastern Nigeria. East Afr Med J 1997;74:382‑4.
Do you think information on 11. Asuquo ME, Ekpo R, Ngim O. A prospective study of burns
television or radio will be helpful trauma in children in the University of Calabar Teaching
in preventing burn injuries Hospital, Calabar, south‑south Nigeria. Burns 2009;35:433‑6.
12. Mondozzi MA, Harper MA. In search of effective education in
Yes 316 (94.3) 304 (90.7) burn and fire prevention. J Burn Care Rehabil 2001;22:277‑81.
No 19 (5.7) 31 (9.3) 13. Shani E, Bahar‑Fuchs SA, Abu‑Hammad I, Friger M,
Rosenberg L. A burn prevention program as a long‑term
investment: Trends in burn injuries among Jews and Bedouin
of the media campaigns and determine whether there is children in Israel. Burns 2000;26:171‑7.
14. Piazza‑Waggoner C, Adams CD, Goldfarb IW, Slater H.
a reduction in burn injuries after education. Furthermore, An assessment of burn prevention knowledge in a high
a burn safety curriculum in school could be designed burn‑risk environment: Restaurants. J Burn Care Rehabil
to complement the electronic media program to ensure 2002;23:342‑50.
repeated and lasting messages regarding burn safety. 15. Heinle JA, Jensen RW, Lewis RW 2nd, Kealey GP. An effective
Burn prevention is an essential part of an integrated method of educating junior high‑aged children in fire and
burn safety without disruption of the school curriculum.
burn management protocol globally. Focusing on burn J Burn Care Rehabil 1995;16:91‑5.
prevention in low resource settings rather than treatment 16. Lehna C, Myers J. Development of an instrument that assesses
cannot be over‑emphasized. It remains the major and individuals’ burn prevention knowledge. J Burn Care Res
probably the only available way of reducing the current 2011;32:26‑30.
state of burn morbidity and mortality.[2,5,8,12,26] 17. Duke J, Wood F, Semmens J, Edgar DW, Spilsbury K, Rea S.
An assessment of burn injury hospitalisations of adolescents
and young adults in Western Australia, 1983‑2008. Burns
Conclusion 2012;38:128‑35.
18. Park JO, Shin SD, Kim J, Song KJ, Peck MD. Association
This study demonstrates that knowledge deficits exist between socioeconomic status and burn injury severity.
in burn prevention and first aid knowledge among Burns 2009;35:482‑90.
adolescents in Zaria. There is significant room for 19. Sakallioğlu AE, Başaran O, Tarim A, Türk E, Kut A, Haberal M.
Burns in Turkish children and adolescents: Nine years of
improvement and educational intervention may be experience. Burns 2007;33:46‑51.
highly efficacious. Those who had previous knowledge 20. Delgado J, Ramírez‑Cardich ME, Gilman RH, Lavarello R,
of burn prevention and first aid for burns were more Dahodwala N, Bazán A, et al. Risk factors for burns in children:

African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1

15
[Downloaded free from http://www.afrjtrauma.com on Tuesday, July 24, 2018, IP: 223.255.228.85]

Ibrahim, et al.: Burn prevention and first aid knowledge

Crowding, poverty, and poor maternal education. Inj Prev
2002;8:38‑41.
21. Kinner MA. Relationship between knowledge of burn
prevention and emergency treatment and risk‑taking attitudes
in 11‑15 year olds. Issues Compr Pediatr Nurs 1986;9:353‑67.
22. Graham HE, Bache SE, Muthayya P, Baker J, Ralston DR. Are
parents in the UK equipped to provide adequate burns first
aid? Burns 2012;38:438‑43.
23. Skinner AM, Brown TL, Peat BG, Muller MJ. Reduced
hospitalisation of burns patients following a multi‑media
campaign that increased adequacy of first aid treatment.
Burns 2004;30:82‑5.
24. Opaluwa AS, Orkar SK. Emphasise burns prevention in
developing countries. BMJ 2004;329:801.
25. Hsiao M, Tsai B, Uk P, Jo H, Gomez M, Gollogly JG, et al.
“What do kids know”: A survey of 420 Grade 5 students
in Cambodia on their knowledge of burn prevention and
first‑aid treatment. Burns 2007;33:347‑51.
26. Liao CC, Rossignol AM. Landmarks in burn prevention. Burns
2000;26:422‑34.
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.
Source of Support: Nil, Conflict of Interest: None declared.

African Journal of Trauma | Jan-Jun-2014 | Vol. 3 | Issue 1

16