“A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS OF
UNDER FIVE CHILDREN REGARDING BURNS AND ITS PREVENTION
IN SELECTED RURAL AREA OF TUMKUR WITH A VIEW
TO DEVELOP INFORMATION BOOKLET”.
PROFORMA FOR REGISTRATION OF SUBJECT FOR THE DISSERTATION
SUBMITTED BY
TAJINDER KAUR
CHILD HEALTH NURSING
M.Sc 1st YEAR
AKSHAYA COLLEGE OF NURSING
2ND CROSS, ASHOKNAGAR
TUMKUR.
2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA, INDIA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
01 / NAME OF THE CANDIDATE AND ADDRESS / : / Mrs. TAJINDER KAURM.Sc. NURSING, 1st YEAR,
AKSHAYA COLLEGE OF NURSING,
TUMKUR.
02 / NAME OF THE INSTITUTION / : / AKSHAYA COLLEGE OF NURSING.
03 / COURCE OF STUDY AND
SUBJECT
/ : / MASTER DEGREE IN NURSING, CHILD HEALTH NURSING.
04 / DATE OF ADMISSION TO COURSE / :
05 / STATEMENT OF PROBLEM / : / “A DESCRIPTIVE STUDY TO ASSESS THE KNOWLEDGE OF MOTHERS OF UNDERFIVE CHILDREN REGARDING BURNS AND ITS PREVENTION IN SELECTED RURAL AREAS OF TUMKUR WITH A VIEW TO DEVELOP INFORMATION BOOKLET”.
6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
Children are the future of every country and all societies strive to ensure their health and safety Since India’s independence, continuous efforts have been made to improve the status of children. The large burden of communicable, infectious and nutritional disorders is gradually on the decline due to massive efforts and investments by successive Indian government, even though it is an unfinished agenda. Parallel to these changes, it is also becoming apparent that children saved from disease of yesterday are becoming victim of injury on road, at home and in public, recreational places.1 Children are naturally curious. As soon as they are mobile, begin to explore their surroundings and play with new objects, at the same time though, they come into contact with objects that can cause severe injuries playing with fire or touching hot objects can result in burns. 2
A burn is defined as an injury to the skin or other organic tissue caused by thermal trauma, it occurs when some or all of the cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns). Injuries to the skin or other organic tissue due to radiation, radioactivity, electricity, friction or contact with chemicals are also considered as burns. 3
Burns may be distinguished and classified as thermal burns, inhalational burns, first degree or superficial burns, second degree or partial-thickness burns, third-degree or full-thickness burns. Chemical burns electrical burns, radiation burns.2
Risk factors of burns includes, according to data collected from the national burn information exchange reveal that 75% of all burn injuries result from the actions of the victim, with many of these injuries occurring in the home environment. Contact with scalding liquids is the leading cause of burn injury. Toddlers suffer more scald injuries than any other age group. Scald injuries are frequently the results in the performance of everyday tasks such as bathing, cooking, overturned coffeepots, overheated foods, liquids cooked in micro wave ovens and hot tap water have been identified as specific causes. Approximately 10% of residential fire deaths are caused by children playing with matches or other ignition sources. Additionally faulty chimney’s, flue vents, fixed heating units, fireplaces, central heating systems. Wood burning stoves, as well as human error, all have been implicated.4 Burns in children under the age of five year old at higher risk of hospitalization often occur from a mixture of curiosity and awkwardness. In children under the age of four years, the level of motor development does not match the child’s cognitive and intellectual development and injuries can thus occur more easily. 5
Clinical features of burns includes, First degree partial thickness burns, Second degree partial thickness burns, Third degree full thickness burns, Fluid and Electrolyte imbalance, Alterations in Respiration, Decreased cardiac output, Substantial pain, Altered level of consciousness, Psychological alterations, withdrawal, suppression.4
Infants under the age of one year are in a particular category, as their mobility starts to develop and they reach out to touch objects. Scald burns are the most frequent type of burns among children under the age of six years on observation that appears to come across geographic and economic groups. Typical scald burns occur when a child pulls down a container of hot fluid, such as a cup of coffee, onto his or her face upper extremities and trunks.2
According to WHO data, approximately 10% of all unintentional injury deaths are due to fire related burns. Studies from high income countries suggest that smoke inhalation is the strongest determinant of mortality from burns, mostly from house fires or other conflagrations. For children over three years of age, smoke inhalation is strongly associated with mortality. Burns from fire contribute to the majority of burn related deaths in children, scalds and contact burns are an important factor in overall morbidity from burns and a significant cause of disability.2
A study in four low income countries found that 65% of childhood burns had occurred in and around the home. The kitchen is usually the most common part of the house. In this room, children may upset receptacles with hot liquids, by exploding stores, stand on hot coals or be splashed with hot cooking oil. Studies have also found that, the children of mothers who smoke while in bed are at higher risk of burns than those who do not have mothers who smoke. Two peak times of the day have been reported for incidents involving burns, the late morning, when domestic tasks are being done, and around the time for the evening meal.2
Childhood burns are largely environmentally conditioned and preventable. It would therefore seem natural that the prevention of burns should focus on a mixture of environmental modifications. Parental education and product safety, special attention needs to be paid to the kitchen. The scene of the majority of burns programmes are needed to ensure proper supervision of children and their general well being, particularly of those with disabilities mothers should receive better information about all types of burns. There must be much greater awareness everywhere about the dangers of storing flammable substances in the home.2
Many times death results because of delay in reaching the casualty to appropriate medical care and low lack of knowledge regarding first aid and treatment on the contrary, if help is provided to casualty as soon as possible following the accident or injury, a life could be saved. The first aider should also have adequate knowledge and skills about what he is doing and be encouraging and reassuring to the victims. This helps lower mortality and morbidity rates, complications due to injury or delay in the treatment and a lesser monetary burden on the casualty.6 it is therefore desirable that all individuals have basic training and knowledge regarding first aid. 7
‘First aid’ is the first assistance or treatment given to an injured person (casualty) for any injury or sudden illness before the arrival of qualified medical care by using facilities and material available at that time. Giving of first aid is an art which is acquired by getting interested in the field and by training. 6
Burns are significant cause of mortality and morbidity among infants and children being depend on their matter or caretaker and they are unable to recognize hazardous situations leading to burn injury. 8 Burns in children result in the loss of precious life, or if the child survives, in much suffering from physical, emotional social and economic problems. These burn accidents to children happen in the bustle of family life and frequently without any warning. 9
It is very important to look into safety and security of children. This will promote sound psycho-social development of children. Safety and security can be ensured by providing clean, safe and comfortable physical environment. 10
6.1 NEED FOR THE STUDY:
Burn injury is second leading cause of accidental death in children. 11 According to the WHO global burden of disease estimates for 2004, just over 3, 10,000 people died as a result of fire-related burns, of which 30% were under the age of 20 years. Fire related burns are the 11th leading cause of death for children between the ages of less than 5 years. Overall children are at high risk for death from burns, with a global rate of 3.9 deaths per 1, 00,000 populations. Among all people globally, infants have the highest death rates from burns. Globally nearly 96,000 children under the age of 20 years were estimated to have been fatally injured as a result of a fire related burn in 2004. 2
The death rate in low income and middle income countries was eleven times higher than that in high income countries, 4.3 per 1, 00,000 as against 0.4 per 1, 00,000. Burns related deaths show great regional variability. Most of the deaths occur in poorer regions of the world among the WHO regions of Africa and South East Asia and the low income and middle income countries of the eastern Mediterranean region.2
A survey in India found that only 22.8% of patients had received appropriate first aid for their burns. The remainder had either received no first aid or else inappropriate treatment such as raw eggs, toothpaste, mashed potato or oil being rubbed into the burn. Education on the effect of immediate application of cool water to burns should be promoted widely as an affective first aid treatment. 12
A retrospective study was conducted to study the incidence, severity, extent, cause, risk factors and overall mortality. 309 children of burn injuries treated over last 10 years in Kasturbha Hospital, Manipal, and Karnataka, India. The study found that the children of less than 5 years were affected more (76% Vs 23.9%). Females were affected more than males (74% Vs 25.9%). Most of the children received burn injuries in the range of 0-20%. Body surface are (63%), electric burn 3.2% scald (72.5%) followed by flame (22.7%) were most common cause of burn injuries. Overall pediatric burn mortality was 7.4%. 13
In much of rural Southeast Asia, kerosene stoves and oil lamps are still in regular use. The combination of “open flames” in overcrowded dwellings, poorly serviced equipment and the wearing of highly flammable sari result in many more flame burns. Asian children are at increased risk of burns due to the use of several unique cooking methods such as the heating of food on the floor. 14 Sadly, the usual fate of a child with an extensive third degree burn in a low income country is death. The risk of mortality from burns covering over 30% of total body surface area is roughly 50%. The risk of burns covering more than 50% of total body surface area is nearly 100%. 15
In high income countries children under the age of five years old at the highest risk of hospitalization from burns. Nearly 75% of burns in young children are from hot liquid, hot tap water or steam. Infants under the age of one year are still at significant risk for burns, even in developed countries. The burns they suffer are most commonly the result of scalds from cups containing hot drinks or contact burns from radiators or hot water pipes.
The following give an indication of the situation in some high income countries.
1. In Canada, in a single year there were over 6000 visits to emergency departments in the province of Ontario due to burns. Almost half the cases of burns are among children under five years of age.
2. In Finland an 11 year study found that scalds were responsible for 42.4% of children being admitted to two pediatric burns units. Among children under 3 years of age 100% of burns were the result of hot water. In the 11-16 years group, 50% of burns were due to electricity, with the other 50% resulting from fire and flames.
3. In Kuwait the incidence of burns in children under 15 years of age was 17.5 per 1, 00,000 population. Scalds, followed by flames were the leading causes of burns.
In low income and middle income countries, children under the age of five years have been shown to have a disproportionately higher rate of burns than in the case in high income countries.
1. In Kenya, for example, 48.6% of children presenting to the Kenyatta National Hospital were under the age of five years. Although scalds were the most common type of burns those caused by open flames were also prominent.
2. In Maiduguri, north east Nigeria, the commonest cause of burns was scalds (64.4%) children under the age of three years were disproportionately represented.
3. In Brazil and India infants account for nearly half of all childhood burns. 2
Burns are one of the most neglected areas of health care in developing countries. These countries have 90% of global burn injuries with 70% of these injuries occurring in the children. Burns typically occur in the home environment and should be amenable to prompt appropriate first aid. In India more than 10,000 burn associated deaths and over 1 million non fatal moderate to severe burns occur each year. 2
Community based cross sectional survey was carried out in a slum in Delhi, India from September 2003 to December 2003, accommodated 1597 people belonging to 400 families covered in this study. The researcher found that, a total of 57 persons (14.25%) had received burns in the past one year, majority (43.8%) of them were below 15 years of age. Half of the victims (50.80%) were either illiterate or children below 7 years. Most of the victims (89.5%) had received burns at home. Sixteen persons (28%) had received burn injury more than once. Scalds with hot liquids/ steam were the leading cause of burn injury (43.8%). Flame related burn injuries were observed in 33% of cases followed by those due to crackers (14%), electric shock (5.3%) and iron (35%). This study reveals that the overall prevalence of burn injury was found to be 14.2%. The peak incidence being in children <5 years and most of the injuries in the present study occurred at home and the hot objects/liquids were the commonest ones. There was a matter of serious concern and requires intensive health education to avoid undesirable remedies in the form of coconut oil, ghee, toothpaste etc.