RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / NANDINI GUNASEKHARI YEAR M.Sc. NURSING STUDENT
Smt. NAGARATHNAMMA COLLEGE OF NURSING,
ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90
2. / NAME OF THE INSTITUTION / Smt. NAGARATHNAMMA COLLEGE OF NURSING,
ACHARYA DR.SARVEPALLI RADHAKRISHNAN ROAD,BANGALORE – 90
3. / COURSE OF STUDY AND SUBJECT / I YEAR M.Sc. NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO COURSE / 30.06.2012
5. / TITLE OF THE TOPIC / EFFECTIVENESS OF CHILD TO CHILD PROGRAMME ON, “FIRST AID AND PREVENTION OF BURN INJURIES”, AMONG HIGHER PRIMARY SCHOOL CHILDREN AT A SELECTED GOVERNMENT SCHOOL, BANGALORE."
6. / BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION:
"You can teach a student a lesson for a day; but if you can teach him to learn by creating curiosity, he will continue the learning process as long as he lives."
Clay P. Bedford
Tragedy struck a poor family as their eight-year-old daughter, Apoorva, who sustained burn injuries after accidentally falling into piping hot Sambar pot in her school, later died. Apoorva fell into steaming hot sambar when she raced with her friends to stand in the queue for the mid-day meals at the government school at Katte Hunsur in H D Kote taluk in the district Dec 16 2011.1
Accidents are a major cause of morbidity and mortality in children. An accident can be defined as an unexpected, unplanned occurrence of an event which usually produced unintended injury, death or property damage. Injuries cause almost 40% deaths among children and three times more deaths than the next leading cause i.e. congenital anomalies. Accidents represent a major epidemic of non-communicable disease throughout the world.2 Burn injuries are among the most devastating of all accidents and a major global public health crisis. Burns are the fourth most common type of trauma worldwide, following traffic accidents, falls, and interpersonal violence Approximately 90 percent of burns occur in low to middle income countries, regions that generally lack the necessary infrastructure to reduce the incidence and severity of burns.3
Children often suffer burns after contact with open fires, a cooker, irons, curling tongs and hair straighteners, cigarettes, matches, cigarette lighters and many other hot surfaces. Many of the children who go to accident and emergency department with a burn or a scald are referred on for further hospital treatment. Recovery may be long and painful and many are left with permanent scarring. Hot water cause most scalds to children under the age of five. A child’s skin is much more sensitive than an adult’s and a hot water can still scald a child 15 minutes after being burnt. Young children are also very vulnerable to sunburn. Hot bath water is responsible for the highest number of fatal and severe scalding injuries among young children. Around 2000 attend Accident and Emergency departments every year as a result of bath water scalds.4
The older children have increased prevalence of injuries caused by explosions. The greatest average extent of an injury is from burning of clothing. Most of the areas are burned deeply, localized in more areas of the body, and almost half of the cases required surgical intervention. Scalding comes second in terms of average extent of an injury. More than half of the injured areas are superficial, and areas of injury are different in the individual age groups. The explosion of combustible materials caused a smaller extent of injury, on average, taking third place. The injuries were predominantly superficial, most commonly involving the head, trunk, and upper extremities.5
According to fire safety and Burn injury statistics fire kills more than 600 children ages 14 and under each year and injures approximately 47,000 other children. Approximately 88,000 children aged 14 and under are treated at hospital emergency rooms for burn related injuries, 62,500 were thermal burns and 25,500 are scald burns.6 And in India, over 10 lakh people are moderately or severely burnt every year. Around four out of five burnt cases are children.7
A study was conducted about childhood burns and their prevention and the results showed that people should supervise their children more carefully and should take initiative to modify their homes and premises as necessary so that children would not have access to fires and heat sources. Regarding first aid, the focus group participants reported prevailing harmful practices which are likely to make injuries worse. So it is very essential to educate the children and care takers regarding first aid and prevention of burns. 8
6.1 / NEED FOR THE STUDY
According to an article in economically developed countries,burninjuries remain an important public health concern throughout the world. More, and more effective,burn preventionprograms coupled with renewed efforts to reduce the social and environmental correlates ofburninjuries (poverty, overcrowding, family stress, and educational deficits) are needed to further reduceburnincidence and its long-term sequelae.9
According to WHO, Globally burns are a serious health problem. An estimate of 195000 deaths occurs each year from fires alone. Fire related deaths alone rank the 15th leading causes of death among children. Overall children are at high risk for death from burns, with a global rate of 3.9 deaths per 1, 00,000 populations.10
According to a study done in the BeverwijkBurnCentre, a remarkable rise has been noted in the number of pediatric admissions. The mean number of pediatric admissions in the Dutchburncenters per year increased by 44.0% and 44.3% for the youngerchildren(0–4 years) and the olderchildren(5–17 years), respectively, and there has been a shift in pediatricburncare towards a greater volume of admissions in specializedburn care of especially youngchildrenwith less severeburns.11
According to a study done at Vellore the average age of burn victim was 3.8 years; average total body surface area burn was 24%: 64% scald, 30% flame, 6% electric. Annual death rate was 10%, with average fatal total body surface area burn was 40%. However, burns at this center in Vellore, India were larger, and occurred to younger patients.12
According to a study, 309 children of burns injuries treated over last 10 years (1989-1998) in Kasturba Hospital, Manipal (India) were studied retrospectively and were analyzed for incidence, severity, extent, causes, risk factors and overall mortality. Children of age < 5 years were affected more than children of age > 5 years (76.1 vs. 23.9%). Females were affected more than males (74.1 vs. 25.9%). Most of the children received burn injuries in the range of 0 to 20% BSA (63.1%). Scald (72.5%) followed by flame (22.7%) and electrical burn (3.2%) were most common cause of burn injuries. Overall pediatric burn mortality was 7.4%.13
The cause for burn injury in children are lapses in child supervision, storage of flammable substances in the home, low maternal education and overcrowding.14A study was conducted to identify the chief causal agent for scalds. In this study hot water was the chief agent for scalds and the 2 most common scald injury patterns were the child reached up and pulled a pot of hot water off the stove or other elevated surface and the child grabbed , overturned ,or spilled a container of hot water onto him- or herself. One-year-olds were at highest risk for scalds and thermal burns. Scalds resulted in significantly more hospitalizations than did thermal burns. In nearly all injury patterns, more boys than girls were injured, but the ratio varied depending on the injury pattern.15
A review of first aid treatments for burn injuries, throughout history have been many different and sometimes strange treatments prescribed for burns. Unfortunately many of these treatments still persist today, although they often do not have sufficient evidence to support their use. This reviews common first aid and pre-hospital treatments for burns (water—cold or warm, ice, oils, powders and natural plant therapies), the current recommendations for the first aid treatment of burn injuries should be to use cold running tap water (between 2 and 15°C) on the burn, notice or alternative plant therapies16
World Health Organization advocates the use of energies of young people and children towards health promotion. Child to child program, conceived at the institute of child health by David Morley and his colleagues in 1979, is such an effective, economical and active way of improving the health status of the community. Now the scope of child to child has widened from “sibling care” to “child power” (Aarons & Hewers, 1988). Child to child program is based on the principal that children learn by doing, they interact with each other to learn, they influence adults, and they are equal partners in education. It focuses on issues of health, and not mere absence of disease but the importance of happy relationships. It links with what is learnt in the classroom with what we could do out of the class and at home (Rao & Ganguly), 1988
A study was conducted on learning and teaching child to child. The selected children to encourage care for themselves, younger children and members of their community and improve the education and health care. The children were taught many topics based on step by step process. Findings of the study results revealed improvement in the knowledge and attitude of the children in caring for themselves and also taking care of siblings. He concluded that child to child programme is effective.17
Children are very curious to explore things around them. And this curiosity in children sometimes leads to many accidents and injuries since they lack knowledge on first aid and prevention to be adopted by them. Burn injury is also one type of injury which takes place in most of the children. Many children die every year as a result of a burn injury; many more suffer burn related disabilities and disfigurements leading to personal and economic effects for both individuals and their families. Hence the researcher felt it significant to choose a study on first aid and prevention of burn injuries among high school children. As we know, the peer influence is the highest among upper primary children and they could be better influenced by other children than their parents, teachers and other elders; which explains the use of child to child program in this study. So educating the children through this program would be an effective way of reducing the mortality, morbidity and burn related disabilities.
6.2. / REVIEW OF LITERATURE
A research on burn injury as a leading cause of emergency department visits and hospitalizations for young children was studied. They used statewide linked health administrative data to evaluate the incidence, temporal trends, and cause of burn injuries for children younger than 5 years hospitalized for burn injuries in Western Australia for the period 1983-2008.Epidemiologic analysis of linked hospital morbidity and death data of children younger than 5 years hospitalized with an index burn injury in Western Australia for the period 1983-2008. Poisson regression analyses were used to estimate temporal trends in hospital admissions and the external cause of the burn injury. From 1983 to 2008, there were 5398 hospitalizations for an index burn injury and 3 burn-related deaths. Hospital admission rates declined by an average annual rate of 2.3% (incidence rate ratio: 0.977 [95% confidence interval: 0.974-0.981]). More than half of the admissions were for scald burns. Hospitalizations declined for injury caused by scald, flame, contact, and electrical burns; however, the number of hospital admissions increased for chemical burns during the study period. The burn-injury hospitalizations reported in this study were preventable. Most burns occurred in the home and resulted from exposure to a household hazard. Further effort needs to be devoted to burn prevention and safety strategies, particularly in relation to scalds, to further reduce the incidence of burn injury in young children.18
According to a study scald injuries are the most common type of burn in childhood. The authors' aim in this study was to determine the characteristics of scald burns and to identify clinical signs and symptoms which help to predict the indications for hospitalization after scalding burn injury. All patients were retrospectively evaluated according to gender, ages, cause of burn, burn size and depth, distribution of burn area, first aid given, management, and patient's outcomes. The factors affecting indication for hospitalization were retrospectively analyzed in 165 patients, 95 males and 70 females aged 1 month to 13 years (mean 2.74 ± 2.44 years), with scalding burn injury. The most common cause of scald injuries were hot water (106 patients) or hot tea and coffee (39 patients). The mean percent of TBSA burned was 10.26 ± 7.26%. Sixty-nine patients had required hospitalization. In the multivariate logistic regression analyses, among study subjects, only age and TBSA were risk factors significantly correlated to hospitalization (P< .001,P< .01, respectively). Prevention of scald injuries will require a two-prolonged approach: educating families and changing the traditional methods of preparing soup, milk, and tea in Turkey and elsewhere. To create effective programs for preventing scald injuries, it is essential to consider ethnic, cultural, socioeconomic, and environmental factors based on these characteristics.19
A study conducted to examine comprehensively the patterns and trends of burn-related injuries in children treated in US emergency departments between 1990 and 2006 was undertaken. An estimated 2054563 patients ≤15 years of age were treated in US emergency departments for burn-related injuries, with an average of 120856 cases per year. Boys constituted 58.6% of case subjects. Children <6 years of age sustained the majority of injuries (57.7%), and more than one half of all injuries (59.5%) resulted from thermal burns. The body parts injured most frequently were the hand/finger (36.0%), followed by the head/face (21.1%). Of the 1542913 cases for which locale was recorded, 91.7% occurred at home. The rate of burn-related injuries per 10000 children decreased 31% over the 17-year time period. Burn-related injuries are a serious problem for individuals ≤15 years of age and are potentially preventable. Children <6 years of age consistently sustained a disproportionately large number of injuries during the study period. Increased efforts are needed to improve burn-prevention strategies that target households with young children. 20