Determinants of First Aid Knowledge and Basic Practice Among Elementary School Teachers in Debre Tabor Town, Northcentral Ethiopia

1. INTRODUCTION

First-aid is commonly defined as the “immediate assistance given at the time of injury or sudden illness by a stander or other layperson before the arrival of expert medical aid” [1]. First aid is by no means a replacement for emergency services; it is a vital initial step for providing effective and immediate action that helps to reduce serious injuries and improve the chances of survival. Emergency services’ response time is very important since the likelihood of an injured person living or dying depends on the timeliness of life-saving measures [2].

Injuries are the major causes of morbidity and mortality in the world, especially in middle and low-income countries [3, 4]. Globally, in 2013, there were 973 million people who had sustained injuries, of which 77.9% had unintentional injuries that warranted some types of care [4]. Injuries among school-age children are common in developing countries, which account for 13% of all diseases pattern and disability [5]. Unintentional injuries are the leading causes of morbidity and mortality in pediatrics children [5, 6]. Childhood DALY (Disability Adjusted Life Year), attributed to injuries was higher in sub-Saharan African countries [5]. In Ethiopia, injuries caused 25 thousand deaths among 0-14-year olds and unintentional injuries accounted for the majority. The country longitudinal projection survey suggests that there will be 27,807 and 30,364 deaths due to injuries by the year 2020 and 2030, respectively [7].

School-age children are more likely to experience unintentional injuries in the school, while they are playing [8]. School teachers are the primarily responsible body for keeping the welfare of the pupils and oversee their activities. They are the first contact and responsible person when children face injuries [8]. However, studies showed that the level of knowledge and basic practice of first aid among school teachers were found to be poor [9-13]. Different studies were conducted among primary school teachers on first aid level of knowledge in Turkey, India, Bagdad, China, and Ethiopia, which showed that 55%, 74%, 77%, 96.3% and 60% respectively had poor knowledge of first aid management [9-12, 14]. Previous studies indicated that factors affecting the level of knowledge of first aid among elementary school teachers were: age of the participant, year of experience, having previous training on first aid, exposure to children in need for first aid, and level of education [9, 13, 15].

A study conducted in Ethiopia among kindergarten teachers, 80% of participants were encountered a child in need for first aid, but only 89.7% were given first aid [14]. In the country, schools have no nurses or physicians who will give first aid. However, pre-hospital school-based EMS at school by school personnel is mandatory for saving the pupils from disability and death attributed to injury-related problems [16]. Therefore, addressing knowledge and basic practice gaps of a school teacher on first aid is vital, especially at the elementary school level. To the best of researchers’ knowledge, school teachers’ knowledge and basic practice of first aid in Ethiopia, is not clearly known. Thus, this study is the first study in Ethiopia, which assesses the teachers’ knowledge and basic practice of first aid in elementary schools.

2. METHODS

3. RESULTS

3.2. Knowledge of Elementary School Teachers on First Aid

In this study, 35.2%(76), and 81%(175) of the participants took training on first aid and had information about first aid, respectively. Regarding first aid information sources, 21 (12%), 50 (28.6%)), 38 (21.7%), 121 (69.1%), and 82 (46.9%) were obtained from family, books, mass media, health personnel, and health facilities, respectively. Of the total study participants, 99 (45.8%) scored above the mean value of knowledge questions, which implies more than half of the study participants, 117 (54.2%) had no knowledge about first aid.

Based on the respondents' point of view, whether the cases need first aid or not, most of the respondents, 190 (88%), agreed on the needs for first aid in bleeding. Whereas, more than three fourth of the participants did not agree with the need for first aid for human/animal bite (Fig. 1).

Most of the respondents knew the correct measures against stopping bleeding 186(86.1%), followed by choking 147 (68.1%), epilepsy 133(61.6%), epistaxis/nose bleeding 154(71.3%), and breathing difficulty 145(67.1%).

Table 1.

Variable	Frequency	Percent (n=216) (%)
Age in years: 20-24 25-29 30-34 >34	47 71 29 69	21.8 32.9 13.4 31.9
Sex: Male Female	107 109	49.5 50.5
Marital status: In union Not in union	119 97	55.1 44.9
Education: Certificate Diploma Degree & above	34 137 45	15.7 63.4 20.8
Service year: <5 5-10 >10	97 37 82	44.9 17.1 37.9
Type of school: Government Private	133 83	61.6 38.4

4. DISCUSSION

In the present study, less than half (n=99, 45.8%) of the study participants were knowledgeable about first aid. However, 64% (117) reported as they provide first aid at least once. Our finding indicated that study participants provide first aid measures without having detailed knowledge about the problem. The finding of our study is consistent with a study conducted among kindergarten teachers in Addis Ababa, Ethiopia [14], and a sample of elementary school teachers in Kayseri, Turkey [11]. Our finding was higher than a study conducted in Isparta, Turkey, among preschool teachers, which found only 15.5% of participants to have good knowledge of first aid [13]. The variations could be explained by variations in sample size in which the aforementioned studies were conducted among 110 teachers, unlike our study. Variation in measurement could also explain the discrepancy. The finding of our study is also higher than a study conducted in Baghdad, Iraq, among primary school teachers with regards to external bleeding and fracture [10]. This difference might be due to the variation of the number of trained staff on first aid, the accessibility of information, and variation in a school setup.

In this study, those participants who did not take any training on first aid were found to be less knowledgeable compared with those who had training on first aid. The finding suggests that training is an important strategy to increase the knowledge of school teachers on first aid. The finding of our study is consistent with previous studies conducted in Addis Ababa, Ethiopia [14], Shanghai, China [9], and Mangalore, South India [12]. Thus, basic and refreshment training on first aid shall be conducted to increase the knowledge of elementary school teachers on first aid.

With regards to information about first aid, eighty percent of the respondents have information about first aid in this study. The finding is in line with a study conducted in Mangalore, South India (74%) [12] but lower than the finding in Addis Ababa, which was 100%. The variation might be explained by variation in the level of awareness between study participants and the setting in which Addis Ababa is a more urbanized place than Debre Tabor [14]. Unlike the previous studies [11, 13, 18], our study participants’ main sources of information were health personnel and health facilities. In this study, those participants who did not have previous information about first aid were less likely to be knowledgeable than counterparts. A similar finding was reported in the study in Addis Ababa, Ethiopia, in which participants whose sources of information were a health professional or health institution were more likely knowledgeable than others [14].

Service year was found to be significantly associated with the level of knowledge about first aid. Consistent with a previous study [14], the multivariable logistic regression analysis revealed that the odds of being knowledgeable were found to be 3.5 times higher among teachers who had more than five years of experience compared to counterparts. This implies that people can learn from experience in addition to the chance of getting training on first aid and emergency medical care through time. The finding of our study revealed that special emphasis shall be given to newly employed teachers since experience plays its role in the acquisition of knowledge of first aid.

Our study showed that there is a significant association between educational status and their knowledge of first aid. Those diploma holder elementary school teachers were found to be more likely to be knowledgeable compared to certificates. Similarly, those who were degree and above were twelve times more likely to be knowledgeable than counterparts. The finding implies that, the higher the education level, the more likely to be knowledgeable of first aid. A similar finding was reported in the study conducted in Shanghai, China, among preschool teachers which found high knowledge about first aid among teachers who had attended college or more level of education [9]. This implies that educational status affects the level of understanding.

Regarding the basic practice, 163 (75.5%) of the study participants encountered a child who needs first aid, of whom only 64% (n=101) had provided emergency medical aid, 52 (34.2%), and 5 (3.1%) take measure by transferring the injured child to the hospital and calling ambulance respectively. The finding of our study showed that a third of elementary school teacher could not provide appropriate emergency first aid at a school level. Thus, special attention shall be given for improving the practice of elementary school teacher on first aid since unintentional injuries are common in a school setting. The finding of our study is consistent with the study in South India, which found 36.8% did not provide first aid for those in need, and the study in Mysore, India, reported 45.4% poor first aid practice among school teachers [19]. The finding of our study is not supported by the study in Addis Ababa, which found 89.7% of kindergarten teachers provide first aid for children in need [14]. Similarly, our finding is inconsistent with other studies in India, which reported 72%-84% of school teachers provided first aid [12, 20]. The discrepancy may be explained by the difference in availability of first aid room, first aid kit, and emergency drugs in a school setting.

This study shall be seen in consideration of the following limitations. Firstly, the study was conducted in one town, which might affect the generalizability and representativeness of the finding. Secondly, the cross-sectional study design was used, which may affect causal inference. Thirdly, there is a limited number of published papers in Ethiopia and developing countries, so only available literature were used.

CONCLUSION AND RECOMMENDATION

More than half of elementary school teachers did not have knowledge of first aid. Those with an education level of degree and above, having previous training on first aid, availability of information on first aid and work experience of 5 years and more were found to be more knowledgeable than counterparts. School administrators shall give due emphasis for the training of staff on first aid. Integrating first aid in teachers' training curricula shall be considered by the ministry of education.

REFERENCES