Designing a multifaceted, community-driven, behavioural change intervention to improve first response to childhood burns (Cool-Burn20)

Burn injuries are extremely common among young children living in urban slum communities in Uganda. Current first aid responses frequently involve home remedies such as applying cooking oil, sugar, eggs and other food materials, commercial creams, toothpaste, soap or traditional medicines such as urine, mud or cow dung. Yet best practice involves simply cooling the burn for 20 minutes with clean water and then, if indicated, seeking formal medical care to reduce complications and disability.

This study, therefore, aims to codevelop an intervention to improve the early response to burns in children <5 years in Kisenyi slum in Kampala and to identify the best delivery mechanism. Our study leverages our previous success working with communities in Uganda, and Makerere University's extensive work with slum communities.

We will develop a low-cost education-based intervention that targets increased knowledge as well as appropriate first-aid responses by parents and carers to childhood burns. We will train Village Health Workers (VHTs) to provide education and advice to carers on cooling the burn and when to seek medical attention. To maximise the reach and success of this intervention, we will explore multiple potential intervention delivery points including through Faith-based Organizations (FBOs), schools and during VHT home visits.

Empowering carers to respond appropriately to burns is key to reducing short- and long-term consequences of burns. Identifying an inexpensive, effective and far-reaching measure to change current practices in urban slum communities in Uganda has the potential to significantly reduce the health burden attributable to burns in these communities and other similar low-resource settings.

Nearly 9 million injuries and 180,000 deaths occur annually due to burns. Almost two-thirds occur in Africa and South-East Asia. Young children are disproportionally affected with under 5's in the African region having an incidence rate >2 times the global rate. Burn injuries are particularly problematic in urban slum communities such as Kisenyi in Uganda, where our recent work revealed a high incidence (32%) of burns among those under 5's. Appropriate first aid - cooling the burn - is critical yet this rarely happens because of a lack of knowledge among carers who generally use home remedies and often only seek formal medical care as a last resort. Such inappropriate first aid and delays in hospital presentation are key factors for poor outcomes. There is thus an urgent need to improve knowledge about what constitutes appropriate first aid and to shift how communities respond to burn injuries.

This study aims to co-develop a sustainable theory-driven contextual intervention to improve burn first aid by carers of under 5's in Kisenyi and to improve timely access to further treatment. We will use the 6SQuID framework to guide the development of the intervention and the socio-ecological model of health behaviour to shape the delivery mechanisms. The study aim will be achieved through a series of four mixed-methods studies including an iterative small-scale pilot study to finalize our theory of change. A co-designed educational package for carers and a training programme for VHTs will be utilized to improve knowledge, attitudes and behaviours. To maximise the reach and success of the intervention, we will explore multiple potential delivery points across Faith-based Organizations, schools and during VHT home visits.

This body of work has the potential to fill many gaps in knowledge important for reducing the health burden in children attributable to burns in Uganda.