Strategies and Challenges of a Safe Fireplace Program in Rural Kenya: A Qualitative Study

There is a lack of information on effective burn prevention strategies. The objective of this study was to examine a safe fireplace program, as a method of burn prevention, in a resource-limited setting. We conducted a qualitative, phenomenological study at a community health and development program for a rural population in Kenya. Semi-structured, in-depth interviews were conducted with a purposive sample of community health workers involved with the safe fireplace program. Data were reviewed iteratively and coded independently by two researchers using NVivo 12. The study included five participants. Reflections from participants fell into three main domains: (1) effective methods of education, (2) strategies to incorporate stakeholders, and (3) implementation challenges. The results of this study emphasize the importance of community engagement in implementing a successful burn injury prevention program in a resource-limited setting. The participants involved in this study reported that rather than focusing on resources outside the community, effective methods of education and strategies for incorporating stakeholders depended on involving peers and community leaders. The challenges to the program were similarly specific to community concerns about resources and maintenance. These findings provide information to guide future community health programs in creating successful models for burn prevention strategies in resource-limited areas.

Burn injuries in KwaZulu-Natal Province, South Africa: Quantifying the healthcare burden

BACKGROUND

Most burn injuries occur in low- and middle-income countries (LMICs) and affect those of lower socioeconomic status disproportionally. A multifaceted approach is needed to improve burn outcomes. Healthcare strategies and reform should be data driven, but South Africa (SA) currently lacks sufficient baseline data related to burn injuries. The absence of local data is compounded by a global lack of published data from LMIC settings. The Pietermaritzburg Burn Service Registry (PBSR) is the only established registry for burn injuries in SA.

OBJECTIVES

To use the high-quality, detailed data from the PBSR to estimate the KwaZulu-Natal (KZN) provincial burden of burns in terms of length of stay, need for surgery and mortality. Our broader aim is to quantify the magnitude of the problem to highlight the need for specific burn care strategies in SA.

METHODS

We conducted an observational, retrospective review of burns data from two databases, the District Health Information System (DHIS) between 2013 and 2018, and the more detailed PBSR between 2016 and 2019. We compared the distribution of mild, moderate and severe injuries as well as the distribution of adult and paediatric admissions between the DHIS and PBSR data sets. We then assumed that outcomes for the province would follow similar patterns to the Pietermaritzburg Burn Service and applied the proportions to the DHIS data set to estimate the annual provincial burden.

RESULTS

In the DHIS, there was an annual mean (standard deviation (SD)) of 4 807 (760) children (age ≤12 years) and 3 622 (588) adults (age >12 years) admitted to hospitals in KZN with burn injuries. Annual average injury severity was 76.0% mild (mean (SD) n=5 539 (1 112.4)), 19.8% moderate (n=1 441 (148.8)) and 4.2% severe (n=312 (24.5)). These proportions were similar in the PBSR. Projections estimate that 2 967 patients would need surgery, with 212 500 hospital days required annually in the province. Additionally, provincial mortality would be 586 patients, including 84% with burns of mild and moderate severity. These deaths are potentially preventable.

CONCLUSION

There is a significant, unquantified burden of burn injury in KZN, highlighting the urgent need for development of specialised surgical services for burns. Collection of more robust national data to verify our projections is required to confirm the need and guide required healthcare reform.

1646. Education Level is Associated with Tetanus Vaccine Coverage: Results from the 2016 BRFSS

Background

Vaccination coverage among US adults for tetanus, a potentially fatal disease, continues to be lower than the national goals. Education has been considered to have positive impact on vaccination coverage. However, recently there have been outbreaks of vaccine preventable conditions in areas with high college completion rates. This study aims to assess the relationship between education and vaccination coverage. Specifically, we looked at the association between education level and tetanus vaccination status of the US adults.

Methods

Data from the 2016 Behavioral Risk Factor Surveillance System, a self-reported annual survey for non-institutionalized adults in the United States from the Centers for Disease Control, were analyzed. The outcome was up-to-date tetanus coverage (within the last 10 years) defined by the response to: have you received tetanus vaccine since 2005? Education was stratified into four categories: (1) grade 11 or less, (2) grade 12/GED, 3) college 1–3 years, and (4) college 4 or more years. Bivariate analyses and multivariable logistic regression were conducted on the analytic sample (n = 417,473) using Stata 15, accounting for weighting and the complex survey design of the BRFSS.

Results

This study identified that 59.9% of US adults are up-to-date on the tetanus vaccine status (Table 1). Higher education level was found to be associated with increased odds of up to date tetanus vaccination. The highest odds were for those with 4 or more years of college education [aOR = 1.31; 95% CI: 1.26–1.35)] while the lowest odds were for those less than grade 11 education, when compared with those with a high school degree [aOR = 0.93; 95% CI: 0.88–0.98] (Figure 1). Other covariates identified as negatively associated with up-to-date tetanus status were race/ethnicity, female sex, unemployment, not being married, not having insurance or a personal healthcare provider, and being above 45 years of age (Figure 1).

Conclusion

This study identified a positive association between up-to-date tetanus status and higher education level. Introducing community-specific vaccination education programs for those without tertiary education, especially for those above age 45 and without insurance, may help increase the overall vaccination status in the United States.

Disclosures

All authors: No reported disclosures.