Teaching Safety, Saving Skin: Preventing Childhood Hot Water Burns Through Caregiver Education in Soweto, South Africa

BACKGROUND: Though preventable, burns are the leading cause of trauma-related death in children under 4 years in South Africa and account for almost half of all pediatric trauma cases at Chris Hani Baragwanath Academic Hospital. We investigated the impact of an education-based pediatric hot water burns prevention program on the knowledge and behavior of caregivers in Soweto. METHODS: We conducted a quasi-experimental nonequivalent controlled before-and-after intervention study with a 7-month follow-up. Households were randomly selected within purposively identified high-burden burns clusters. At baseline, household assessments and caregiver surveys captured burn history, burn risk, first aid knowledge, and household injury risk. Subsequently, all caregivers received structured education on pediatric burns, prevention measures, and first aid. At follow-up, the same households and individuals were reassessed to evaluate for knowledge and behavior change. RESULTS: A total of 242 intervention and 52 control households were assessed. There were no significant differences between the control and intervention households. Most households were severely overcrowded (70.8%, 208/294). Only 7.1% (21/294) had geysers, with 89.8% (264/294) dependent on manually boiled water for bathing, despite most households being electrified (97.9%, 288/294). Relative to baseline, there was a 30.8% (95% CI 22.2%-40.9%) increase in knowledge on the correct first aid for hot water burns postintervention. A 43.3% (95% CI 36.5%-50.5%) increase in stove tops being kept > 1.4 m off the ground, 40.3% (95% CI 30.0%-51.4%) increase in appropriately checking the temperature of bath water, 38.3% (95% CI 29.1%-48.4%) increase in ensuring pot handles are out of reach, and 23.5% (95% CI 15.8%-33.6%) decrease in handling of hot beverages while holding a child were also noted postintervention (all exact McNemar p < 0.001). There was no change in the number of households with childfree safe zones postintervention. CONCLUSIONS: Caregiver education was associated with significant improvements in caregiver knowledge and selected safety practices. Structural constraints, such as overcrowding, may limit the adoption of some positive behavioral changes, underscoring the need for additional system level intervention.