Prehospital burn care for children remained rare in Mazabuka, despite clear first-aid priorities
In Mazabuka District, superficial burns in children were usually met with suboptimal care before arrival at a health facility. Among 337 caregivers of children aged 0–15 years, only 44 provided what the study classified as good prehospital management, a rate of 13.1%. In practical terms, most children reached care after home responses had already drifted away from recommended first aid, where immediate cooling and avoidance of harmful topical applications can limit ongoing tissue injury, pain, and deeper thermal damage. The study focused on a setting where everyday caregiving decisions, travel barriers, and local health messages intersect long before a clinician sees the child.
Burn injury is not finished when the flame goes out or the hot liquid is wiped away.
A small set of caregiver and access variables tracked with better first aid
The cross-sectional study was conducted between September and December 2025 at three health facilities in Mazabuka District. Caregiver interviews were paired with clinical records, and prehospital care was classified as good or poor based on recommended first-aid practices. To evaluate the determinants of better care, investigators used Firth penalised logistic regression, a method suited to sparse outcome data. The analysis identified several independent associations. Urban residence was linked with lower odds of good management, with an adjusted odds ratio of 0.22 and a 95% confidence interval of 0.05 to 0.92. Older caregiver age also tracked with poorer prehospital care, with an adjusted odds ratio of 0.92 per year and a 95% confidence interval of 0.86 to 0.98. By contrast, increasing child age improved the odds of good care, with an adjusted odds ratio of 1.25 and a 95% confidence interval of 1.10 to 1.43.
Longer time to reach a facility was also associated with poorer care, with an adjusted odds ratio of 0.96 and a 95% confidence interval of 0.94 to 0.98. The pattern suggests that distance alone did not operate as a simple geographic problem; the interval between injury and professional assessment likely reflected a broader chain of household decisions, transport delays, and whether first aid was delivered correctly at home. In burns, the earliest minutes matter because cooling with running water can interrupt ongoing heat transfer into the skin, while traditional or improvised treatments can trap heat or contaminate the wound surface.
Why older caregivers and urban households may still miss the recommended response
The finding that urban residence correlated with poorer prehospital management is counterintuitive at first glance, because urban communities are often assumed to have better access to health information and services. Yet access to facilities does not guarantee access to correct first-aid behavior. In urban households, caregivers may still rely on family tradition, prior experience, or community advice that promotes toothpaste, grease, herbs, or other non-recommended applications after a burn. Older caregivers may also carry habits formed long before current injury-prevention messages became routine, and those practices can persist even when a child’s injury is minor and clearly superficial. A child who is older may also be easier to calm, inspect, and treat promptly, while burns in younger children can trigger panic, delay, or uncertainty about severity.
These relationships matter because superficial burns are often the point where prevention and early home care can still alter the trajectory of symptoms and healing. Pain control, infection prevention, and reassurance all begin with the first response, not with later clinic care. When the first response is delayed or misguided, the wound can become more painful and more difficult to manage, even if the burn itself started as a limited injury.
Care messages need to reach households before a child is burned
The study points toward a public health problem that is behavioral as much as logistical. Programmes that promote cooling with running water, avoidance of harmful home applications, and prompt care-seeking are likely to have the greatest value if they reach caregivers before an injury occurs. Routine child health services may be a workable channel for caregivers of younger children, since those visits already bring families into contact with the health system. That pathway may be less effective for older caregivers or for households that live in urban settings and may not attend child-focused services as consistently.
The investigators also show why the label “close to a facility” can be misleading. A family may live within reach of care and still provide poor first aid, and another may be farther away but manage the burn more appropriately while seeking help. The measured association with time to facility therefore likely captures both geography and the urgency of the household response. In burns, the first choice made at home can shape the wound before any clinician can intervene.
What this preprint adds, and what it cannot yet answer
This is a preprint and has not undergone peer review, so the findings should be read as an early step rather than a settled practice guide. The study is still useful because it describes a specific care gap in a pediatric population that often receives fragmented injury advice in low-resource settings. It also identifies the kinds of caregivers who may need different messaging: older adults, urban households, and families where delays to facility arrival coincide with weaker first-aid practice.
The design is cross-sectional, which means it can identify associations but not prove causation. It also evaluates prehospital care as classified from interview and record data, so the study cannot capture every detail of the household response or the exact timing of each first-aid action. Even so, the clinical message is direct: good prehospital burn care was uncommon, and the most actionable determinant was not proximity to a clinic alone but the combination of caregiver characteristics, child age, residence, and the time it took to obtain professional care. Future work will need to test which communication strategies actually change home practice, especially in communities where burn first aid remains shaped more by habit than by evidence.