Fire safety knowledge and emergency preparedness assessment among health care workers at three hospitals in Kunene region, Namibia

Abstract

Background

Hospital preparedness for accidents like fires is essential because fire outbreaks in healthcare settings can occur anytime and require quick responses. Therefore, this study assessed the knowledge of fire safety and emergency preparedness among healthcare workers, as well as the predictors of knowledge of fire safety and emergency preparedness among healthcare workers.

Methods

An institutional-based descriptive cross-sectional online survey was employed to assess knowledge of fire safety and emergency preparedness among 257 healthcare workers from three hospitals in the Kunene region. Both descriptive and inferential statistics were carried out using STATA version 18. Frequencies and percentages were used in the descriptive statistics and Pearson’s chi square test, correlation analysis and logistic regression were adapted for the inferential statistics. The statistical significance level was set at p-value ≤ 0.05 at 95% confidence interval.

Results

The study observed that 72.76% of the healthcare workers lack adequate level of knowledge concerning emergency preparedness while 73.15% of healthcare workers lack sufficient knowledge regarding fire safety. The findings further indicated that there is a strong relationship (r = 0.992) between fire safety knowledge and emergency preparedness among healthcare workers. The study findings also shows that gender (< 0.0001), and place of work (< 0.0001) were associated with knowledge of fire safety and emergency preparedness. Male participants were more likely to have adequate knowledge of fire safety (aOR: 3.74; 95%CI: 2.016 – 6.950) and emergency preparedness (aOR: 3.64; 95%CI: 1.956 – 6.756) compared to females. The healthcare workers at Khorixas district hospital had lower odds (aOR: 0.354; 95%CI: 0.173 – 0.724) of having adequate knowledge of emergency preparedness compared to those working at the Opuwo hospital.

Conclusion

The majority of the studied healthcare professionals did not have adequate knowledge regarding emergency preparedness. Addressing the gaps in fire safety knowledge and preparedness among healthcare workers is critical to ensuring a safe healthcare environment. By implementing targeted training programs and safety protocols, healthcare facilities can significantly enhance their emergency response capabilities, ultimately safeguarding both staff and patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-12211-z.

Background

Hospitals play a critical role in saving lives and help relieve people's suffering during and after disasters. Safe and resilient hospitals have a strong and organized structure, provide efficient services with an emergency response plan, and continue to operate at maximum capacity in the event of a disaster [1]. However, one of the biggest hospital threats is fire outbreak [2].

Fire risks are a broad category, which includes anything that impairs the performance of fire extinguishing materials or equipment, and anything that complicates safety in the event of a fire. For example, a blockage of safe drainage and a faulty irrigation system would be considered fire hazards. This is because the risk level of a structure affects both the likelihood of a fire and the severity of the potential damage a fire could cause if it occurred [3]. For individual fire protection elements to be effective, they should not be viewed separately, but as an integral part of the entire fire protection system. An unintentional fire can cause serious harm to persons, property, corporate operations, cultural assets, and the environment [4].

The toxic risk to humans from fires depends on the main physiological and pathological effects of exposure to poisonous fire fumes and the mechanisms by which they impede escape and lead to disability and death [5]. According to the latest statistics from the U.S. Office of the Deputy of Prime Ministers, the total number of fires in hospitals and health facilities has increased by 10% in the last five years compared to 1998. At the same time, the number increased to false alarms due to equipment failures observed [6].

In 2011, a major fire broke out at AMRI Hospitals, a large private specialty facility in Kolkata, following a shocking and horrific accident, killing 93 people. Unlucky patients in the wards and intensive care units suffocated and died because local fire safety measures were not implemented and firefighters were unable to access the narrow road leading to the hospital [7]. In 2021, a fire caused extensive damage at Charlotte Maxeke Hospital, one of South Africa's largest public hospitals. Although no casualties were reported, hundreds of patients were forced to evacuate the hospital [8]. In May 2022, it was reported that the Ministry of Health in Gauteng, South Africa, was investigating the causes of a fire at a hospital in the capital Pretoria that occurred early Monday morning. No patients or staff were injured in the fire in the temporary buildings of Steve Biko Hospital. For safety reasons, 18 patients and one body had to be moved to other areas of the hospital [9]. This fire is the third such accident to occur at the hospital since last year Namibia, fire incident cases have been reported from different hospitals across the country, (Opuwo District Hospital, Mariental District Hospital, Swakopmund District Hospital, Onandjokwe District Hospital, and Namibia Defence Force Hospital) resulting in the damage of properties in an already poor infrastructural settings [10]. Adequate fire safety knowledge and emergency preparedness are very crucial among healthcare workers in case of fire events in healthcare settings.

A systematic review conducted in sub-Saharan Africa shows that hospital disaster preparedness, including fire incidents, has improved over time. However, health systems in sub-Saharan Africa are still generally considered fragile [11]. An earlier study conducted in South Africa among healthcare workers on disaster preparedness demonstrated a significant relationship between knowledge, attitude, and practices and disaster preparedness among healthcare workers [12]. A cross-sectional study was carried out at a teaching hospital in the Marathwada district to evaluate fire safety knowledge and behaviors. The study concluded that the majority of healthcare professionals had adequate knowledge of fire safety [13]. However, to the best of researchers’ knowledge, there is no study assessing fire safety knowledge and emergency preparedness among healthcare workers working in district hospitals in Kunene region, Namibia.

Opuwo, Outjo, and Khorixas District Hospitals are three hospitals situated in the Kunene region, situated in north-western Namibia. It is vast, dry, mountainous, remote, and sparsely populated with nomadic communities, poor infrastructure, and geographical barriers. These hospitals are vulnerable to fires and the evacuation process could be challenging [3]. It is therefore important to ascertain the knowledge of fire safety and emergency preparedness among healthcare workers working in these major hospitals in the region. Findings from this study will be used to inform policy formation on fire safety and emergency preparedness protocols in these critical health facilities. Additionally, understanding the level of healthcare workers' knowledge of fire safety standards, evacuation procedures, and emergency response measures can help health facilities develop focused training programs and interventions to improve preparedness and response abilities.

Research objectives

1. To assess healthcare workers’ knowledge level of fire safety and emergency preparedness.

2. To assess healthcare workers ability to make use of available firefighting tools within the health facilities.

3. To identify predictors of knowledge of fire safety and emergency preparedness knowledge among healthcare workers.

Methods: study design and area

Study design

The study employed descriptive cross-sectional design. This design collected data from healthcare workers at a single point in time to provide a snapshot of their current fire safety knowledge and preparedness levels at all three hospitals selected for the study [14]. The cross-sectional design enabled the description of the characteristics of a population and analyze relationships between the independent variables (socio-demographic characteristics) and the dependent variables (knowledge of emergency preparedness and fire safety) [15]. Cross-sectional studies are cost-effective and quick to conduct, and as such the researchers adopted this design because the study was not funded and was time bound.

The study is reported using Strengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guideline (Supplementary file 1).

Study area

The study was conducted in the Kunene region of Namibia, encompassing the district hospital environments of Opuwo, Outjo, and Khorixas. Opuwo Hospital is located in north-western Namibia (Opuwo town) and, is the administrative capital of the Kunene Region, Khorixas District Hospital is positioned to the southwest of Opuwo and south of Outjo in Khorixas town while Outjo District Hospital is located in the town of Outjo, which is situated in the southern part of the Kunene Region in Namibia. All these three district hospitals act as referral centers for smaller clinics in the surrounding areas. Outjo and Khorixas district hospitals are in more accessible locations than Opuwo. Opuwo District Hospital being located in a remote area made it challenging in logistical issues such as delivery of supplies. Figure 1 shows the map of Namibia.

Fig. 1.

Map of the Namibia

Study population and sample size

The target population of this study was all healthcare workers at all three hospitals in the region including student healthcare workers at all three hospitals. The sample size was determined based on the total number of healthcare workers available at each hospital during the study period by using mean and Standard deviation from preliminary results calculated using this formula:

$$n={((Z\_(1-\alpha /2)\times \sigma )/\delta m)}^{\wedge }2\text{where}\mathit{n}=\text{Sample size},\mathit{Z}1-\mathit{\alpha }/2=\mathrm{significant}\mathrm{level}\mathrm{of}0.05(95\%CI),\mathit{\sigma }=\text{Standard deviation},\mathit{\delta }=\text{Margin}/\text{allowable error}.$$

Total population: Opuwo District Hospital = 170 HCWs

Outjo District Hospital = 114 HCWS

Khorixas District Hospital = 143 HCWs

Total = 427

Mean and Standard deviation from preliminary results

$$\overline{x}=4.875\sigma =3.72$$

$$n={((1.96\times 3.73)/0.5)}^{\wedge }2=214\times 1.2=256.8\approx 257$$

Number of survey personnel per hospital were selected proportionately

Opuwo District Hospital = 102

Outjo District Hospital = 69

Khorixas District Hospital = 86

Figure 2 shows the selection process for the study participants.

Fig. 2.

Flow chart of selection of participants

Data collection

A semi-structured questionnaire, adapted from the previous studies [16, 17], was used to collect data from the study participants. The questionnaire consisted of six sections. Section 1 of the questionnaire consisted of the Research title and introduction part of the researcher, Sect. 2 had the respondent’s consent part, Sect. 3 consisted of the demographic information of respondents, Sect. 4 with fire safety knowledge questions, Sect. 5 with emergency preparedness questions, and Sect. 6 for the conclusion. The questionnaire was built into an electronic questionnaire using google form. The link to the form was shared with the participants to complete. The researchers assigned co-researchers at all three district hospitals to collect data from participants who could not access the survey link.

The validity and reliability of the knowledge questions were assessed using Cronbach’s Alpha. Cronbach’s Alpha between 0.7 – 0.79 and 0.8 – 0.9 were considered acceptable and good, respectively [18]. The Cronbach’s alpha for fire safety and emergency preparedness knowledge was 0.73 and 0.87, respectively.

Sampling techniques

Participants were recruited using a stratified random sampling method. This approach involved dividing the healthcare workers into distinct strata based on their departments and job roles. Within each stratum, participants were randomly selected to ensure a representative sample from each category.

Healthcare workers were approached during their shifts and invited to participate voluntarily by the assigned co-researcher at all three health facilities. This method ensured that the sample included a diverse range of healthcare professionals, providing a comprehensive overview of the workforce.

Ethical consideration

The respondents were given an option of consent to participate in the study in the first section of the questionnaire, and they were assured that there would be no harm if they chose not to participate. Additionally, the researcher informed the participants that the data from the study would be used solely for educational research purposes and would be kept confidential. Respondents were treated fairly, especially during the selection process of the study sample, as each respondent had an equal chance of participating. The researcher also provided contact details in case the respondents needed clarification. To ensure validity and reliability, the researcher ensured that the instrument accurately represented all of the components of the study's aims and objectives.

Data analysis and statistical techniques

The data were manually cleaned, and uploaded in the SPSS version 25.0 for coding and checking for discrepancies. The data was exported into STATA version 18 for analysis. Descriptive analysis, in the form of frequencies and percentages, was used to summarize the socio-demographic characteristics of the participants, as well as the variability of responses related to fire safety knowledge and emergency preparedness. Also, the level of knowledge of fire safety and emergency preparedness was summarized using descriptive statistics.

The fire safety knowledge section had 8 questions while emergency preparedness section had 9 questions, and Sect. 5 contained 9 questions. Both sections had three possible responses: 'Yes', 'No', and 'Not sure'. 'Yes' marked a right answer, whilst 'No' and 'Not sure' represented incorrect answers. The questions and knowledge scores scales were adapted from the previous studies [17, 19]. Table 1 presents the score interpretation.

Table 1.

Score interpretation

Question scale	Score
Yes	1 point
No	0 point
Not Sure	0 point
Level of Knowledge on Fire Safety
Adequate knowledge	5- 8 points
Inadequate knowledge	0—4 points
Level of knowledge on Emergency Preparedness
Adequate knowledge	6- 9 points
Inadequate knowledge	0- 5 points

Pearson’s correlation analysis was also used to assess whether there were any correlations between fire safety and emergency preparedness parameters among healthcare workers. Additionally, logistic regression analysis was used to identify factors/ predictors that significantly influence the level of knowledge of fire safety and emergency preparedness among healthcare workers, at a significant level of p-value ≤ 0.05 at 95% confidence interval (CI).

Missing data

The study had a 100% response rate. Also, data cleaning was done to remove all inconsistencies and discrepancies in the data. The study had no missing data in the study.

Results

A total of 257 participants from three different hospitals in Namibia were included in the study. All respondents returned the completed questionnaire giving the study a 100% response rate. The study included a higher proportion of females (57%). The majority of healthcare workers who participated had 5 to 10 years of experience (43.2%), followed by those who had worked for less than 5 years (33.1%). While 13.2% of healthcare workers had worked for 11 to 15 years. A smaller percentage, 5.45% of health care workers had more than 20 years of experience. A large number of the participants (126) held bachelor's degrees, accounting for 49% of the sample, whereas 14% (36) had tertiary (non-degree) degrees and only three people (1%) had master’s degree (Table 2).

Table 2.

Social demographic characteristics

Social Demographics	Frequency ( n = 257)	Percent ( %)
Gender
Female	146	56.8
Male	111	43.2
Occupation
Healthcare and Medical Staff	117	45.5
Support and Operational Staff	96	37.4
Others	44	17.1
Age category
18–27	53	20.6
28–37	88	34.2
38–47	85	33.1
48–60	31	12.1
Hospital
Opuwo DH	105	40.9
Outjo DH	67	26.1
Khorixas DH	85	33.1
Years of experience
< 5 years	85	33.1
5–10 years	111	43.2
11–15 years	34	13.2
16–20 years	13	5.1
> 20 years	14	5.4
Level of education
Primary education	22	8.6
Secondary education	70	27.2
Tertiary education	36	14
Bachelor degree	126	49
Masters	3	1.2

The responses provided by each of the participants on the knowledge of fire safety and emergency preparedness are tabulated in Table 3. 85.6% of participants know the location of fire extinguishers in their departments. Majority of participants are unaware of the many different kinds of fire extinguishers and their suitable usage. Approximately 44.0% of healthcare workers know the right technique of operating fire extinguishers.

Table 3.

Knowledge assessment on fire safety and emergencies preparedness

Questions on knowledge assessments	Yes (%)	No (%)	Not Sure N (%)
Knowledge on fire safety
Do you know the locations of fire extinguishers in your department?	220 (85.6%)	37 (14.4%)
Are you familiar with the different types of fire extinguishers and their appropriate uses?	98 (38.1%)	159 (61.9%)
Do you know about different types of fires	108 (42.0%)	149 (58.0%)
The very first thing you will do when you discover a fire at your workplace is to activate the fire Alarm and dial the emergency fire service number. (Yes)*	243 (94.6%)	14 (5.4%)
Do you know the contact number for the local fire department in case of an emergency?	126 (49.0%)	131(51.0%)
Are you aware of any fire alarm system within your workplace?	94 (36.6%)	163 (63.4%)
The important causes of death in fire accidents are smoke and suffocation (Yes)*	243 (94.6%)	14 (5.4%)
Awareness of exit routes in the workplace is important for every employee to escape from fire. (Yes)*	236 (91.8%)	21 (8.2%)
Knowledge on emergency preparedness
Do you know the correct technique for operating a fire extinguisher?	113(44.0%)	144(56.0%)
Can you effectively use a fire hose reel?	90(35.4%)	167(65.0%)
Could you activate the fire alarm system if you discover a fire?	156(60.7%)	101(39.3%)
Do you know the location of the designated fire assembly at your facility in case of a fire emergency?	138(53.7%)	119(46.3%)
Is there an evacuation map displayed in your facility?	63(24.5%)	61(23.7%)	133 (51.7%)
Have you received training on firefighting tools at your facility (hospital) before, i.e., fire extinguishers, fire hose reels, etc.?	51(19.8%)	206(80.2%)
Were you oriented about emergency (fire) escaping routes when you started working?	64(24.9%)	193(75.1%)
Are you aware of emergency evacuation routes (fire signage) in your facility?	194(75.5%)	63(24.5%)
Have you ever participated in any fire safety training, fire drills, or emergency evacuation exercises?	72(28.0%)	185(72.0%)

The findings further shows that 51.7% of healthcare workers are not sure if there is an evacuation map displayed within their working places. A little over quarter of the participants (28.0%) participated in fire safety training, 19.8% never received training on firefighting tools at their facilities. It was also observed that 72.0% of participant have never participated in any fire safety training, fire drills, or emergency evacuation exercises while 80.2% have never received training on firefighting tools at their facilities before, i.e., fire extinguishers, fire hose reels, etc. (Table 3).

A total of 188 (73.15%) and 187 (72.76%) healthcare workers demonstrated an inadequate level of knowledge concerning fire safety and emergency preparedness, respectively.

Table 4 shows the level of knowledge of fire safety and emergency preparedness among the health care workers. Level of knowledge of fire safety was found to be associated with gender (p < 0.0001), place of work (p < 0.0001), and level of education (p < 0.01). Female participants, 121 (82.9%), had inadequate knowledge of fire safety and 45 (40.5%) males had adequate knowledge of fire safety. Also, 43 (40.9%) participants working at Opuwo District hospital had adequate knowledge and 56 (83.6%) participants working at Outjo district hospital had inadequate knowledge.

Table 4.

Association between demographic characteristics and the level of knowledge of fire safety and emergency preparedness

Variables	Level of Knowledge
	Inadequate (%)	Adequate (%)	χ2	p-value
Level of Knowledge fire safety
Gender			17.4	< 0.0001
Female	121 (82.9)	25 (17.1)
Male	66 (59.5)	45 (40.5)
Age catergory			6	p = 0.110
18—27	35 (66.0)	18 (34.0)
28—37	59 (67.1)	29 (32.9)
38—47	69 (81.2)	16 (18.8)
48—60	24 (77.4)	7 (22.6)
Occupation			2.9	p = 0.233
Healthcare and Medical	90 (76.9)	27 (23.1)
Support and Operation	69 (71.9)	27 (28.1)
Others	28 (63.6)	16 (36.4)
Place of work			16.9	< 0.0001
Opuwo District hospital	62 (59.1)	43 (40.9)
Outjo DH	56 (83.6)	11 (16.4)
Khorixas DH	69 (81.2)	16 (18.8)
Years of working experience			2.9	p = 0.581
< 5	57 (67.1)	28 (32.9)
5—10	82 (73.9)	29 (26.1)
11—15	26 (76.5)	8 (23.5)
16—20	11 (84.6)	2 (15.4)
> 20	11 (78.6)	3 (21.4)
Level of education			13.7	< 0.01
Primary education	14 (63.6)	8 (36.4)
Secondary education	56 (80.0)	14 (20.0)
Tertiary education	22 (61.1)	14 (38.9)
Bachelor of education	95 (75.4)	31 (24.6)
Masters	0	3 (100)
Level of Knowledge emergency preparedness
Gender			16.3	< 0.0001
Female	121 (82.9)	25 (17.1)
Male	67 (60.4)	44 (39.4)
Age category			6.9	p = 0.072
18—27	35 (66.0)	18 (34.0)
28—37	59 (67.1)	29 (32.9)
38—47	70 (82.4)	15 (17.7)
48—60	24 (77.4)	7 (22.6)
Occupation			2.9	p = 0.237
Healthcare and Medical	90 (76.9)	15 (12.8)
Support and Operation	70 (72.9)	26 (27.1)
Others	28 (63.6)	16 (36.4)
Place of work			15.7	< 0.0001
Opuwo District hospital	63 (60.0)	42 (40.0)
Outjo DH	56 (83.6)	11 (16.4)
Khorixas DH	69 (81.2)	16 (18.8)
Years of working experience			3.1	p = 0.554
< 5	57 (67.1)	28 (32.9)
5—10	83 (74.8)	28 (25.2)
11—15	26 (76.5)	8 (23.5)
16—20	11 (84.6)	2 (15.4)
> 20	11 (78.6)	3 (21.4)
Level of education			13.1	p = 0.011
Primary education	15 (68.2)	7 (31.8)
Secondary education	56 (80.0)	14 (20.0)
Tertiary education	22 (61.1)	14 (38.9)
Bachelor of education	95 (75.4)	31 (24.6)
Masters	0	3 (100)

Similar to knowledge of fire safety, it was also observed that gender (p < 0.0001), place of work (p < 0.0001) and level of education (p = 0.011) were associated with knowledge of emergency preparedness. Forty-four (39.4%) male participants had adequate knowledge of emergency preparedness compared to 25 (17.1%) female participants. Also, 42 (40.0%) participants working at Opuwo District Hospital had adequate knowledge of emergency preparedness (Table 4).

Figure 3 shows a very strong positive correlation (r = 0.992) between knowledge of fire safety and emergency preparedness among healthcare workers.

Fig. 3.

Correlation between knowledge of fire safety and emergency preparedness

In logistic regression models, similar observations were made for both the unadjusted and adjusted models regarding the predictors of knowledge of fire safety and emergency preparedness. However, the study reported only the adjusted model. Regarding the level of knowledge of fire safety, male participants were almost four times more (aOR: 3.74; 95%CI: 2.016 – 6.950) likely to have adequate knowledge, compared to their female counterparts. Also, participants age 38 – 47 years were 31% less likely (aOR: 0.31; 95%CI: 0.132 – 0.746) to have adequate knowledge of fire safety compared to participants age 18 – 27 years. Regarding place of work, participants working in Outjo district hospital were less likely to have adequate knowledge (aOR: 0.28; 95%CI: 0.125 – 0.607).

Regarding knowledge of emergency preparedness, it was also observed that male participants had higher odds (aOR: 3.64; 95%CI: 1.956 – 6.756) of having adequate knowledge of emergency preparedness compared to female participants. Also, participants age 38 – 47 years were less likely to have adequate knowledge (aOR: 0.29; 95%CI: 0.122 – 0.697) compared to those between 18 – 27 years. Similarly, participants working at Khorixas district hospital had lower odds (aOR: 0.354; 95%CI: 0.173 – 0.724) of having adequate knowledge of emergency preparedness compared to those working at the Opuwo district hospital (Table 5).

Table 5.

Logistic regression models for level of knowledge and demographic characteristics

Variables	Model I	Model II
	cOR (95% CI)	aOR (95% CI)
Knowledge of fire safety
Gender
Female	Ref	Ref
Male	3.30 (1.860—5.856) ***	3.74 (2.016—6.95) ***
Age category
18—27	Ref	Ref
28 – 37	0.96 (0.464—1.967)	0.87 (0.391—1.920)
38—47	0.45 (0.205—0.990) *	0.31 (0.132—0.746) **
48—60	0.57 (0.205—1.566)	0.56 (0.188—1.669)
Occupation
Healthcare and Medical	Ref
Support and Operation	1.304 (0.703—2.422)
Others	1.90 (0.90—4.032)
Place of work
Opuwo District hospital	Ref	Ref
Outjo DH	0.28 (0.133—0.602) **	0.28 (0.125—0.607) **
Khorixas DH	0.33 (0.171—0.652) **	0.340 (0.166—0.694) *
Years of working experience
< 5	Ref
5—10	0.72 (0.387—1.338)
11—15	0.63 (0.252—1.560)
16—20	0.37 (0.077—1.785)
> 20	0.55 (0.143—2.151)
Level of education
Primary education	Ref
Secondary education	0.44 (0.153—1.247)
Tertiary education	1.11 (0.371—3.336)
Bachelor of education	0.57 (0.219—1.489)
Masters	1
Level of Knowledge of emergency preparedness
Gender
Female	Ref	Ref
Male	3.18 (1.789—5.646) ***	3.64 (1.956—6.756) ***
Age category
18—27	Ref	Ref
28—37	0.96 (0.464—1.967)	0.87 (0.394—1.923)
38—47	0.42 (0.188—0.924) *	0.29 (0.122—0.697) **
48—60	0.57 (0.205—1.566)	0.56 (0.189—1.667)
Occupation
Healthcare and Medical	Ref
Support and Operation	0.14 (0.664—2.307)
Others	1.9 (0.90—4.03)
Place of work
Opuwo District hospital	Ref	Ref
Outjo DH	0.29 (0.138—0.627) **	0.287 (0.130—0.633) **
Khorixas DH	0.348 (0.178—0.679) ***	0.354 (0.173—0.724) **
Years of working experience
< 5	Ref
5—10	0.69 (0.368—1.280)
11—15	0.63 (0.252—1.560)
16—20	0.37 (0.077—1.785)
> 20	0.56 (0.143—2.151)
Level of education
Primary education	1
Secondary education	0.54 (0.184—1.56)
Tertiary education	1.36 (0.445—4.178)
Bachelor of education	0.70 (0.261—1.872)
Masters	1

cOR crude odds ratio, aOR adjusted odds ratio

^*—p ≤ 0.05; **—p < 0.001; p < 0.0001

Discussion

This study was an institutional-based descriptive cross-sectional online survey carried out among 257 healthcare workers at three different district hospitals in Kunene region from November to December 2023. The primary objective of this study was to assess the fire safety knowledge and emergency preparedness among healthcare workers in district hospitals of the Kunene region. The findings indicate a significant gap in knowledge, with 72.76% of healthcare workers lacking adequate fire safety knowledge and 73.15% had inadequate knowledge of emergency preparedness.

This findings of the study is reflective in the responses to questions assessing the level of knowledge of fire safety and emergency preparedness among the study participants. For instance, almost 62% of the participants were not familiar with the different types of fire extinguishers and more than half of the participants did not know the different types of fires. Additionally, over half of the participant did not know the contact number for the local fire department in case of an emergency.

This study findings corresponds to the previous studies conducted in Botswana and Kenya [20, 21]. The study in Botswana showed that despite the training the employees had received, they still reflected a knowledge gap towards fire safety measures [20]. Out of 145 participants in a study done in Kenya on an assessment of workplace fire safety preparedness, 72.0% of the staff in the medical training college did not know the emergency telephone numbers to report fire outbreaks [21]. However, the level of knowledge of fire safety of healthcare workers is in contrast with a study conducted in India, where more than half (51.8%) had good knowledge regarding fire safety in hospitals [22]. It is not surprising that the healthcare workers in this study had limited knowledge of fire safety, as a significant majority (72%) of the healthcare workers have never participated in any fire safety training, fire drills, or emergency evacuation exercises. However, there is a need for comprehensive training and education initiatives to enhance healthcare workers awareness and proficiency in fire safety procedures within healthcare settings.

Additionally, the study findings indicates that a majority of healthcare workers (73.2%) lack adequate knowledge on fire emergency preparedness. The findings are further supported by the responses from healthcare workers, who revealed that just over one quarter (28%) of them had taken part in emergency evacuation drills, fire drills, or fire safety training and over half (56.%) of the study population did not know the correct method to operate a fire extinguisher.

Additionally, about 80.2% of healthcare workers had never received any training on firefighting equipment from their workplaces. These findings are similar to two studies, one conducted in Nigeria to assess knowledge and preparedness, and England to evaluate fire safety preparedness among healthcare workers showed that about 64.8% and 73.8% did not know how to operate fire extinguishers, respectively. [18, 19]. Furthermore, the same study conducted in England showed that 89.9% of care workers had not participated in fire drills before [18]. Two studies that were conducted in South East Nigeria public tertiary healthcare facilities and Indian teaching hospitals showed that only 9% and 54% had received training on fire preparedness [13]. These findings emphasize the importance of focused interventions or training programs to improve healthcare personnel's overall preparation of fire emergency preparedness.

The study observes a strong positive relationship between adequate knowledge of fire safety and emergency preparedness among healthcare workers. As fire safety knowledge is increasing, emergency preparedness tends to increase as well. Fire safety education is an effective means of increasing knowledge about fire safety as well as attitudes towards perceived behavioral control over, behavioral intention towards, and behavior related to fire safety [23]. As fire safety training has a potentially positive impact on knowledge and practice of healthcare workers regarding fire management. The study also looked at predictors that can significantly affect the level of knowledge of fire safety and emergency preparedness among healthcare workers. The findings show that gender, place of work, and age can significantly affect the knowledge of fire safety and emergency preparedness among healthcare workers (p < 0.05). Males had higher odds of having adequate fire safety and emergency preparedness knowledge compared to females. As the distribution of knowledge and training may be determined by sociocultural variables and traditional gender roles, men may be more likely to seek out or undergo fire training because of their attitudes towards safety. The disparity in fire safety knowledge between males and females suggests a need for gender-sensitive training programs. Policies should ensure equal access to fire safety training for all healthcare workers, regardless of gender, to bridge this knowledge gap.

Healthcare workers between the age of 38–47 years were less likely to have adequate knowledge of fire safety and emergency preparedness compared to healthcare workers between the age of 18 – 27. Young healthcare workers are more likely to be driven to develop their careers by improving their skills and understanding as well as participate in ongoing professional development and training activities.

Additionally, how well-prepared healthcare workers are for fire safety and emergencies depends on the type of facility, its location, institutional policies, staff experience, responsibilities, and the availability of resources. This is reflected in more healthcare workers at Opuwo district hospital where majority of healthcare workers have adequate knowledge of fire safety and emergency preparedness compared to Khorixas and Outjo district hospital. Opuwo district hospital is located to much populated area, exposing it to high risk of fire outbreak. The variation in preparedness based on the type of facility and its location indicates that policies should be tailored to the specific needs of each healthcare facility. High-risk areas, like Opuwo district hospital, should have more rigorous fire safety protocols and frequent drills.

Strength of the study

To avoid possible bias, the study was carried out using participants from a different study sites. The study discovered significant predictors that can affect healthcare workers' knowledge of fire safety and emergency preparedness. The findings will help in designing and implementation of tailored training programs that will improve healthcare workers' knowledge on fire safety and emergency preparedness issues. Furthermore, this kind of study has never been done in Kunene region, making it the first study to be conducted in these areas and pave the door for future research assessments.

Limitations of the study

The study employed a cross-sectional design which affects the possibility of generalization of study findings. The study relies on self-reported data from healthcare workers, which may introduce recall bias due to respondents providing socially desirable responses or overestimating their knowledge and preparedness level of knowledge.

Conclusion

The study concluded that a significant majority of healthcare workers lack a sufficient level of knowledge about both awareness of fire safety and fire emergency preparedness. The findings indicated a substantial gap in training initiatives. The implications of these findings are alarming, as they suggest a potential risk to both healthcare workers and patients in the event of a fire emergency. Addressing the gaps in fire safety knowledge and preparedness among healthcare workers is critical to ensuring a safe healthcare environment. By implementing targeted training programs and robust safety protocols, healthcare facilities can significantly enhance their emergency response capabilities, ultimately safeguarding both staff and patients.

Abbreviations

DH

District Hospital

EP

Emergency preparedness

FS

Fire safety

STROBE

Strengthening the Reporting of OBservational Studies in Epidemiology

Authors’ contributions

Conceptualization—ENJ; Methodology – MHK, & ENJ; Data Curation: ENJ; Formal analysis – MHK & ENJ; Writing of Original draft – ENJ; Writing review & editing – ENJ & MHK; Supervision & Validation –MHK.

Funding

There was no funding for the study.

Data availability

Data is available upon request.

Declarations

Ethics approval and consent to participate

The Namibian Ministry of Health and Social Services Executive Director's Office provided ethical clearance (Ref: 22/4/2/3). The Kunene regional health directorate also approved the study to be conducted in three respective hospitals as well as healthcare professionals after reviewing and agreeing to the participants’ consent form. Participants were informed of the details of the study before recruiting. Participants who agreed to take part in the study signed an informed consent. Participants’ privacy and confidentiality were ensured.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.