Comparing burn wound for under-five children between rural and urban areas in Dodoma Region: understanding caregiver supervision, household hazards, and children’s risk behaviours on the burn wound

Abstract

Background

Burn injuries among children under five remain a significant public health concern globally, particularly in low- and middle-income countries like Tanzania. Despite various national efforts, the burden and associated factors of burns, particularly in relation to rural-urban differences, have not been well-documented in the Dodoma Region. The study aimed to compare the prevalence of burn wounds and associated factors among children under five years old between rural and urban areas in Dodoma Region.

Methods

An analytical cross-sectional study was conducted from May to June 2025, involving 299 children under five years from both rural and urban areas in the Dodoma Region. Data were collected through structured questionnaires and analyzed using SPSS version 27 with descriptive and inferential statistics.

Results

Overall, the prevalence of burn wounds for children under five was 78 (26%) for both urban and rural areas. By categorizing, 31 (39.7%) of burn wound cases were from urban areas, and 47 (60.3%) cases were from rural areas. In rural areas, good caregiver supervision was associated with the majority of children under five ending up with no burn wound (χ² = 4.16, P = 0.04). The household hazards in urban areas were associated with burn wounds among children under-five (χ² = 17.69, P < 0.001). In rural areas, the under-five children without risk behaviours were associated with most of under five children ending up with no burn wound (χ² = 4.31, P = 0.038). Moreover, several participants’ sociodemographic characteristics were associated with the prevalence of burn wounds.

Conclusion

This study found that burn injuries among under-five children in the Dodoma region are more prevalent in rural areas than in urban areas. In comparing predictors of burn wounds in rural and urban areas, a major contributing factor to burn wounds in rural areas is poor caregiver supervision, while the predictor of burn wounds in urban areas is household hazards.

Introduction

Globally, burns are a significant concern, mainly affecting young children, especially those under five years of age [1]. It is estimated that burn wound accounts for about 180,000 deaths annually [2]. The incidence of burn deaths among those under 5 years of age in Africa is over 2 times greater than that among children under 5 years of age worldwide [3]. In Uganda, the prevalence of burns among children under five years, especially those aged 2–5 years, is high at 32% [4]. Factors associated with burn injuries globally have been reported, such as low family income, children of teenage mothers [5], overcrowding, open cooking stoves without demarcated cooking areas, and caregiver negligence [4]. Moreover, children under five are vulnerable to burn injuries due to their limited physical and cognitive development [6].

Burns in the human body are injuries caused by heat, electricity, radiation, friction, contact with a chemical [7], or moist heat [8]. The types of burn are classified by depth criteria of burn wound as follows: superficial burns (first degree) involve only the epidermis and are warm, painful, red, soft, and blanch when touched. Usually, there is no blistering [9]. Partial-thickness burns (second-degree) extend through the epidermis and into the dermis; the depth into the dermis can vary (superficial or deep dermis). Examples include burns from hot surfaces, hot liquids, or flames [7]. Full-thickness burns (third-degree) extend through both the epidermis and dermis and into the subcutaneous fat or deeper. These burns have little or no pain, can be white, brown, or charred, and feel firm and leathery to palpation with no blanching [10].

In Tanzania, burns among children under five remain a public health concern, with the prevalence of 36.6%, whereby 36.9% of burn wounds occur at home with open flame [11]. Traditional practices, such as applying cooked herbs to children’s skin, can cause burns and infections at the wound site [12]. Poor storage of hazardous materials, which makes them easily accessible to children, was found to be a contributing factor in some burn wound cases, as reported in research [12]. With little documentation of burn wounds for under-five in Tanzania, but one scholarly work dated ten years ago shows the following to be associated with burn wound for children under five; children aged 1–2 years of age, lack of enough space for playground, and under-five children to be under custodian of male parents/guardians [13]. The most recent study indicated that the majority of children under-five who encounter burn wounds are females [14].

Even though the prevalence and the influencing factors for burn wounds in children under five are reported, little is known about the differences between rural and urban settings. Also, the linkage of caregiver supervision, household hazards, and children under-five’s risk behaviors with burn wounds is less known. Therefore, the study aimed to compare the prevalence of burn wounds in children under five and associated factors between rural and urban areas in the Dodoma region. The study had four specific objectives (i) to determine the prevalence of burn wound among under-five children in rural and urban areas of Dodoma Region (ii) to examine caregiver supervision factor influencing burn wound for under-five children in rural and urban areas of Dodoma region (iii) to identify household hazards influencing burn wound among under-five children between rural and urban areas of Dodoma region (iv) to assess under-five children risk behaviors influencing burn wound between rural and urban areas of Dodoma region.

Methods

Study area

The study was conducted at Dodoma Region Referral Hospital in Dodoma region, Tanzania. The facility has a pediatric unit that receives children of different age groups and with various medical issues. Dodoma is one of Tanzania’s administrative regions and its capital city. The Dodoma region was chosen as the reported household hazard, where the majority of residents use biomass energy for cooking. The household hazards are relatively higher in the rural setting (89%) as opposed to the urban setting (53.1%) [15]. Furthermore, the Dodoma region is chosen because it accounts for 16.3% of burns for children under five [16].

Study design

It is an analytical cross-sectional study for comparing the prevalence of burn wounds for children under five and associated factors between rural and urban areas in the Dodoma region. The study design is chosen because the outcome and the exposures in the study participants are investigated at the same time, and it is the design recommended for assessing the prevalence of diseases in clinic-based samples [17].

Study population

The study population was under-five children who are reported to be a vulnerable group for burn wounds [18]. This population belonged to either urban or rural areas and lived with parents or guardians.

Inclusion and exclusion criteria

The study included children who were under 5 year’s old and considered caregivers who were able to communicate in Swahili or English. The study excluded participants whose parents/guardians were not ready to complete the informed consent.

Sample size calculation and sampling technique

Sample size

From the study conducted in Dar es Salaam, which reported 26% of burn wounds for children under-five [19], the proportion of 26% was used for the calculation of the sample size.

The sample size was calculated by using this formula.

Sample size (n):

Whereby.

n = Sample size.

Z = Confidence interval level, 95% in this study is 1.96.

P used by the previous study was 26% for the maximum sample size.

Margin error (e) was approximately 5%.

Hence;

Therefore, the Sample size of the study is 299 participants.

Simple random sampling was applied, in which all children under five years had an equal chance to participate, provided that they met the criteria.

Data collection procedure and data collection tools

Data were collected by the principal investigator from June to July 2025 at Dodoma Region Referral Hospital, where a self-administered questionnaire was used to collect the data. The questionnaires used in this study were adopted from the previous studies [4] and [20], conducted in Tanzania. All questionnaires were valid and reliable, with an acceptable Cronbach’s Alpha. The questionnaire had five sections: Sect. 1, Demographic and Household Information; Sect. 2, Prevalence of Burns (with one item asking parents/guardians whether their under-five children have ever got burn wound); Sect. 3, Caregiver Supervision (three items); Sect. 4, Household Hazards (five items); and Sect. 5, Risk-Taking Behavior (seven items). The original questionnaires were initially in English, but they were translated into the Swahili language for the convenience of participants.

Data analysis

Data were entered and analyzed using SPSS Version 27. Descriptive statistics were used to summarize the data findings, including frequencies, means, percentages, and standard deviations, which were presented in tables and figures. The Chi-squared test (x²) was used to determine the association between variables, and a p-value ≤ 0.05 was considered statistically significant.

Ethics approval and consent to participate

Ethical approval for conducting this research study was obtained from the Institutional Research Review Board of the University of Dodoma, with Reference Number PB.22/1307/02. All procedures were conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. Informed consent, either verbal or written, was obtained from each parent/guardian of a child under five. Participants were free to participate voluntarily and free to withdraw from the study anytime they felt like doing so. The confidentiality was ensured by keeping the participants’ names anonymous.

Results

Social demographic characteristics of study participants

The total number of participants in the current study was 299 under-five children, distributed as urban area (n = 151) and rural area (n = 148). The majority of participants belonged to the 12-35-month age group, 33.92 ± 6.89 (8–59 months), with 125 (82.8%) from urban areas and 131 (88.5%) from rural areas. Regarding the sex of the child, most were males in urban areas 97 (64.2%) and females in rural areas 77 (52%). Refer to Table 1.

Table 1.

Social demographic characteristics of study participants (n = 299)

Variable	Urban n = 151		Rural n = 148
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Under-five Age group (months)
Mean ± SD (Min-Max) 33.92 ± 6.89 (8–59 months)
Infant (0–11 months)	2	1.3	2	1.4
Toddler (12–35 months)	125	82.8	131	88.5
Pre-school (36–60 months)	24	15.9	15	10.1
Head of the family
Grand father	1	0.7	11	7.4
Father	128	84.8	107	72.3
Mother	22	14.6	29	19.6
Grand mother	0	0	1	0.7
Number of Under-five children per household
One child	109	72.2	65	43.9
More than one child	42	27.8	83	56.1
Sex of child
Female	54	35.8	77	52.0
Male	97	64.2	71	48.0
Who takes care of the child
Grand mother	2	1.3	12	8.1
Mother	85	56.3	103	69.6
Child sister	14	9.3	21	14.2
House maid	35	23.2	2	1.4
Aunt	14	9.3	9	6.1
Father	1	0.7	1	0.7
Sex of parent/guardian
Female	150	99.3	135	91.2
Male	1	0.7	13	8.8
Age of parent/guardian
Mean ± SD (Min-Max) 31.02 ± 9.818 (15–70)
15–19	33	21.9	15	10.1
20–29	28	18.5	50	33.8
30–39	85	56.3	63	42.6
40–49	3	2.0	8	5.4
50–70	2	1.3	12	8.1
Parent/guardian education level
Never gone to school	3	2.0	16	10.8
Primary educational level	41	27.2	119	80.4
Secondary educational level	82	54.3	8	5.4
University/college educational level	15	9.9	2	1.4
Vocational training education	10	6.6	3	2.0
Parent/guardian occupation
Farming	4	2.6	97	65.5
Entrepreneur	107	70.9	44	29.7
Employed	33	21.9	6	4.1
Housewife	3	2.0	1	0.7
Type of housing
Mud house	1	0.7	141	95.3
Brick house	150	99.3	7	4.7
Cooking energy
Firewood	56	37.1	114	77.0
Charcoal	80	53.0	33	22.3
Gas	15	9.9	1	0.7

About sociodemographic characteristics for only participants with burn wounds, 47 (60.3%) were from rural areas and 31 (39.7) from urban areas. The majority of participants, 19 (61.3%), from urban areas were pre-school (36–60 months), while most of the under-five in rural areas, 30 (63.8%), were toddlers (12–35 months). In all areas, urban and rural, the father was reported as the head of the family, with 27 (87.1%) and 27 (57.4%), respectively. Most of the households in the urban areas 20 (64.5%) had one child who was under-five years, while most of the households in the rural areas 38 (80.9%) had more than one child under five years. Regarding the sex of the child, most were males in urban areas 25 (80.6%) and 24 (52%) in rural areas. Housemaids were found to be fully taking care of under-five children in urban areas, 14 (45.2%), while mothers in rural areas 26 (55.3%) were responsible for taking care of under-five children. Most of the carers of the under-five children were female, with 41 (87.2%) in the urban and 41 (87.2%) in the rural areas. The participants from urban areas were aged 15–19 years, 13 (41.9%), while 15 (31.9%) participants in the rural areas were aged 30–39. Regarding educational level, the majority of parents from urban and rural areas had a primary educational level, 12 (38.7%) and 36 (76.6%), respectively. Parent/guardian living in the urban area 21 (67.7%) were entrepreneurs, but 26 (55.3%) of parents from rural areas were farmers. Regarding cooking, energy, the majority of participants, 16 (51.6%) from the urban area used gas, but 37 (78.7%) from the rural area used firewood. Refer to Table 2.

Table 2.

Sociodemographic characteristics of under-five-children with burn wound (n = 78)

Variable	Urban n = 31		Rural n = 47
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Under-five Age group (months)	Mean ± SD (Min-Max) 35.32 ± 12.483 (8–58 months)		Mean ± SD (Min-Max) 31.72 ± 13.36 (8–59 months)
Infant (0–11 months)	2	6.5	2	4.3
Toddler (12–35 months)	10	32.3	30	63.8
Pre-school (36–60 months)	19	61.3	15	31.9
Head of the family
Grand father	-	-	8	17.0
Father	27	87.1	27	57.4
Mother	4	12.9	12	25.5
Number of Under-five children per household
One child	20	64.5	9	19.1
More than one child	11	35.5	38	80.9
Sex of child
Female	6	19.4	23	48.9
Male	25	80.6	24	51.1
Who takes care of the child
Grand mother	1	3.2	8	17.0
Mother	12	38.7	26	55.3
Child sister	2	6.5	10	21.3
House maid	14	45.2	2	4.3
Aunt	2	6.5	1	2.1
Sex of parent/guardian
Female	41	87.2	41	87.2
Male	6	12.8	6	12.8
Age of parent/guardian
Mean ± SD (Min-Max) 31.02 ± 9.818 (15–70)
15–19	13	41.9	9	19.1
20–29	7	22.6	12	25.5
30–39	10	32.3	15	31.9
40–49	-	-	3	6.4
50–70	1	3.2	8	17.0
Parent/guardian education level
Never gone to school	3	9.7	6	12.8
Primary educational level	12	38.7	36	76.6
Secondary educational level	9	29.0	4	8.5
University/college educational level	5	16.1	1	2.1
Vocational training education	2	6.5	-	-
Parent/guardian occupation
Farming	-	-	26	55.3
Entrepreneur	21	67.7	18	38.3
Employed	9	29.0	3	6.4
Housewife	1	3.2
Cooking energy
Firewood	-	-	37	78.7
Charcoal	10	32.3	10	21.3
Gas	16	51.6	-	-
Electricity	5	16.1

Prevalence of burn wounds in children under five by location

Overall, the prevalence of burn wounds for children under five was 78 (26%) for both urban and rural areas. By categorizing, 31 (39.7%) of burn wound cases were from urban areas, and 47 (60.3%) cases were from rural areas.

Association of participants’ sociodemographic characteristics and prevalence of burn wounds

The prevalence of burn wound in the urban areas for under-five children was associated with the child being a preschooler (36–60 months) (χ² = 70.35, P < 0.001), male child (χ² = 4.57, P = 0.03), parents/guardians aged 15–19 (χ² = 13.38, P = 0.01), child being taken care by housemaid (χ² = 12.27, P = 0.031), the carer being a female (χ² = 3.89, P = 0.048), and the carer with primary educational level (χ² = 19.63, P = 0.001). Meanwhile, the prevalence of burn wound in the rural areas for under-five children was associated with the child being a toddler (12–35 months)(χ² = 41.27, P < 0.001), father being the head of the family (χ² = 12.33, P = 0.006), household with one under-five child (χ² = 17.16, P < 0.001), parents/guardians aged 30–39 (χ² = 15.62, P = 0.004), and the child being taken care by mothers (χ² = 17.74, P = 0.003). Refer to Table 3.

Table 3.

Sociodemographic factors associated with the prevalence of burn wounds

Variable	Prevalence of burn wound in urban areas		χ2	P	Prevalence of burn wound in rural areas		χ2	P
	Yes n (%)	No n (%)			Yes n (%)	No n (%)
Under-five Age group (months)
Infant (0–11 months)	2 (6.5)	0 (0)	70.35	< 0.001	2 (4.3)	0 (0)	41.27	< 0.001
Toddler (12–35 months)	10 (32.3)	115 (95.8)			30 (63.8)	101 (100)
Pre-schooler (36–60 months)	19 (61.3)	5 (4.2)			15 (31.9)	0 (0)
Head of the family
Grand father	0 (0)	1 (0.8)	0.36	0.84	8 (17)	3 (3)	12.33	0.006
Father	27 (87.1)	101 (84.2)			27 (57.4)	80 (79.2)
Mother	4 (12.9)	18 (15)			12 (25.5)	17 (16.8)
Grand mother	-	-			0 (0)	1 (1)
Number of Under-five children per household
One child	20 (64.5)	89 (74.2)	1.14	0.29	9 (19.1)	56 (55.4)	17.16	< 0.001
More than one child	11 (35.5)	31 (25.8)			38 (80.9)	45 (44.6)
Sex of child
Female	6 (19.4)	48 (40)	4.57	0.03	23 (48.9)	54 (53.5)	0.26	0.61
Male	25 (80.6)	72 (60)			24 (51.1)	47 (46.5)
Age of parent/guardian
15–19	13 (41.9)	20 (16.7)	13.38	0.01	9 (19.1)	6 (5.9)	15.62	0.004
20–29	7 (22.6)	21 (17.5)			12 (25.5)	38 (37.6)
30–39	10 (32.3)	75 (62.5)			15 (31.9)	48 (47.5)
40–49	0 (0 )	3 (2.5)			3 (6.4)	5 (5)
50–70	1 (3.2)	1 (0.8)			8 (17)	4 (4)
Who takes care of the child
Grand mother	1 (3.2)	1 (0.8)	12.27	0.031	8 (17)	4 (4)	17.74	0.003
Mother	12 (38.7)	73 (60.8)			26 (55.3)	77 (76.2)
Child sister	2 (6.5)	12 (10)			10 (21.3)	11 (10.9)
House maid	14 (45.2)	21 (17.5)			2 (4.3)	0 (0)
Aunt	2 (6.5)	12 (10)			1 (2.1)	8 (7.9)
Father	-	-			0 (0)	1 (1)
Uncle	0 (0)	1 (0.8)			-	-
Sex of parent/guardian
Female	30 (96.8)	120 (100)	3.89	0.048	41 (87.2)	94 (93.1)	1.36	0.35
Male	1 (3.2)	0 (0)			6 (12.8)	7 (6.9)
Parent/guardian education level
Never gone to school	3 (9.7)	0 (0)	19.63	0.001	6 (12.8)	10 (9.9)	3.3	0.51
Primary educational level	12 (38.7)	2 9(24.2)			36 (76.6)	83 (82.2)
Secondary educational level	9 (29)	73 (60.8)			4 (8.5)	4 (4)
University/college educational level	5 (16.1)	10 (8.3)			1 (2.1)	1 (1.0)
Vocational training education	2 (6.5)	8 (6.7)			0 (0)	3 (3)
Parent/guardian occupation
Farming	0 (0)	4 (3.3)	2.17	0.54	26 (55.3)	71 (70.3)	4.19	0.24
Entrepreneur	21 (67.7)	86 (71.7)			18 (38.3)	26 (25.7)
Employed	9 (29)	24 (20)			3 (6.4)	3 (3)
Housewife	1 (3.2)	6 (5)			0 (0)	1 (1)
Cooking energy
Firewood	-	-	1.77	0.41	37 (78.7)	77 (76.2)	0.52	0.77
Charcoal	10 (32.3)	46 (38.3)			10 (21.3)	23 (22.8)
Gas	16 (51.6)	64 (53.3)			0 (0)	1 (1)
Electricity	5 (16.1)	10 (8.3)			-	-

Caregiver supervision practices

Regarding whether children are left unsupervised, most children are allowed in the kitchen while cooking in both urban and rural areas, 27 (87.1%) and 42 (89.4%) in rural areas. Meanwhile, 20 (64.5%) of parents/guardians from urban areas store hot liquids within reach of children compared to 10 (21.3%) of parents/guardians in rural areas. Most parents/guardians in the urban areas, 26 (83.9%), train their children on the risk of burn wounds compared to 37 (78.7%) parents/guardians in the rural areas who don’t train their children. Refer to Table 4. In rural areas, the Chi-squared test revealed that good caregiver supervision was associated with the majority of children ending up with no burn wounds (χ² = 4.16, P = 0.04), different from urban areas, where caregiver supervision was not significantly associated with the prevalence of burn wounds. Refer to Table 5.

Table 4.

Caregiver supervision practices

Variable	Urban area (n=31)		Rural area (n=47)
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Children allowed in kitchen while cooking
No	4	12.9	5	10.6
Yes	27	87.1	42	89.4
Hot liquids are stored within reach of children
No	11	35.5	37	78.7
Yes	20	64.5	10	21.3
Don’t Train child on the risk of burn wound
No	26	83.9	10	21.3
Yes	5	16.1	37	78.7

Table 5.

Caregiver supervision practices, household hazards, and children’s risk behaviours associated with the prevalence of burn wounds

Variable	Prevalence of burn wound in urban areas		χ2	P	Prevalence of burn wound in rural areas		χ2	P
	Yes n (%)	No n (%)			Yes n (%)	No n (%)
Caregiver supervision practices
Poor supervision	11 (35.5)	54 (45)	0.91	0.34	11 (23.4)	41 (40.6)	4.16	0.04
Good supervision	20 (64.5)	66 (55)			36 (76.6)	60 (59.4)
Household hazards
Non-Hazardous home	8 (25.8)	81 (67.5)	17.69	< 0.001	33 (70.2)	73 (72.3)	0.07	0.79
Hazardous home	23 (74.2)	39 (32.5)			14 (29.8)	28 (27.7)
Children’s risk behaviours
Without risk behavior	16 (51.6)	67 (55.8)	0.18	0.67	32 (68.1)	84 (83.2)	4.31	0.038
With risk behavior	15 (48.4)	53 (44.2)			15 (31.9)	17 (16.8)

Household hazards

This study found that most of the children from rural areas 45 (95.7%) had no safe areas for playing compared to 27 (87.1%) of children from the urban areas who had safe areas to play. Children from urban areas, 27 (87.1%), belonged to families with the presence of open fire for cooking, but 37 (78.7%) children in the rural areas did not belong to families with open fire for cooking. Most of the children in both urban and rural areas lived in families without the presence of unsealed electric wire in the house, 16 (51.6%) and 47 (100%), respectively. There was a presence of hot objects like iron accessible by children in the urban areas, 19 (61.3%), but in the rural areas, 42 (89.4%) indicated no presence of hot objects accessible by children. Similarly, there was a presence of chemical liquids accessible by children in the urban areas, 17 (54.8%), while 46 (97.9) showed the presence of no chemical liquids accessible by children in rural areas. Refer to Table 6. Through a Chi-squared test, the household hazards in urban areas were associated with burn wounds among children under-five (χ² = 17.69, P < 0.001), in contrast with rural areas, where household hazards were not associated with the prevalence of burn Refer to Table 5.

Table 6.

Household hazards

Variable	Urban n = 31			Rural n = 47
	Frequency (n)	Percentage (%)	Frequency (n)		Percentage (%)
Have no safe area for children to play
No	27	87.1	2		4.3
Yes	4	12.9	45		95.7
Presence of any open fire in the house for cooking
No	4	12.9	37		78.7
Yes	27	87.1	10		21.3
Presence of unsealed electric wire in the house
No	16	51.6	47		100.0
Yes	15	48.4	0		0
Presence of hot object like iron accessible by children
No	12	38.7	42		89.4
Yes	19	61.3	5		10.6
Presence of chemical liquids accessible by children
No	14	45.2	46		97.9
Yes	17	54.8	1		2.1

Children’s risk behaviours

This study found that the majority of the study participants from both rural and urban areas imitated adults’ practices, with 46 (97.9%) and 30 (96.8%), respectively. Children in both areas were not practicing risk activities, with 29 (93.5%) in urban and 45 (95.7%) in rural areas. Most of the children from urban areas, 27 (87.1%), imitate what they watch on TV compared to 46 (97.9%) children in rural areas who did not imitate what they watched on TV. In both rural and urban areas, most children explored things without permission, with 47 (100%) and 29 (93.5%), respectively. Meanwhile, children did not attempt to break or open prohibited things in both urban 45 (95.7%) and rural areas 45 (95.7%). Similarly, children did not play with fire in both urban and rural areas, 29 (93.5%) and 27 (57.4%), respectively. In both rural and urban areas, children play near the kitchen, with 17 (54.8) in urban areas and 26 (55.3%) in rural areas. Refer to Table 7. In rural areas, the Chi-squared test demonstrated that under-five children without risk behaviours were associated with most children ending up with no burn wound (χ² = 4.31, P = 0.038), in contrast with urban areas, where children’s risk behaviours were not associated with the prevalence of burn wounds. Refer to Table 5.

Table 7.

Children risk behaviours

Variable	Urban area n = 31		Rural area n = 47
	Frequency (n)	Percentage (%)	Frequency (n)	Percentage (%)
Children imitate adult practices
No	1	3.2	1	2.1
Yes	30	96.8	46	97.9
Children practice risk activities
No	29	93.5	45	95.7
Yes	2	6.5	2	4.3
Children imitate what are watched from the tv
No	4	12.9	46	97.9
Yes	27	87.1	1	2.1
Children explored things without permission
No	2	6.5	0	0
Yes	29	93.5	47	100.0
Children attempt to break or open prohibited things
No	45	95.7	45	95.7
Yes	2	4.3	2	4.3
Children play with fire
No	29	93.5	27	57.4
Yes	2	6.5	20	42.6
Children play near the kitchen
No	14	45.2	21	44.7
Yes	17	54.8	26	55.3

Discussion

The prevalence of burn wounds among five children in rural and urban areas of the Dodoma Region

From the hospital-based study, it was found that out of 299 children, 78 (26.1%) had a history of burn wounds. Of these, 60.3% were from rural areas, while 39.7% were from urban areas. This finding suggests a higher prevalence of burn injuries in rural areas compared to urban areas. The findings of this study are comparable to the previous study conducted in Iran, indicating five out of sixty cases, which is equivalent to 8.3% are, occur in rural areas, and 14 out of 270, equal to 5.2%, occur in urban areas [21]. It is also consistent with the findings of the retrospective descriptive study, showing that 58.7% of burn cases for children were from rural areas compared to 41.3% of urban areas [22]. The leading cause of burn wounds in the rural areas is also reported from central China, showing 38.30% in the urban area and 61.70% in the rural area [23].

Caregiver supervision factor influencing burn wounds among children under-five in rural and urban areas

It was found in the current study that good caregiver supervision was associated with the majority of children under-five ending up with no burn wound in rural areas, which is supported by the previous cross-sectional study carried out in Gambia, which reported that supervisory neglect has been associated with child burn wounds [24]. Similarly, a study done in Dar es Salaam, Tanzania, reported a strong association between lack of caregiver supervision and burn injuries [19]. Descriptively, the caregiver supervision between urban and rural areas differed in two areas, namely “storing hot liquids within reach of children and “training children about the risk of burn wounds”. Parents/guardians from urban areas stored hot liquids within the reach of children compared to parents/guardians in rural areas. This might be triggered by a certain kind of person taking care of the child. Since housemaids are the ones employed to look after children under-five while parents are at work, their seriousness of handling risks of burn wounds, like safe storing hot liquids, is suboptimal compared to if a real parent were at home. This is supported by the findings in the previous study showing that under-five children with tighter mother supervision had lower odds of childhood injuries [25]. With house maid, supervision for under-five children seems unsatisfactory because they are very much occupied with routine home activities, underpaid, less valued, and harassed. All of these aspects make them tired and decrease their work morale, which directly affects the supervision of children under-five. It is supported by findings from a mixed-methods study reported that the majority of house maids (92.5%) are underpaid if compared to International and National standards [26]. It is further reported that house maids have been turned into abused, where they encounter sexual harassment from their employers [27]. Furthermore, most homes have no architectural infrastructure for special rooms for storing hot liquids; rather, most homes use unlocked kitchen and unlocked dining rooms to store hot liquids. Also, some of the cupboards for storing hot liquids are not elevated from the surface to prevent children from reaching them. Therefore, community interventions should be directed to housemaids to improve their supervision of children under-five. Moreover, the improvement of home infrastructure might reduce burn wound incidents.

Household hazards influencing burn wounds among children under-five

The household hazards were highly identified in the urban areas compared to rural areas. These hazards were significantly associated with burn wounds for children under-five. The identified hazards in the urban area were the presence of open fire for cooking, the presence of hot objects like iron accessible to children, and the presence of chemical liquids accessible to children. These results are supported by previous studies done, which have identified that open flames, hot liquids, and unsafe storage of chemicals are common household hazards that contribute to pediatric burns in children under 18 months old [28]. Most households tend to leave the open fire setting after using and these children do not have well-developed cognitive abilities to judge its future consequences and end up with burns. Further reasons for hazards in the urban areas might be due to the lack of enough space in the house. The majority of people are renting houses, just with a single room, which makes it difficult for them to have enough space to store hot liquids, chemicals, or hot objects out of reach of children. The single room accommodates the kitchen, bed, and storage, exposing children at high risk to easily access hot liquids, chemicals, and hot objects. The lack of enough space in homes is reported in the survey from Poland, indicating that the lack of a separate kitchen, separate bathroom, or separate children’s room is the source of burn wounds for children under-five [29]. Meanwhile, another reason for the hazardous urban area on burn wounds could be due to the busy situation of residents. Most of the time, people are thinking about earning money, which leaves them no time to keep hazardous things out of children’s reach. It is consistent with previous studies that in the urban area, the work is more important than attention to the child [30]. Regarding the open fire in the urban area, most families use natural gas for cooking, which might be a risk when a child lighten it or touches the fire, leading to a burn wound. Most common household burns for children under five years old are caused by open fire flames [31]. The previous literature shows that children living in families using natural gas were three times more likely to have a burn wound [32].

Under-five children’s risk behaviours influencing burn wounds

The study found that having no risk behaviours by children under-five is associated with a low incidence of burn wounds. Most of the risk behaviours for children under-five were the same in urban and rural areas. The majority of children in both areas were not practicing risky activities, were not imitating adults’ practices, did not attempt to break or open prohibited things, and did not play with fire. The similarities could be attributed to the similar parenting style of parents rebuking children whenever they attempt any risky action, making children hesitate to practice risky behaviour. Moreover, in both rural and urban areas, children under-five explored things without permission and played near the kitchen, which could be caused by the developmental process of the children. Since they are newly exposed to things, they often desire to learn them through observing and touching. Previous studies have revealed that children are curious about new exposure that may lead to burn wounds [33]. Also, young children have more natural curiosity and a lack of fear as contributing factors to injuries [34]. Regarding children playing near the kitchen, it is supported by the previous literature showing that children playing near the kitchen is a leading factor in the increased burn wounds among children under-five. Playing near the kitchen, the child could be feeling hungry and know that food is always obtained from the kitchen. Sometimes play near the kitchen because they need the attention of the parent who might be in the kitchen cooking or washing dishes. In contrast, the only difference identified between rural and urban areas was that most of the children from urban areas imitate what they watch on the TV compared to children in rural areas. This is due to the availability of television and electricity in the urban areas. The previous literature shows that the urban population has more access to electricity compared to the rural population [35].

Under-five children’s sociodemographic characteristics associated with the prevalence of burn wounds in rural and urban areas

The prevalence of burn wounds in the urban areas for children under-five was associated with individual child factors and parent factors. One of the individual factors was the child being a preschooler. It is in line with a finding from the previous literature showing that burn wounds are most common in preschool children [36]. A preschooler is always at home, where they can play near the kitchen and access hot liquids or chemicals. It is a development age, make them try new experiences that can endanger them to get a burn wound. Moreover, it is this age group where children are not aware of the risk of burn wounds, which is supported by a narrative review showing children have insufficient hazard perception, leading them to end up with burn wounds [18].

The study also revealed that male children are prone to burn wounds compared to female children. This is supported by a previous study showing that 63.9 of burn wounds are observed in male children [37]. A male child is at a higher risk of burn wounds due to the type of play they engage in. While playing with the ball near the kitchen can accidentally cause the bottles of hot liquid to break and cause a burn wound. Additionally, a character of a male child attempting to try new things puts them at a higher risk of burn wounds. It is consistent with a hospital-based retrospective cross-sectional study, which reported that hyperactivity of male children is the result of predominance of burn wounds in males [38].

Meanwhile, the burn wounds for children under-five were associated with parents’ factors such as age, type of carer, and the education level of the carer. For instance, children taken care of by parents/guardians aged 15–19 were likely to get burn wounds. This is because parents are not mature enough to take care of the child and supervise them against the risk of burn wounds. It is at this that age that the parent has less experience in parenting children and has never been exposed to the incidence of burns in children.

Also, children taken care of by a housemaid were associated with their burn wound cases. Housemaids are always assigned many daily tasks that demand their energy and time. When they are busy with daily activities don’t pay attention to children’s supervision, leading to burn wounds. Some of the housemaids have neglected taking care of the children; instead of supervising children, they are always watching television. Meanwhile, a carer with a primary educational level was associated with a burn wound. This educational level might be low to empower carers’ understanding of precautions for burn wounds in their under-five children. Compared to a carer with the highest level of education, whose curriculum supports learning injury precautions.

Study limitations

The study was hospital-based, which might have resulted in selection bias of participants and might have limited the clear understanding of burn wounds in the communities. The data were collected based on parents/guardians’ self-reports, which might have affected the accuracy of the findings due to social desirability and recall bias. The cross-sectional study design adopted in the current study is limited, as the exposure and outcome are simultaneously assessed, making it difficult to draw a predictive conclusion.

Conclusion

This study found that burn wound among children under-five in Dodoma Region are more prevalent in rural areas than in urban areas. In comparing predictors of burn wounds in rural and urban areas, a major contributing factor to burn wounds in rural areas is poor caregiver supervision, while the predictor of burn wounds in urban areas is household hazards. Under-five children’s risk behaviours were also associated with the prevalence of burn wounds; however, they do not differ much in rural and urban areas. These findings call for healthcare stakeholders to implement awareness-raising programs in the rural region, to empower residents to improve the care supervision of their under-five children. In the urban areas, awareness programs should encourage parents/family members to keep their home environment free from hazards. The policymakers should develop or improve policies guiding the strengthening of awareness programs in both rural and urban areas. The policies should emphasize budget allocation, preparation of implementers of the program, and sustainability of the program. Meanwhile, out of the studied major predictors, some sociodemographic factors in urban and rural areas have shown their influences on burn wounds for children under-five, calling scholars to consider them whenever planning to implement future interventions. More observation studies are still needed to identify leading factors for burn wounds among children under-five. This requires the utilization of different prevention and behavioral theories and models.

Authors’ contributions

NCS: Conceptualization, Writing the draft, Data Collection, Data Analysis, and Reviewing the draft. JFM: Conceptualization, Writing the draft, Data Analysis, Review of the draft, Supervision, Resources, and Project Administration.

Funding

The study has not received the funds.

Data availability

The dataset and other supplementary materials are available upon request from the corresponding author.

Declarations

Ethics approval and consent to participate

Ethical approval for conducting this research study was obtained from the Institutional Research Review Board of the University of Dodoma, with Reference number PB.22/1307/02. All procedures were conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. Informed consent, either verbal or written, was obtained from each parent/guardian of a child under five. Participants were free to participate voluntarily and free to withdraw from the study at any time they felt to do so. The confidentiality was ensured by keeping the participants’ names anonymous.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.