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2- Department of Philosophy, Faculty of Arts, Olabisi Onabanjo University Ago-Iwoye, Nigeria
3- Department of Human Kinetics and Health Education, Faculty of Education Olabisi Onabanjo University Ago-Iwoye, Nigeria , ridwanadekola99@gmail.com
Insect Stings and Bites: Teachers’ Knowledge of Prevention and First Aid Treatment regarding Allergies and Anaphylaxis in Primary Schools in Nigeria
Samuel Adesina Okueso a*
, Victor Olusegun Adefarasin b , Ridwan Ademola Adekola a a Department of Human Kinetics and Health Education, Faculty of Education Olabisi Onabanjo University Ago-Iwoye, Nigeria.
b Department of Philosophy, Faculty of Arts, Olabisi Onabanjo University Ago-Iwoye, Nigeria.
b Department of Philosophy, Faculty of Arts, Olabisi Onabanjo University Ago-Iwoye, Nigeria.
| A R T I C L E I N F O | A B S T R A C T | |
| ORIGINAL ARTICLE |
Background: Insects’ stings and bites are common phenomenon among school children in rural areas. Knowledge of teachers on allergies and anaphylaxis due to insect bites and stings is important to promote healthy school living; hence, this study investigated the knowledge of primary school teachers on stinging insects and allergic reactions.
Methods: Descriptive survey research design was used with 120 participants selected. Knowledge of insect stings prevention questionnaire (KISPQ r = 8.27) and knowledge of insect stings first aid treatment questionnaire (KISFATQ, r = 7.68) were the main instruments used for the study. Mean and standard deviation were used to answer the four research questions while linear regression analysis was used to test the two postulated hypotheses at 0.05 alpha levels. Results: Findings revealed that teachers were not significantly knowledgeable about insects’ stings regarding allergies and anaphylactic reactions. This was because only about 50% of the teachers could recognize the insects causing allergies and anaphylactic reactions. The result of F-value of 81.760 whose probability was close to zero percent showed that, statistically, the teachers' knowledge of the prevention and first aid treatment of allergy due to insect bite had a significant influence: R = 0.640, R2 = 0.409; F = 81.760 P < 0.05 on prevention of anaphylaxis. The result of F-value of 110.618 whose probability was close to zero percent indicated that teachers' knowledge of an etiology and prevention of allergy regarding insect bite had a significant influence on first aid skills.
Conclusion: There is inadequate knowledge of primary school teachers on stings/bites and allergies. Allergies and anaphylactic prevention should be added to health education curriculum input in primary school.
Keywords: Prevention, First Aid, Insect Sting Allergy, Treatment |
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Article History:
Received: 25 Jan 2023 Revised: 29 Apr 2023 Accepted: 01 May 2023 |
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*Corresponding Author: Samuel Adesina Okueso Email: okueso.samuel@oouagoiwoye.edu.ng Tel: +23 47086511631 |
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Citation: Samuel Adesina Okueso, Victor O. Adefarasin, Ridwan Ademola Adekola. Insect Stings and Bites: Teachers’ Knowledge of Prevention and First Aid Treatment regarding Allergies and Anaphylaxis in Primary Schools in Nigeria. Journal of Social Behavior and Community Health (JSBCH). 2023; 7(1): 1000-1008.
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Introduction
Anaphylaxis to an insect sting is classified not only on the foundation of cardio-respiratory reaction, but also by any abdominal cramps or vomiting. This is not like allergic reaction to food substance where gastrointestinal symptoms can be part of the nonanaphylactic reactions, since the gastrointestinal system is the site of allergen exposure (Bilo, Rueff, Mosbech, Bonifazi, and Oude-Elberink, 2005). Anaphylaxis to an insect sting can cause a terrifying and rapid death, with initial cardio-respiratory arrest within 5-10 minutes of the sting/bite in many of such cases (Whyte, Popescu, and Carlson, 2020, Pumphrey, 2000, Jones, Blair MacNeil, Welch, Hole and Baxter et al 2017). The likelihood of such anaphylactic incident causes significant anxiety and social restriction regarding an insect sting especially among children in the school premises for both parents and the teacher (Sabogal Lozano, Mercado, Cantillo, Moncada, Quinones, et al, 2019). The large order of insects called hymenoptera are commonly responsible for anaphylactic reaction (Helbling, Hurni, Mueller and Pichler, 2004; Gonzalez-Estrada, Silvers, Klein, Zell, Wang and Lang, 2017., Fehr, Miccaletto, Moehr and Schmid-Grendelmeier, 2019., Schiener, Graessel, Ollert, Schmidt-Weberand and Blank, 2017).
The symptoms of an insect sting allergic reaction include: shortness of breath, wheezing, coughing, pale skin, weak pulse, fainting, tight throat and difficulty in breathing, swelling of the lips and sometimes the tongue, hives and confusion. In the case of nonallergic children, symptoms include: swelling which may appear and disappear for about 48 hours, redness on the skin which can last for three days to one week with swelling, mild reactions like sneezing, itchy nose and mouth, a few hives or a stomachache (Caravedo-Martinez, Ramirez-Hernandez, and Blanton, 2021., American Academy of Pediatrics, 2018).
Anaphylactic reaction may occur with bee, wasp, fire ant stings, and yellow jacket. But, it is important to note that anaphylaxis is very rare for other species of insect bites. The expected courses of reaction with insect bites are: felling itchy for several days, redness for three days, and swelling for seven days. Bites of the upper face region may cause severe swelling around the eye which is usually worse in the morning as a result of lying down through night. Insect sting allergy happens to anybody at any age, and most of the times when there are multiple stings which are always the case. Systemic reaction is estimated to occur in 3% of adults, and approximately 1% of children have a medical history of severe sting reactions (Caravedo-Martinez, Ramirez-Hernandez, and Blanton, 2021, Golden, Demain, Freeman, Graft, Tankersley, M., Tracey et al, 2017).
The knowledge of first aid treatment of insect bite include reassuring both the child and parents that swelling and redness are normal inflammatory process which will subside; this does not meant that the spot is infected. For itchy insect bite, steroid cream can be applied, and in Nigeria, there are several anti-inflammatory antibiotic and anti-allergic three-in-one creams such as FUNBACT A.
Insect stings in school are not accurately reported to the local epidemiological units of the primary healthcare centers in Nigeria. But, some few cases discussed when cases become complicated (Jimoh, Akuse, Bugaje and Mayaki, 2016). It has been reported that between 90-100 deaths per year in Nigeria is the result of insect stings anaphylaxis (Greenstickeduation servies, 2023). Researchers in the field of health and medical science have not much focused on this area of concern, in spite of its poorly reported prevalence. Regarding teachers of health education who teach courses like allergies and its prevention in school, having adequate knowledge of allergies caused by stings is very important. Otherwise, poor reporting occurs. As against the background of this identified phenomenon and variables, the researchers investigated the phenomenon to raise awareness for intervention in these areas.
Demographic characteristics of the study participants (N= 120)
The demographic characteristics of primary school teachers in Ogun Waterside local government area of Ogun state as shown in Table 1.
| Table 1. Showing the demographic characteristics of respondents (N= 120) | ||
| Demographic details | Frequency (F) | Percentage (%) |
| Gender | ||
| Male | 48 | 40.0 |
| Female | 72 | 60.0 |
| Work experience | ||
| 11-20 | 64 | 53.3 |
| 21-30 | 56 | 46.7 |
| Age group | ||
| 30-39 | 8 | 6.7 |
| 40-49 | 88 | 73.3 |
| 50 years and above | 24 | 20.0 |
| Religion | ||
| Muslim | 60 | 50.0 |
| Christian | 60 | 50.0 |
Descriptive statistics indicated primary school teachers' knowledge of stinging/biting insects as shown in Table2. Overall, the teachers can recognize a good number of the stinging/biting insects (average mean of 2.52 > criteria mean of 2.50). Based on the overall average mean of 2.38 compared to the criteria mean of 2.50, teachers were not knowledgeable regarding prevention of insects' bites/stings and allergic /anaphylactic reactions.
Knowledge about first aid treatments in case of insect stings/bites' allergy/anaphylaxis
Descriptive statistics indicated teachers' knowledge of first aid treatments in cases of insect stings/bites and allergy/anaphylaxis. Based on the overall average mean of 2.68 compared to the criteria mean of 2.50, the teachers were significantly knowledgeable about first aid treatments in cases of insect stings/bites and allergic/anaphylactic reactions, Table 2
| Table 2. Descriptive statistics showing teachers' knowledge of stinging and biting insects | ||||
| Allergic forming insect | N | Mean | Std. Deviation | Remarks |
|
120 | 3.33 | 1.02 | Known |
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120 | 3.17 | 1.10 | Known |
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120 | 3.17 | 1.13 | Known |
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120 | 3.10 | 1.05 | Known |
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120 | 3.07 | 1.13 | Known |
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120 | 2.93 | 1.10 | Known |
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120 | 2.93 | 1.13 | Known |
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120 | 2.90 | 1.17 | Known |
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120 | 2.83 | 1.16 | Known |
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120 | 2.80 | 1.33 | Known |
|
120 | 2.67 | 1.28 | Known |
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120 | 2.63 | 1.41 | Known |
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120 | 2.43 | 1.26 | Not known |
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120 | 2.33 | 1.28 | Not known |
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120 | 2.23 | 1.29 | Not known |
|
120 | 2.23 | 1.26 | Not known |
|
120 | 2.20 | 1.28 | Not known |
|
120 | 2.20 | 1.23 | Not known |
|
120 | 2.17 | 1.22 | Not known |
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120 | 2.13 | 1.26 | Not known |
|
120 | 2.10 | 1.14 | Not known |
|
120 | 2.10 | 1.14 | Not known |
|
120 | 1.90 | 1.23 | Not known |
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120 | 1.80 | 0.95 | Not known |
| Criteria mean = 2.50; Average mean = 2.52 | ||||
| Table 3. Descriptive statistics for teachers' knowledge of prevention and first aid treatment of allergies caused by insect stings/bites | |||
| Statement on prevention | N | Mean | Std. Deviation |
| Avoiding food preparation outside | 120 | 2.50 | 1.34 |
| Avoiding eating outdoors | 120 | 2.57 | 1.31 |
| Avoiding flowering plants | 120 | 2.03 | 1.11 |
| Avoiding drinking from straws and cans | 120 | 2.03 | 1.23 |
| Avoiding drinking from bottles outdoors | 120 | 2.07 | 1.27 |
| Avoiding removing fallen fruits | 120 | 2.37 | 1.26 |
| Avoiding pet poop | 120 | 2.67 | 1.05 |
| Covering trash cans | 120 | 2.60 | 1.18 |
| Watching for nests in bushes | 120 | 2.47 | 1.26 |
| Avoiding going out barefoot | 120 | 2.66 | 1.14 |
| Watching the ground when mowing | 120 | 2.30 | 1.10 |
| Criteria mean = 2.50; Average mean = 2.38 | |||
| Statement on first aid treatment | N | Mean | Std. Deviation |
| Reassuring the child | 120 | 2.20 | 1.20 |
| Reassuring parents | 120 | 2.23 | 1.18 |
| Using anti-inflammatory cream | 120 | 3.27 | 0.93 |
| Applying ice cube | 120 | 2.67 | 1.25 |
| Direct pressure to the bitten spot | 120 | 2.93 | 1.21 |
| Using anti-histamin like piriton | 120 | 2.80 | 1.23 |
| Criteria mean = 2.50 Average mean = 2.68 |
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| Table 4. Coefficients of the linear regression analysis for relative contributions of teachers’ knowledge | ||||||
| Coefficientsa | ||||||
| Model | Unstandardized coefficients | Standardized coefficients | T | Sig. | ||
| B | Std. Error | Beta | ||||
| 1 | (Constant) | 21.216 | 4.165 | 5.094 | .000 | |
| Knowledge on causes of allergic and anaphylactic reactions | 1.375 | .152 | .640 | 9.042 | .000 | |
| R = 0.640, R2 = 0.409; F = 81.760 P < 0.05 | ||||||
| a. Dependent variable: Knowledge of prevention of insect stings/bites | ||||||
Nevertheless, the result of F-value of 110.618 whose probability was close to zero percent suggested that teachers' knowledge had a significant influence on first aid skills. Hence, the null hypothesis was rejected. Teacher’s knowledge had a significant effect on first aid treatment skills, Table 5
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Table 5. Coefficients of the linear regression analysis regarding teachers’ knowledge of causes of allergy
on first aid skills |
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| Coefficientsa | ||||||
| Model | Unstandardized coefficients | Standardized coefficients | T | Sig. | ||
| B | Std. Error | Beta | ||||
| 1 | (Constant) | 9.286 | 4.699 | 1.976 | .050 | |
| Knowledge on causes of allergic and anaphylactic reactions | 2.984 | .284 | .696 | 10.518 | .000 | |
| R = 0.696, R2 = 0.484; F = 110.618 P < 0.05 | ||||||
| a. Dependent variable: knowledge of first aid skills | ||||||
Discussion
Primary school teachers in Ogunwaterside Nigeria (60% females and 40% male), with a minimum of 11 years of work experience and age of 30 and above,
Could significantly recognize stinging and biting insects. This is because of the 24 insects listed; a great percentage of them could recognize twelve of them. Twelve of them, however, could not be recognized by a high percentage of them. It was revealed through demographic characteristics of gender that female teachers were more knowledgeable (awareness level of 60%) compared with male teachers. On the list of the insects, teachers had poor knowledge regarding stings and their ability to cause allergy and anaphylaxis (55% males and 45% females). This was not in line with the findings by Demirkale et al in 2020.It was among bee keepers, over 80% of whom had good knowledge of allergic reactions (Demirkale, Yucel, Cimen, Suleyman, Ozdemir, Kara and Tamay, 2020) This might be due to poor understanding of the term allergy and anaphylaxis, which was duly explained for improved understanding. The result revealed that only 8 cases had a mean of above 2.5 while 16 recorded a mean of less than 2.5. Teachers need to be further educated with regard to the understanding of allergy/anaphylaxis caused by insect stings/bites. This implied that there was a need for more knowledge on the consequences of insect bites as supported in the report of study conducted by David, and Golden et al, (2017) which revealed that on the prevention of stings/bites, teachers had no adequate knowledge on how to prevent insect stings, which requires serious attention to prevent allergies/anaphylaxis caused by bites. This was in agreement with the study by Barish, and Arnold, 2022, Power and McDowell, 2022. It reported the need for patient education on signs and symptoms of insect bites and stings. The results support the findings by American Academy of Pediatrics (2011) which presented several strategies to prevent insect stings including wearing long pants. Moreover, the US Department of Labor reported the need to educate on insect stings for prevention of fatality (US Department of Labor, 2021). The results supported the finding of American Academy of Pediatrics (2011) which presented several strategies that helps to prevent insect stings such as wearing of long pants.
Good knowledge of causes significantly contributes to the knowledge of prevention of allergies and anaphylaxis. This result was not in line with the one by Billo, Martini, Pravettoni, Bignardi, and Bonadonni et al (2019) work which reported inadequate knowledge of treatment due to insect stings allergy. The finding was in line with Fukutomi and Kawakami's research (2021). They confirmed that insects cause respiratory allergies which require knowledge to eradicate them. Insects have been identified to cause series of allergies especially respiratory conditions which can be prevented through knowledge of preventive methods (Dhami, Panesar, Roberts, et al 2014, Raj, Lodha, Pandey, Mukherjee and Agrawal, 2013).
The result of the findings on the knowledge of teachers in giving first aid treatment in cases of allergies revealed that the teachers are significantly knowledgeable on how to treat allergic reaction. On the effect of knowledge of stinging/biting insects on allergy revealed that teachers’ knowledge of insect has significant effect on their knowledge of allergic causing insects. The result agrees with the position of (Rompis, Willar, Rondonuwa, Halim, 2022., College of Food, Agricultural and Natural Resource Sciences (CFANS) 2022., Guillet, Jeorg, Schmid, et al, 2022) the institution reported that Bed Bugs should be prevented in school through the provision of adequate knowledge to the teachers and that bed bugs are causing allergies (Sheele, 2021). It is then noted that if the teachers are knowledgeable about general insects’ characteristics, they will be significantly aware of those causing allergies and anaphylaxis.
The study revealed that significant knowledge of causes of insect stings/bites would significantly contribute to teacher’s knowledge of first aid skills in cases of allergies and anaphylaxis (National Institute for Health and Care Excellence, 2020). This study may be limited by the mood of the participants sampled during the Teachers’ Day celebration. They may not have had adequate concentration in their responses to all the question items on the instrument. The research might also have been limited by understanding of English names and local description of some of the biting and stinging insects.
Conclusion
The study was carried out to determine teachers’ knowledge of allergies and anaphylaxis regarding insect stings and bites. Teachers' significant knowledge of causes of insect stings/bites will significantly contribute to their knowledge of first aid skills in cases of allergies and anaphylaxis.
The results revealed that teachers are significantly knowledgeable about some of the existing stinging and biting insects. However, they do not know enough about some of the allergies caused by the bites or stings from some of the insects. Additionally, the knowledge of allergic reaction regarding insect bites is important to the knowledge of prevention of stings and bites and also the knowledge of first aid skills in cases of insect’s stings and bites. Therefore, it is imperative that a course regarding allergies prevention of insect bite and stings be added to the primary school health education curriculum for better understanding of both the teachers and pupils. On the other hand, teachers should also be trained on prevention and treatment of allergic reaction in schools.
Acknowledgement
The authors would like to thank Nigeria :union: of Teachers (NUT) Ogun State branch, particularly Mr. Ibrahim (the Chairman of NUT Ogunwaterside local government), who approved and allowed the administration of instrument during 2022 teachers’ day celebration at the teachers’ house Abigi.
Conflict of interest
The authors declared no conflict of interest.
Authors' contribution
Conceptualization, design and construction of the instrument were carried out by S. A. O.; proof-reading, data set and analysis by V. O. A.; and
administration of instrument and typesetting was conducted by R. A. A. The manuscript was reviewed and approved by all the authors.
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Received: 2023/01/25 | Accepted: 2023/05/1 | Published: 2023/05/4
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