Implementing a Young First Aiders (YoFA) Training Program Amongst Early Secondary School Children on Injury and Trauma First Aid in Fako Division.
Phase: NA
Conditions: Trauma/Injury Problem
Sponsor: University of Buea

1 
 
UNIVERSITY OF BUEA 
 
FACULTY OF HEALTH SCIENCES 
DEPARTMENT OF PUBLIC HEALTH AND HYGIENE 
 
 
 
 
 
 
 
 
BY 
TABE OROCK-BENEM VANESSA 
MD, IMPH 
 
 
 
SUPERVISOR 
                                                 CO-SUPERVISOR 
PROF. ALAIN CHICHOM MEFIRE                   DR SABRINAH ARIANE-CHRISTIE
 
 
 
 
November 15, 2024 
 
 
PRE- AND POST-IMPLEMENTATION OF A YOUNG FIRST 
AIDERS (YOFA) TRAINING PROGRAM AMONGST EARLY 
SECONDARY SCHOOL CHILDREN ON INJURY AND 
TRAUMA FIRST AID IN FAKO DIVISION. 
 

2 
 
 
TABLE OF CONTENTS 
 
CERTIFICATION ........................................................... Error! Bookmark not defined. 
ACKNOWLEDGEMENTS ............................................ Error! Bookmark not defined. 
TABLE OF CONTENTS .................................................................................................. 2 
LIST OF ABBREVIATIONS ........................................................................................... 5 
LIST OF TABLES ............................................................................................................ 6 
LIST OF FIGURES ........................................................................................................... 7 
SUMMARY ...................................................................................................................... 8 
ABSTRACT ...................................................................................................................... 9 
RÉSUMÉ ........................................................................ Error! Bookmark not defined. 
CHAPTER ONE 
INTRODUCTION AND BACKGROUND 
1.1 INTRODUCTION ..................................................................................................... 10 
1.1.1 Conceptual Definitions ........................................................................................... 10 
1.1.2 Operational Definitions .......................................................................................... 12 
1.2 BACKGROUND ....................................................................................................... 13 
1.2.1 Goals of First Aid ................................................................................................... 13 
1.2.2 Benefits of First Aid Training in Schools ............................................................... 15 
1.3 PROBLEM STATEMENT ....................................................................................... 18 
1.4 RATIONALE OF THE STUDY ............................................................................... 19 
1.5 RESEARCH QUESTIONS ....................................................................................... 20 
1.6 RESEARCH OBJECTIVES ...................................................................................... 20 
1.6.1 General Objective ................................................................................................... 20 
1.6.2 Specific Objectives ................................................................................................. 20 

3 
 
 
CHAPTER TWO 
LITERATURE REVIEW 
2.1 CONCEPTUAL REVIEW ........................................................................................ 25 
2.2 CONTEXTUAL REVIEW ........................................................................................ 28 
2.2.1 Importance of First Aid Skills among School Children and Teachers ..................... 29 
2.2.2 Potential Impacts of First Aid Training on Reducing Injury-Related Morbidity and 
Mortality in the School Setting and Beyond .................................................................... 30 
2.2.3 Types of First Aid Training programs for children ................................................. 31 
CHAPTER THREE 
MATERIALS AND METHODOLOGY 
3.1 STUDY AREA .......................................................................................................... 36 
3.2 STUDY POPULATION ............................................................................................ 38 
3.3 STUDY DESIGN ...................................................................................................... 38 
3.3.1 Qualitative Part ....................................................................................................... 39 
3.3.2 Quantitative Part: .................................................................................................... 39 
3.4 ELIGIBILITY CRITERIA ........................................................................................ 40 
3.4.1 Inclusion Criteria .................................................................................................... 40 
3.4.2 Exclusion Criteria ................................................................................................... 40 
3.5 SAMPLE SIZE AND SAMPLING ........................................................................... 41 
3.6 STUDY PROCEDURE ............................................................................................. 44 
3.7 STUDY VARIABLES AND TYPE .......................................................................... 47 
3.8 DATA COLLECTION TOOLS ................................................................................ 49 
3.9 DATA COLLECTION PROCEDURE ..................................................................... 61 
3.10 DATA MANAGEMENT AND ANALYSIS .......................................................... 61 

4 
 
3.11 DATA ANALYSIS PLAN ...................................................................................... 61 
3.12 ETHICAL CONSIDERATIONS ............................................................................. 63 
CHAPTER FOUR 
EXPECTED RESULTS 
4.1 LIMITATIONS ......................................................................................................... 66 
TIMELINE ...................................................................................................................... 72 
BUDGET ........................................................................ Error! Bookmark not defined. 
REFERENCES ................................................................................................................ 73 
APPENDICES ................................................................ Error! Bookmark not defined. 
Appendix 1: Letters of Principle Agreement from Study Site Managers .................. Error! 
Bookmark not defined. 
APPENDIX 2: Curriculum Vitae Of Principal InvestigatorError! 
Bookmark 
not 
defined. 
Appendix 3: ETHICAL REVIEW FEE RECEIPT FOR SOUTH WEST REGION
 ........................................................................................ Error! Bookmark not defined. 
Appendix 4: ETHICAL REVIEW FEE RECEIPT FOR FHSError! 
Bookmark 
not 
defined. 
Appendix 5: MAIL SEND TO ETHICAL REVIEW SECRETARIAT .................. Error! 
Bookmark not defined. 
 
 
 
 
 
 

5 
 
 
 
 
 
 
 
LIST OF ABBREVIATIONS  
ABBREVIATIONS 
MEANING 
CBT-LFRs 
Community-based trained-LFRs 
CoSTRs 
Consensus on Science with Treatment Recommendations 
CTR 
Cameroon Trauma Registry 
DALYs 
Disability Adjusted Life Years 
ERCFAWG 
European Resuscitation Council First Aid Writing Group 
(ERCFAWG) 
FA 
First Aid 
HD 
Health Districts 
IFRC 
International Federation of the RedCross 
ILCOR 
International Liason Committee on Resuscitation 
Km 
Kilometers 
LFR 
Layperson first responder 
LMIC 
Low- and middle-income countries 
LTB 
Life Threatening Bleeds 
MINSANTE 
Ministry of Public Health 
MoPH 
Ministry of Public Health 
OSHA 
Occupational Safety and Health Administration 
SBEAT 
Stop the Bleed Educational Assessment tool 
SSA 
Sub-Saharan Africa 

6 
 
STB 
Stop the bleed 
WHO 
World Health Organization 
YoFA 
Young First Aiders 
SSC 
Secondary School Children 
 
 
 
 
 
 
LIST OF TABLES 
 
Table 1: Average number of Trauma cases in the past four years on DHIS2 [47] ......... 37 
Table 2: Number of Participants to be chosen per school for the FGDs ......................... 43 
Table 3: Number of Participants to be chosen per school for the In-depth interviews ... 43 
Table 4: Initial plan of the YoFA training Prticipants. ................................................... 44 
Table 5: Number of students to train on YoFA Program ............................................... 44 
Table 6: Plan of training and Evaluation of intervention groups .................................... 46 
Table 7: Objectives and their Indicators ......................................................................... 62 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

7 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LIST OF FIGURES 
Figure 1: Illustration of Bronfenbrenner's ecological framework by Mash in 2019 ............ 26 
Figure 2: Table of what children should be Encouraged, Know/Know-How, and when to 
receive Refresher/Repeat courses on the Previous FA skills. .............................................. 35 
Figure 3: Map of the Southwest Region of Cameroon. Source, Southwest Regional 
Delegation of Public Health ( RDPH), Cameroon .............................................................. 36 
Figure 4: The number of trauma cases recorded in Fako division over 4 years [47] ........... 37 
Figure 5: Selection of HAs and Schools for Implementation. .............................................. 42 
 
 
 
 
 
 

8 
 
 
 
 
SUMMARY 
First aid (FA) is very important for dealing with serious medical issues in order to help 
save lives, reduce pain, and support recovery. Anyone can provide first aid even young 
children as studies have shown us from the global North. Training programs have been 
effective in different places, including some African countries. It's important to include 
first aid training in schools to help young people learn how to protect themselves and their 
communities. The culture of First aid is almost inexistent and just as adult lay first-
responders have shown effective in the case of road traffic crashes. We want to ascertain 
the contribution of young children in learning and acquiring these skills and to raise a 
culture of alert young people in the face of conflict 
The goal of this research is to understand how young people view first aid training and 
what obstacles they face in learning it. The study will focus on children aged 10 to 14 in 
Fako Division, Cameroon, aiming to improve their knowledge, attitudes, and practices 
(KAP) towards first aid. It will also look into the challenges of teaching first aid and its 
impact on children's health and safety. 
The research will use a mix of methods, including surveys and interviews in two areas of 
Fako Division. One area will receive first aid training (the intervention group), while the 
other will not (the control group). Data will be collected through interviews, group 
discussions, and questionnaires, and then analyzed using specific software. 
The study aims to identify problems that make it hard to teach first aid in schools and find 

9 
 
solutions to these issues. It is also expected that children's knowledge and skills related to 
first aid will improve, allowing them to respond better in emergencies. 
 
 
ABSTRACT 
 
Background/Justification: Initial care is paramount for acute medical conditions to 
preserve life, alleviate suffering, prevent further illness or injury and promote recovery. 
This initial care is called first aid (FA). Anyone in any situation, including oneself can 
initiate the act. Adult lay-first responder FA programs have shown effectiveness in 
curbing acute injury and illness even in some African nations. However, just like in the 
West, it is necessary to incorporate FA training in the school curricula of the young for 
self and community awareness raising and safeguarding of one’s life. 
Objectives: To gain insights into the perceptions and barriers surrounding a Young First 
Aiders' (YoFA) training program on trauma/injury first aid in both the school setting 
and the community in the Fako Division and to assess and measurably improve KAP of 
early SSC on trauma/injury FA using the YoFA training program in Fako Division. The 
research aims to determine the Knowledge, attitudes and practices (KAP) of FA, 
identify the challenges of implementing first aid training, evaluate its effectiveness, and 
assess its overall impact on the well-being of school children and the community among 
children aged 10 to 14 years in Fako division, Cameroon. 
Methods: The study will employ a mixed-methods exploratory sequential approach, 
combining quantitative surveys and qualitative interviews in the Tiko and Buea health 
Districts of the Fako Division. It will incorporate cross-sectional surveys and an 
experimental intervention. One of the districts will be the intervention group and the 
other the control. The qualitative part will use in-depth interviews, Focused group 
discussions (FGDs) and scenario observations as data collection methods. While the 
quantitative part) will use self-administered questionnaires. Following the qualitative 
data collection of stakeholders including parents, pretested adapted questionnaires will 
be administered to the children. Data will be analysed using Nvivo and R software to 
analyse qualitative and quantitative data respectively. 
Expected Results: Identification of challenges that prevent FA from being 
implemented in schools, and understanding probable solutions to address these 
challenges. Additionally, we expect to increase the KAPs of children in early secondary 
school regarding FA aspects such as staying safe, calling for help, doing something, and 
stopping a bleed after building their self-efficacy during the training. 

10 
 
Keywords: First aid, injury/trauma, first aid training, first aid training in school 
children. 
 
 
CHAPTER ONE 
INTRODUCTION AND BACKGROUND 
1.1 INTRODUCTION 
In an increasingly unpredictable world, the ability to respond effectively to emergencies 
is a vital skill that can save lives and mitigate injuries. Among the most critical of these 
skills is first aid, which encompasses the immediate care provided to individuals 
experiencing injury or trauma before professional medical help arrives. Despite the 
importance of first aid knowledge, many young people lack adequate training, leaving 
them ill-equipped to handle emergencies that may occur in their daily lives. This gap 
highlights the urgent need for initiatives aimed at empowering youth with essential first 
aid skills. The "Young First Aiders (YOFA) Training Program" aims to address this 
need by equipping early secondary school children in the Fako Division with the basic 
knowledge and skills necessary to manage injuries and trauma effectively before 
professional help arrives at the scene or before a victim is transported to the closest 
health facility. By targeting this age group, the program seeks to instill a sense of 
responsibility and confidence in young individuals, enabling them to act decisively in 
emergency situations. The Fako Division, with its unique socio-economic landscape and 
diverse population, presents both challenges and opportunities for implementing such a 
program. This research proposal outlines the framework for implementing the YOFA 
Training Program, which will include comprehensive training modules and practical 
exercises, and community engagement initiatives. Through this program, we aspire to 

11 
 
not only enhance the first aid capabilities of young individuals but also to foster a 
culture of safety and preparedness within the community. This initiative represents a 
proactive approach to child and youth empowerment, ultimately contributing to a more 
resilient society capable of responding to emergencies with skill and compassion. 
1.1.1 Conceptual Definitions 
First aid: The European Resuscitation Council (ERC), during its 2020 International 
Consensus on Cardiopulmonary Resuscitation (CPR) Science with Treatment 
Recommendations, defined first aid as the preliminary or initial care given to someone 
with an acute illness or injury [1]. Other international bodies have included the need for 
care to be given until professional help arrives in the face of a sudden traumatic or 
debilitating health event [2]. Yet others like the Occupational Safety and Health 
Administration (OSHA) have included aspects of the aid being given at the location of 
the event, it being a one-time act, and requiring only little technology and training [3] to 
preserve life or prevent sequelae. 
Youth Empowerment: The process of equipping young individuals with the skills, 
knowledge, and confidence necessary to take control of their lives and make informed 
decisions. In the context of the YOFA program, it refers to enabling children to act 
effectively in emergency situations [1]. 
Injury and Trauma: Refers to physical harm or damage to the body resulting from 
various causes, including accidents, falls, or violence. Trauma can be classified as either 
minor (e.g., cuts and bruises) or major (e.g., fractures or severe bleeding), necessitating 
different levels of first aid response [2,3]. 
Training Program: A structured educational initiative designed to impart specific 
knowledge and skills to participants. In this study, it refers to the YOFA program that 

12 
 
aims to teach early secondary school children essential first aid techniques and principles 
[4,5]. 
Emergency Response: The actions taken to address an urgent situation that poses a risk 
to health, life, or property. This includes the immediate steps taken by individuals trained 
in first aid to stabilize a person in distress until professional help arrives [6,7]. 
Skill Acquisition: The process through which individuals learn and master specific 
abilities or techniques. In the context of the YOFA program, it refers to the development 
of practical first aid skills among early secondary school children through hands-on 
training and practice. 
These conceptual definitions provide a foundational understanding of the key terms and 
ideas that underpin the YOFA Training Program, facilitating a clearer focus for our 
objectives.  
1.1.2 Operational Definitions 
First Aid Knowledge: Measured by a standardized questionnaire assessing participants' 
understanding of basic first aid principles, including recognition of injuries, appropriate 
responses, and the use of first aid equipment. A pre-test and post-test will be 
administered to evaluate knowledge gained from the training. 
Practical Skills Proficiency: Evaluated through hands-on assessments where 
participants (children) demonstrate specific first aid techniques, such as identification of 
injuries including wounds and take action towards care. Proficiency will be rated on a 
scale from 1 to 5 by the trainers based on accuracy and confidence in performing the 
skills. 
Training Attendance: Defined as the percentage of scheduled training sessions 
attended by each participant. Attendance will be tracked through a sign-in sheet at each 

13 
 
session, with a minimum attendance threshold set at 80% to qualify for the evaluation 
phase. 
Behavioral Intent to Use First Aid: Assessed using a Likert scale survey administered 
after the training program, measuring participants' self-reported likelihood of applying 
first aid skills in real-life situations. This will include scenarios where they might 
encounter injuries or emergencies. 
Community Engagement: Measured by the number of community members who give 
favourable feedback on the activities of the YoFA trainees during and after the 
intervention. The effectiveness of these activities will be evaluated through feedback 
forms from community members. 
Self-Efficacy in First Aid: Evaluated using a self-report scale that assesses participants' 
confidence in their ability to perform first aid tasks taught. This will be measured before 
and after the training program to determine changes in self-efficacy levels. 
Injury Response Time: Measured by timing participants' responses in simulated 
emergency scenarios during training sessions. The time taken to initiate appropriate first 
aid measures will be recorded and analyzed to assess improvement over the course of 
the program. 
These will help us ensure that the study effectively measures the impact of the YOFA 
Training Program on early secondary school children in the Fako Division, providing 
clear metrics for evaluation and analysis. 
1.2 BACKGROUND 
1.2.1 Goals of First Aid 
The ERC First Aid Writing Group (ERCFAWG) stated the goals of first aid to include 
life preservation, suffering alleviation, preventing further illness or injury and 

14 
 
promoting recovery [1]. They equally agreed that the process can be undertaken or 
initiated by “anyone in any situation” including oneself. In their guidelines, it was 
agreed upon that, first aid training at EVERY level should contain pertinent principles 
which include: Identifying, evaluating, and determining the urgency of first aid 
requirements, 
administering 
care 
with 
suitable 
skills 
and 
acknowledging 
constraints/limitations and requesting further assistance when necessary, including 
activating the emergency medical services (EMS) system or seeking other medical aid 
[1]. These principles therefore include individuals or groups of individuals irrespective 
of age, gender, race or other socioeconomic or demographic characteristics. As such, 
children are not left out. This is why, in most countries of the Global North, first aid is 
included in the educational curriculum from a tender age, as young as kindergarten 
[4,5]. Several countries have succeeded in lowering morbidity and mortality by 
developing a strong and resilient emergency medical service [6,7] which includes lay- 
first responders (LFR). This has begun trickling into sub-Saharan Africa [8]. However, 
the focus is on training adult lay-first responders, particularly regarding road traffic 
crashes as timely transportation to a care service is essential for favourable outcomes. 
Children can also save lives and training children on first aid has proven effective in 
some pilot studies carried out in India and other African settings [9]. It is helpful when 
planning to train individuals on FA that trained bystanders act promptly and 
appropriately in the face of emergencies needing a first aid response compared to those 
that are untrained.  [10]. 
However, it is important to consider the self-efficacy of performing a delicate act such 
as FA and there needs to be a change of culture and mindset of people within a given 
sphere or community. Habits cultivated, knowledge refreshers, and application of 
certain practices over time increase people’s self-confidence and efficacy in performing 

15 
 
such activities [11]. 
As such, we not only want to improve the knowledge of adults about first aid, but we 
want to build a culture of trained bystanders who are physically and psychologically 
equipped to alleviate emergencies in the face or at least call for help. This, we believe 
needs to be inculcated from a tender age so that the instinct to help alleviate suffering 
and/or prevent complications from emergencies, particularly trauma/ injury emergencies 
stays in the subconscious of individuals and develops over time to save lives better. For 
this reason, we want to use the full developmental potential of our children in the lower 
secondary schools to begin this initiative. 
To achieve our objectives, we must consider some key principles of first aid should 
adhere to medical standards and be supported by the most reliable scientific 
findings, should be accessible to all, with universal participation in learning these 
skills, encouraging supportive actions should be a priority for all individuals and the 
extent of first aid and supportive actions can differ and might be impacted by 
environmental, resource, training, and regulatory elements [1]. 
These principles have further emphasized the need to include children or students in our 
cohort of trained bystanders or LFRs for our communities, particularly our schools. 
1.2.2 Benefits of First Aid Training in Schools 
Integrating first aid training into the school curriculum in Sub-Saharan Africa, including 
Cameroon is crucial for equipping young people with life-saving skills, addressing 
health challenges, and contributing to overall educational and societal well-being 
specifically via the development of, firstly, 
Vital Life-Saving Skills as responding to medical emergencies, and potentially saving 
lives in their settings. First aid training provides highly sought-after skills that can be 

16 
 
crucial in emergencies and later in life [12]. Neglecting the importance of first aid could 
be to the detriment of society which is a similar situation in our country. 
Secondly, Risk Evaluation abilities especially since young people are unable to assess 
risk evaluation in the same way as adults [13][12]. 
Thirdly, first-aid training decreases disease and injury burden which is a cost- 
effective way to decrease the burden of disease and injury, particularly in low- and 
middle-income countries [14]. 
Fourthly, access to quality education is key to social mobility and poverty reduction, 
and incorporating first aid training into the curriculum of young children can contribute 
to this aspect of education [15]. 
Also, SSA has a high rate of Education Exclusion or inequality. This can be 
addressed by incorporating first aid training in schools, thus providing additional skills 
and knowledge to the students or pupils [15]. 
Fourthly, access to quality education is key to social mobility and poverty reduction, 
and incorporating first aid training into the curriculum of young children can contribute 
to this aspect of education [15]. 
Also, SSA has a high rate of Education Exclusion or inequality. This can be 
addressed by incorporating first aid training in schools, thus providing additional skills 
and knowledge to the students or pupils [15]. 
Lastly, positive impact on Education Recovery as there is a persistent teacher gap 
in SSA. Integrating FA training in the educational system, can contribute to the 
wellbeing of students overall. Thereby, support the education recovery efforts in the 
region [16]. 
Since trauma and injury incidents are common in Africa, and the lack of adequate first 

17 
 
aid training often leads to adverse outcomes, this study seeks to identify the challenges 
in implementing first aid training, evaluate the effectiveness of such training, and assess 
the overall impact on the well-being of school children and the community. 
Limited access to medical facilities and trained professionals exacerbates the 
consequences of such incidents. First aid training has the potential to mitigate these 
challenges by equipping students with the knowledge and skills to provide immediate 
assistance in emergencies around them. However, such training programs' effectiveness 
and long-term impact in our context are not well-documented. 
There have been several FA interventions programs to train children such as “Stop the 
Bleed” [17]. 
The "Stop the Bleed" program in the United States is a thorough effort focused on 
providing people with the abilities and understanding to adeptly address serious 
bleeding emergencies. The program's reliance on evidence, backing from legislation, 
and tailored training for high school students demonstrate its dedication to enabling 
individuals in diverse environments to promptly assist in bleeding emergencies. 
“I wanted my kids and others if they were in a situation – it may be an active-shooter 
situation, or it may be a loved one at home who got hurt – that they could help instead 
of just standing there, and they could have some kind of power to affect the situation 
positively,” Kate Carleton, a Sutter Roseville Medical Center trauma nurse and educator 
said.[17] In the context of the Northwest and Southwest regions of Cameroon that have 
been in crisis since 2016, this training is timely and should relieve helpless young 
people when in the face of trauma or injury cases that involve bleeding. 
FA training to save lives and alleviate the burden of complications from life-threatening 
bleeds or injuries from various causes is a useful public health tool to curb preventable 

18 
 
morbidity and mortality. Since Africa faces a double burden of disease (increasing 
prevalence of communicable and non-communicable disease (NCD), and injuries fall 
under the NCDs, it is important to put in place strategies and create mental and physical 
environments that favour the acquisition of basic life-saving skills. Moreover, starting 
such a practice from a tender age grooms the individuals and their environment to be 
prepared to give every life another chance by a simple “call for help” or “stop the bleed” 
act. Eventually improving life expectancy and reducing the rate of handicap from an 
acute injury. 
1.3 PROBLEM STATEMENT 
The lack of formal first aid training or its emphasis in the curriculum of most medical 
schools makes one understand the degree of the gap in knowledge, attitudes and 
practices in the regular university not to talk of the high, secondary schools and within 
the communities [18]. This emphasizes the need to raise the awareness of communities 
of individuals including school children and teachers on FA [19]. As such, it is 
important for school children and teachers to learn the most basic FA skills as they are 
often first on the incident or accident scenes within the campuses. This cannot be 
overstressed as the school is the place where students and teachers spend most of their 
day. It could be assumed that all schools have dispensaries or infirmaries but in our 
setting, only a few are effectively functional. According to a report by the World Health 
Organization (WHO), only four countries in Africa meet the recommended density of 
health workers per 1000 people, indicating a severe shortage of healthcare professionals 
on the continent [8,9]. This may translate to the situation of dispensaries or infirmaries 
in schools in sub-Saharan Africa and Cameroon. 
 Although there is an improvement in school enrolment over the years in schools in sub-
Saharan Africa including Cameroon, there is little or no evidence of the same 

19 
 
improvement in functional dispensaries or infirmaries in the increasing numbers of 
schools too. Nor is there information on a strategized referral system from the school 
setting to the health facility despite the need for collaboration between schools and 
proximate health facilities. Moreover, in the advent of an injury in school premises, 
there may be delays in referral to appropriate facilities because of undefined standard 
operating procedures and knowledge deficits with no prior alleviation of the immediate 
danger to the victim. 
Thus the importance of introducing the YoFA program with refresher courses over time 
in which the people get better at the skill and some may even get into formal training in 
future. 
1.4 RATIONALE OF THE STUDY 
Since the most common first aid needs will arise from falls, cuts/wounds, during play 
periods, compared to other emergencies like choking or syncope, it is essential to focus 
more on bleeding injuries/trauma first aid since they are more visible trauma injuries 
compared to strains, sprains, fractures, among others. Furthermore, safe and timely 
referral (while raising awareness on the need and importance of the general aspects of 
FA) to the closest HF is essential to maximize the golden hour and avert adverse 
preventable outcomes.  
Since it is a pioneer lay First responder kids’ program, we will not focus on Advanced 
Trauma Life Support as these are not medical professionals although the training 
program will have a great role in honouring the ‘golden hour’ in trauma/injury. As such 
starting with life threating bleeds FA which have proven effective in some countries is a 
worthwhile beginning. 
Despite the numerous factors contributing to life-threatening bleeds (LTB), such as road 

20 
 
traffic crashes (RTCs) and acts of violence, the data on LTB-related fatalities indicates a 
need for enhanced point-of-injury interventions to effectively prevent LTB [20]. As 
such, we will apply an adaptation of the “Stop the bleed” and “Do something” programs 
in our context in Cameroon to help curb complications from emergencies with a special 
focus on LTBs in the community. Since innovations need time to be a culture among a 
people, it is essential to begin in small scale and among a population that can grow with 
the desired behaviour change or culture. One more reason why early secondary school 
students as pioneers for this program in Cameroon is because they do not have a lot of 
financial responsibilities and may not be focused on any monetary reward. What will be 
left to do if the uptake and application is favourable will be to ensure spread to other 
schools and ensure sustainability. 
1.5 RESEARCH QUESTIONS 
1. What community perceptions exist about children learning and/or using FA skills 
within the school setting or thereabouts? 
2. What is the level of Knowledge, the attitudes and practices (KAP) of early secondary 
school children (SSC) on injury/trauma FA? 
3. How efficacious and usable is an injury/trauma Young First Aiders’ 
(YoFA) training program to early SSC and the community? 
4. What are the perceived barriers/challenges and benefits of the YoFA program in 
schools and the community? 
1.6 RESEARCH OBJECTIVES 
1.6.1 General Objective 
1. To gain insights into the perceptions and barriers surrounding a Young First Aiders' 
(YoFA) training program on trauma/injury first aid in both the school setting and the 

21 
 
community in the Fako Division.  
2. To assess and measurably improve KAP of SSC on trauma/injury FA using the 
YoFA training program in Fako Division. 
 
1.6.2 Specific Objectives 
1. To understand the perspectives of stakeholders (school teachers, administrators, 
parents, community leaders and students) on a school-based FA training (YoFA) 
program among SSC. 
Hypothesis 1: The perspectives of stakeholders like school administrators, teachers, 
parents, community leaders, and school children needs to be understood to design a 
comprehensive YoFA program 
2. To assess school children's Knowledge, Attitudes (willingness to) and Practices 
(self-efficacy) (KAP) on t r a u m a / i n j u r y  FA via the built YoFA training to stop 
LTBs. 
Hypothesis 2: School children have limited knowledge, self-efficacy and practices 
regarding trauma/injury FA 
3. To evaluate the effectiveness and usability of the YoFA training program for SSC 
to respond to LTBs safely and promptly in their environs. 
Hypothesis 3: The YoFA training Program is effective in improving the KAP of SSC 
and it is usable within the school and community setting. 
4. To determine the barriers associated with implementing the YoFA program 
among early SSC in the Fako Division. 
Hypothesis 4: There exist some barrier/challenges in implementing a YoFA training 

22 
 
program in secondary schools. 

23 
 
CHAPTER TWO 
LITERATURE REVIEW 
It is important to understand some aspects regarding first aid training for children in 
schools. Here, we will be highlighting the relevance of Advanced Trauma Life Support 
concepts, the injury burden among school children, the qualifications of potential 
educators, and the appropriateness of school-based training. There is a clear consensus 
on the necessity and benefits of teaching first aid in schools, as it equips children with 
essential life skills, enhances their confidence, and promotes a safer environment. 
Future research should focus on developing effective training programs tailored to this 
age group, considering the emotional aspects of learning and the varied contexts in 
which children may need to apply their skills particularly in our setting. 
First aid training is an essential aspect of emergency preparedness, particularly for 
children aged 10 to 14 years. This age group is increasingly exposed to various risks, 
both in schools and everyday life. Here, we will explore four key areas related to first 
aid training for children: the concept of Advanced Trauma Life Support (ATLS), the 
injury burden among school children, potential educators of first aid, and the 
appropriateness of implementing first aid training in schools. 
Advanced Trauma Life Support  
Advanced Trauma Life Support (ATLS) is a systematic approach to the management of 
trauma patients, focusing on rapid assessment and treatment of life-threatening 
conditions [3]. The ATLS course teaches a systematic and concise approach to the early 
care of trauma patients, emphasizing the immediate management of injured patients and 
the rapid assessment of life-threatening conditions [3].  
Additionally, it is recognized as a foundation of care for injured patients, providing a 

24 
 
common language and approach for trauma management. The program is designed to 
ensure that life-threatening injuries are identified and treated promptly, which is crucial 
in trauma care [10]. This systematic approach is essential for improving trauma 
outcomes and is widely adopted in emergency departments around the world [3,11]. 
While ATLS is primarily designed for healthcare professionals, its principles can be 
adapted for educational purposes to teach children basic life-saving skills [2]. Research 
by Heller et al. (2020) suggests that introducing simplified versions of ATLS concepts 
can enhance children's understanding of prioritizing care in emergency situations.[2] By 
familiarizing children with the basic principles of trauma management, such as airway 
management, breathing, and circulation, they can better respond to traumatic incidents 
that may occur in their environments. However, it is crucial to tailor ATLS concepts to 
be age-appropriate. Studies indicate that children aged 10 to 14 are capable of 
understanding basic trauma care principles when presented in an engaging format [12]. 
This adaptation can include role-playing scenarios and interactive demonstrations, 
making the training more relatable and practical for young learners. 
Injury Burden Among School Children 
The injury burden among school children is significant, with various studies 
highlighting the prevalence and impact of injuries in this age group. According to the 
World Health Organization (WHO), unintentional injuries are a leading cause of 
morbidity and mortality among children aged 10 to 14 [13,14]. Common injuries 
include falls, sports-related injuries, and accidents during transportation. The high 
incidence of injuries underscores the necessity for effective first aid training programs 
in schools, which can equip children with the skills needed to respond to such incidents 
[15].A study by Tse et al. (2023) found that children who received first aid training 
were more likely to recognize and respond appropriately to injuries among their peers, 

25 
 
thus reducing the severity of injuries and improving outcome [16]. This highlights the 
critical role of first aid training in mitigating the injury burden and promoting a safer 
school environment. 
Who Can Teach Children First Aid? 
The effectiveness of first aid training is heavily influenced by the qualifications of the 
instructors. Potential educators include trained teachers, parents, healthcare 
professionals, and peers.[17] Research by Baker et al. (2021) indicates that trained 
teachers are often the most effective facilitators, as they can integrate first aid training 
into the school curriculum and ensure that the material is delivered consistently.Parents 
also play a vital role in reinforcing first aid knowledge at home. A study by Alshehhi 
and El-Aidie (2023) found that parental involvement in first aid education significantly 
enhances children's retention of skills [18]. Additionally, peer-led training programs can 
foster a supportive learning environment, where children feel more comfortable 
practicing skills with friends [19]. However, the effectiveness of peer training may 
depend on the peers' knowledge and confidence in first aid skills. 
Is It Appropriate to Train Children in First Aid in Schools? 
The appropriateness of training children in first aid within school settings has been a 
topic of considerable debate. Advocates argue that early education in first aid is 
essential, given the prevalence of injuries and emergencies in school environments. 
Training not only empowers children to act in emergencies but also promotes a culture 
of safety and responsibility [20,21]. Conversely, some critics raise concerns about the 
emotional and psychological readiness of children to handle traumatic situations. 
Research suggests that while children can learn first aid skills, care must be taken to 
ensure training is age-appropriate and does not induce fear or anxiety about 
emergencies. Schools should adopt a balanced approach that emphasizes skill 

26 
 
acquisition while providing emotional support and context, ensuring that children feel 
prepared rather than overwhelmed [15,17]. 
2.1 CONCEPTUAL REVIEW 
First aid, was earlier defined as the initial care provided for an acute illness or injury, 
with goals including: preserving life, alleviating suffering, preventing further illness or 
injury and promoting recovery. First aid can be initiated by anyone in any situation 
including self-care [21]. 
General characteristics of the provision of first aid, at any level of training, include: 
Recognising, assessing and prioritising the need for first aid; Providing care using 
appropriate competencies and recognising limitations; Seeking additional care when 
needed, such as activating the emergency medical services (EMS) system or other 
medical assistance.[1] 
In some studies around the world, it was seen through qualitative and quantitative 
studies that, although people in varying fields are aware of the importance of first aid 
for their professional development (e.g. among teachers in Spain), there is no such 
training in their careers or schools. This raises a challenge in understanding how to act 
or react in case of emergencies on the job [22]. 
The ERC 2021 guidelines advise that yearly, Cardio-pulmonary Resuscitation (CPR) 
training should provided to all schoolchildren. From 2015, the KIDS SAVE LIVES 
statement has recommended that all schools worldwide should offer two hours of 
instruction per year to students by the age of 12 [1]. Additionally, evidence shows that 
prehospital haemorrhage arrest using a tourniquet is more effective than waiting to 
reach a trauma centre before applying one. The latter has higher chances of transfusion 
within the first hour of arrival and higher odds of mortality from haemorrhagic shock 

27 
 
[23]. However, it must be the right type of tourniquet and it should be applied in the 
right way. 
In some developed nations like Spain, the United States of America (USA), and Canada 
among others, the contents of FA are part of the official curriculum of primary 
education (i.e., aged 6–12 years) [24]. Studying the presence of FA in educational 
legislation in Spain showed that although it is included in primary school curricula and 
compulsory in secondary education, it is taught mainly during Physical Education 
classes only. It reveals the need to make it an individual course for optimum outcomes. 
The Ecological model incorporates the individual, interpersonal, institutional, 
community, public policy and chronosystem in the uptake and implementation of the 
YOFA program. 
 
 
 
 
 
 
 
Figure 1: Illustration of Bronfenbrenner's ecological framework by Mash in 2019 
The PPPM guides us through the planning process to avoid missing aspects important to 
a project by first knowing the outcomes, and then walking back to address some factors 
that will enable us to reach our expected results. 
 

28 
 
Predisposing,  
Reinforcing and  
Enabling Constructs in  
Educational 
Diagnosis and 
Evaluation; aim to map educational ‘diagnoses and planning [48]. 
Policy,  
Regulatory, and  
Organisational Constructs in 
Educational/Ecological and 
Environmental  
Development (guides socio-ecological assessment and planning) [48,49]. 
 
 
 
We will be using these two as the components of the former are incorporated in the 
later. 
Predisposing 
genes, risk 
factors, etc. 
Compliance/ability 
to perform FA 
Morbidity/ 
mortality from 
Improve 
injury FA 
Economic, physical, services, 
social 

29 
 
Predisposing Factors to performing skills from the YoFA program taught: 
Knowledge (Training given), attitudes, and practices, motivation, self-efficacy. 
Enabling factors: Antecedents of behaviour that facilitate motivation to perform the 
behaviour e.g., accessibility to FA “Stop the bleed” kit, to a telephones availability of a 
teacher to guide them through, and Health facility to receive the patient, skills, and laws. 
Reinforcing factors: Rewards or punishments following or anticipated as a 
consequence of behaviour e.g., does the family encourage the child to learn the FA 
skills and apply what is learnt? What is/are the thoughts of peers, teachers, and other 
stakeholders? (here we see the interpersonal and community aspects of the ecological 
model come into place). 
2.2 CONTEXTUAL REVIEW 
Approximately 5.1 million deaths each year in sub-Saharan Africa (SSA) can be linked 
to conditions that might have been addressed through prehospital and emergency care 
[25], but which is however below standard or under-developed in SSA. Thus, the World 
Bank has been promoting first-aid training as. A cost-effective way to lower the injury 
and disease burden with an averted Disability-adjusted life year (DALY) of only 8 USD 
[25]. While the majority of research showcasing the effectiveness of adult first aid 
training programs has been carried out in Western settings [26–29], some studies from 
sub-Saharan Africa and various African Red Cross-National Societies conduct first aid 
training for adult laypeople. However, these trainings mostly took into consideration the 
Western context. There was an increased need for first aid in the SSA context by the 
African Red Cross societies, which gave birth to the AFAM (Africa First Aid Materials) 
in 2011 [30,31]. 
Given the growing evidence from Western nations indicating that children and 

30 
 
adolescents between the ages of 5 and 18 can acquire specific first aid skills and are 
open to offering assistance [32–34], instructing children in first aid appears to be a 
favorable approach for maximizing its effectiveness. Before Buck et al., in 2020, there 
was no study to test first aid training effectiveness among children in the African 
context and this led to the development of an educational pathway for FA training 
among kids [14]. 
In SSA, there were some barriers to FA training identified which include: (1) Limited 
scientific research and publication on the topic in SSA has contributed to a limited 
understanding of the specific barriers to FA training there [35] and in the SWR. (2) The 
limited resources allocated to healthcare spending. This restricted healthcare spending 
may impact the availability and accessibility of first-aid training programs, thereby 
acting as a barrier to widespread implementation [14]. (3) The lack of implementation 
plans for FA training in most SSA countries may contribute to the prevalence of 
barriers. The absence of comprehensive strategies and initiatives to promote and 
implement FA training programs could hinder their effectiveness and reach [35]. (4) 
The cost-effectiveness of a comprehensive FA training implementation program in 
LMICs including Cameroon is a current and foreseen problem [14]. 
2.2.1 Importance of First Aid Skills among School Children and Teachers 
Given the challenges in accessing timely medical care, it becomes crucial for school 
children and teachers to have basic first-aid skills. The immediate care given to any 
person in a medical emergency, as provided by first aid, can significantly save lives 
[36,37]. 
The lack of formal first aid training in the teaching curriculum of most medical schools 
further emphasizes the need for first aid skills among school children and teachers. This 
is supported by the American Red Cross, which offers first aid programs for schools, 

31 
 
allowing teachers and administrators to train their students in first aid for free [18,19]. 
In addition, a study aimed to analyze the opinions and knowledge of future teachers at a 
Spanish public university regarding training and the need for first aid. The findings of 
this study can further support the importance of integrating first aid training into the 
education system [22]. 
The combination of inadequate access to health care facilities and emergency services in 
certain regions and the potential for first aid skills to make life-saving differences 
underscores the importance of promoting FA skills among school children and teachers. 
2.2.2 Potential Impacts of First Aid Training on Reducing Injury-Related Morbidity 
and Mortality in the School Setting and Beyond 
First aid training in the school setting can have a significant impact on reducing injury- 
related morbidity and mortality. Here are some potential impacts supported by some 
studies: 
Immediate Assistance and Survival Rates: In rural Bangladesh, it was seen that effective 
bystander cardiopulmonary resuscitation (CPR) provided immediately after cardiac 
arrest can double a person's chance of survival by maintaining vital blood flow to the 
heart and brain [38]. 
Studies conducted in developed countries on non-fatal injuries have reported first aid to 
play a significant role in reducing mortality rates [38]. 
First aid offered by an untrained or trained provider is increasingly essential to reduce 
mortality and severity of injuries in developing countries [38–41]. 
Reduction in Severity of Injuries: 
Research on severe non-fatal injuries such as burns, blunt trauma, and road traffic 

32 
 
incidents in high-income settings has found a significant reduction in mortality rates 
when first aid was applied [38]. 
Disaster Preparedness: Community first aid training for disaster preparedness can play a 
critical role in saving lives and reducing morbidity at the scene in the immediate 
aftermath of a disaster [42]. 
Educational Impact: 
Providing necessary education with more effective methods, such as role-playing, can 
be effective in reducing mortality and morbidity due to lack of first aid care in crucial 
moments [43]. 
First aid training programs should be introduced at the school and college level in 
developing countries to decrease the early mortality and morbidity of accidents and 
emergencies [44]. 
Impact on Children's Safety: Accidents in schools are a significant cause of childhood 
injuries and deaths, and all staff needs to have first aid training to ensure the safety of 
children [45]. 
With all this, it means first aid training in the school setting has the potential to 
significantly reduce injury-related morbidity and mortality by providing immediate 
assistance, reducing the severity of injuries, and preparing individuals to respond 
effectively in emergencies. First aid and home safety training – with a focus on 
2.2.3 Types of First Aid Training programs for children 
In a bid to develop an Evidence-based Educational Pathway for the integration of FA 
straining in school curricula, Buck et al. perused studies in the Cochrane Library, 
Embase and Medline to identify various F A trainings and pathways given to kids. The 

33 
 
studies found included FA training on [14]: 
1. Emergency call – which involved calling an emergency number. A recall amongst 
children 5-16 years old in varying groups and different studies (5-6, 6-7, 10-12, 11- 
12,13-16, 11-16 years). Also, the “Do Something” intervention which spanned 
between calling for help and injury FA was a 6-month course taught among 13-to-
14-year-olds using a textbook style covering the preparation for action, situational 
overview, the ABC plan (Airway, Breathing, Circulation), administering FA, and 
concluding FA. It also included a series of seven (7) videos addressing topics such as 
chest pain/cardiac arrest, severe epileptic seizure, head or neck injuries, burns, 
internal bleeding, airway obstruction, and drowning [14]. 
2. Cardiopulmonary resuscitation (CPR) – hands-on and practised-based use of 
manikins and simulation to demonstrate scenarios among 6-7-, 11-12-, and 13–16-
year-olds [14]. 
3. AED (Automated External Defibrillator) used among 13 to 19-year-olds via video 
clips with different cardiac arrest situations [14]. 
4. Recovery position – this measured the knowledge and ability of children to perform 
correct recovery position in various studies of children aged 6-7, 10-12, 10-11, 
11-12 years old [14]. 
5. Choking – training children on FA for choking and obtaining their knowledge scores 
before and after the training or using a control group of “no training” amongst 10-12- 
and 11–16-year-olds [14]. 
6. Injuries e.g., an Injury Minimization Program for Schools (IMPS) where a program 
developed during an entire academic year within the school curriculum for 10- to 11- 
year-olds. This one contained 2 major packs: an educational pack where kids were 

34 
 
provided with materials and knowledge to handle aspects ranging from road 
safety, home, fire, electricity accidents, poisons and waterways. The second pack 
was the hospital visit where children learnt to perform basic life support and 
resuscitation, watched interactive videos about common accidents (burns, cuts, 
electrocution, FA responses) and toured the emergency and Accident (E&A) unit 
[14]. Another example is the “Stop the Bleed” program in the United States that is 
currently ongoing [17]. 
7. Poisoning – taught within the FA and home safety training by the American Red 
cross alongside bites, stings and allergies to 11 to 16-year-olds [46]. 
Most of these studies measured outcomes in children immediately and sometime after 
the training (3 to 12 months or thereabouts). However, none of these studies had a 
qualitative component that evaluated the usability and acceptance of the program. In our 
context in Cameroon, this is a critical component, particularly with the crises on the 
NOSO and the increasing educational standards and emancipation of individuals. 
Following this study in 2020, an educational pathway was developed outlining the age 
range for which various FA activities should either be “Encouraged”, “Known or Know 
How” and/or “Repeated” with specifics as to the knowledge, skills and attitudes 
regarding the specific act. For instance, preschoolers (3-6 years) should be encouraged 
to know why they must seek help quickly, should know how to wash their hands, be 
encouraged to stay safe and to be encouraged to correctly stop nose bleeds. This is 
different from what is required for 9-10, 11-12, or teenagers of varying age groups 
where they are required to know and apply certain skills and repeat training is always a 
bonus. According to this pathway, children should be able to know why and how to call 
for help in the face of an emergency, put on disposable gloves, ensure their safety, 
recognize a skin wound, equipment needed for treating a skin wound, correctly treat a 

35 
 
skin wound, correctly apply spiral bandage, correctly stop a nose bleed between 7 and 8 
years of age and be encouraged to understand other basic skills.  By 9-10 years, they 
should know that they are not to move seriously painful or hurt parts of the body, know 
the importance of stopping bleeding as fast as possible, know when to refer a victim 
with a nosebleed, etc. By 11-12 years, they should receive a repeat of what they know 
and start applying what they were encouraged to know at a younger age e.g., apply a 
compression bandage, know 3 possible injuries to the motor system (sprain, dislocation, 
breakage or fracture), know how to recognize an injury to bones, muscles, or joints. By 
a later age (13 to 14 years), they should be apt to correctly treat a skin wound if there is 
no clean water or too little. Correctly treat a wound that contains a foreign object. 
Correctly remove a splinter. Using disinfectant, know when to refer someone with a 
splinter to the doctor, among others. As the age group increases, what the child needs is 
mainly a repeat of what they are expected to know or what they were encouraged to 
know at an earlier age. 
 
 
 
 
 
 
 
 
 

36 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 2: Table of what children should be Encouraged, Know/Know-How, and when 
to receive Refresher/Repeat courses on the Previous FA skills. 
 
In the case of injury/trauma it was seen that children 11 to 12 years should Recognize 
the AED pictogram • Know that they must always call the emergency services if the 
victim is unconscious (and when the AED box alarm goes off) • Know the purpose of 
an AED. 
However, in Sub-Saharan Africa, there is no FA training in the tender ages. Starting this 
will require an adaptation of our context to determine when to introduce what and we 
also need to consider the mindsets of stakeholders. 

37 
 
CHAPTER THREE 
MATERIALS AND METHODOLOGY 
3.1 STUDY AREA 
We will carry out this project in the Fako division of the Southwest Region of 
Cameroon. The division is made up of four health districts. These are Buea, Limbe, 
Tiko and Muyuka health districts (HDs). The Buea and Tiko Health Districts will be 
selected based on the district with the highest number of trauma cases recorded in the 
DHIS2 and the security situation within the region.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 3: Map of the Southwest Region of Cameroon. Source, Southwest 
R e g i o n a l  D e l e g a t i o n  o f  P u b l i c  H e a l t h  ( RDPH), Cameroon 
FAKO Division 

38 
 
 
 
Source: DHIS2, Minsante, Cameroon 
Figure 4: The number of trauma cases recorded in Fako division over 4 years [47] 
 
Although the picture shows a drop in the number of cases recorded over the years, there 
is a probability that it is mostly due to underreporting of cases as there have been a lot 
more accidents that have occurred over the years and whose information was not 
captured by the health districts. 
Table 1: Average number of Trauma cases in the past four years on DHIS2 [47] 
Source: DHIS2, Minsante, Cameroon 
 
Year 
Limbe 
Buea 
Muyuka 
Tiko 
2020 
614 
358 
71 
1487 
2021 
694 
726 
89 
1487 
2022 
372 
482 
1254 
1084 
2023 
297 
385 
84 
1064 
Average 
494.25 
487.75 
374.5 
1280.5 
1600 
4-Year Trend in Trauma cases in the Fako Division 
14871487 
1400 
1254 
1200 
10841064 
1000 
800 
694 
726 
614 
600 
482 
400 
372 
297 
358 
385 
200 
71 89 
84 
0 
2020 
2021 
2022 
2023 
Limbe 
Buea 
Muyuka 
Tiko 

39 
 
Although Limbe is the next district with the next highest number of trauma and injury 
cases after Tiko, we took Buea to avoid the confounding effects of the Lay First-
responders (LFR) program taking place in the Limbe Health District. 
3.2 STUDY POPULATION 
The qualitative part will include teachers, principals and vice (of the selected schools), 
parents (whose kids attend the selected schools), regional delegates (of secondary 
education and public health) and a few community leaders like quarter heads and or 
chiefs of both the control and the intervention districts of Buea and Tiko. 
The cross-sectional survey will involve students in the early secondary school classes 
(forms 1 to 3) of the selected state secondary schools (SSS) in Buea and Tiko. These 
classes are chosen because they have most of the children aged 10-14 years which is the 
age trained in most studies and we believe these ones have just crossed a milestone from 
the primary school to get to secondary. 
The intervention part will also involve the early SSC who take part in the cross-
sectional survey before and after the intervention. 
The evaluation will involve all the students as well as the stakeholders in both 
intervention groups who had been interviewed at the start of the study to determine the 
impact of the YoFA training program and challenges faced. It will also include the 
students to assess the need for refresher courses on FA for LTB and equally identify 
challenges faced during the three months prior to the summative evaluation period. 
3.3 STUDY DESIGN 
This research will utilize a mixed-methods exploratory sequential design, incorporating 
both quantitative surveys and qualitative interviews. Exploratory because aspects of the 
qualitative aspects will be used to adjust the design of the YoFA training program which 

40 
 
will help develop a comprehensive program for such a program among SSC. The next 
design is a cross-sectional design with pre and post-tests to both the interventional and 
control groups to obtain a general baseline in both districts and assess the impact of the 
YoFA program. 
3.3.1 Qualitative Part 
Discussions or interviews on perspectives of individuals and groups of individuals 
regarding the acceptability and usability of FA-trained kids within the school and in the 
community. It will also seek to understand their thoughts on incorporating an FA 
training program within the school curriculum. It will be conducted with key 
stakeholders, including school administrators, and community leaders as well as 
students of the school. 
It will precede the qualitative part and include Focused group discussions (FGDs), in-
depth interviews of certain community and administrative stakeholders within the 
school and observations of scenarios. 
3.3.2 Quantitative Part: 
The quantitative aspect will involve administering questionnaires to students to assess 
their knowledge, attitudes (confidence), and practices (utilisation/usability) of FA 
trauma/injury skills before and after their training. This will focus mostly on staying 
safe, calling for help and stopping a life-threatening bleed. The intervention will include 
training the intervention group in reasonable clusters on the same subject matter and 
assessing the change in KAPs before and after the intervention. It will also include 
scenarios to test the efficacy of participants in carrying out the First Aid Act. 
PERIOD OF STUDY 
The study will be a 10-month study from September 2024 to July 2025 including 
administrative and ethical clearance needed. 

41 
 
3.4 ELIGIBILITY CRITERIA 
3.4.1 Inclusion Criteria 
For the Quantitative part 
- Form one (1) to three (3) students (ages 10 to 14 years) in the four (4) state 
secondary schools (SSS) in Tiko and Buea health districts who are willing to 
participate in the study. 
- Students officially enrolled in the school for the academic year 
- Those students whose parents consent for their children to be part of the study. 
For the Qualitative part 
- Stakeholders within the educational care system – Principals, community 
leaders, and parents who consent to be part of the study.  
- Students whose parents give parental consent for their children to participate in the 
study. 
3.4.2 Exclusion Criteria 
- Any child who is not in forms 1 to 3 (10 to 14 years old) in the selected schools  
- Any student who misses any of the training sessions 
- Any student who willingly backs out of the study. 
- Any child whose parents do not give parental consent for them to be part of the study. 
Age Limits 
- For the Secondary School Children (SSC): 10 to 14 years old 
- For the various stakeholders (school administrators, teachers, community leaders, 
and parents): Adults between 21 and 65 years. 
 

42 
 
3.5 SAMPLE SIZE AND SAMPLING 
Sample Size Calculation  
For the cross-sectional study and Intervention 
Assuming an equal number of control and intervention subjects, a prevalence of the 
outcome in the controls of 0.5, and a prevalence in the intervention group of 0.75 (an 
absolute increase of 25%)[17] with a power of 80% and 5% error margin, we calculated 
the sample size needed using STATA. 
Estimated sample sizes for a two-sample proportions test Pearson's chi-squared test 
using STATA 
H0: p2 = p1 versus Ha: p2 != p1 Study parameters: 
alpha = 0.0500 
power = 0.8000 
delta = 0.2500 (difference) 
p1 = 0.5000 
p2 = 
0.7500 
 
Estimated sample sizes: 
 
N = 
116 
N per group = 
58 
 
If we assume a 15% drop out rate, we have a sample size of 15%*116=17.4 Thus, 
sample size is 116+17.4 = 133.4 ~= 134 
For each group, the sample needed is therefore N = 67 students. Sampling 
Since this is a crisis area, we will use convenience sampling to choose the Health Areas 
(HAs) that are secure and geographically accessible (safest) in both HDs. Out of seven 
(7) and eight (8) HAs in Buea and Tiko HDs respectively, there are 4 accessible HAs in 
each. Of these, one HA from each HD does not harbour a state secondary school (SSS). 

43 
 
Leaving us with 3 HAs to work with in each HD. Each of these HAs contains 1 SSS but 
for 1 HA from each District which has 2 SSSs. We would work with all these State 
schools to ensure that we get students from most of the communities around the schools, 
thus ensuring the representativeness of our samples. To avoid spill-over, one of the 
districts will be selected as intervention HD and the other as the control. 
Stratified random sampling will be used to select the students for the study from a 
sampling frame of the list of students in each classroom concerned. 
We would use probability proportionate to size to choose the specific number of 
students to participate in the study per classroom (A, B, and C) for each class. 
 
 
 
 
 
 
Figure 5: Selection of HAs and Schools for Implementation. 
 
*GHS-Government High School; BGS-Bilingual Grammar School; GTHS Government 
Technical High School; GBHS government Bilingual High School 
For each school distribution of the participants will be as follows:  
A) For the Qualitative part:  
The qualitative part will be sampled purposively.

44 
 
Table 2: Number of Participants to be chosen per school for the FGDs 
 
Health District 
Schools 
FGD Category 
of Participant 
Number per 
school 
Buea 
1-BGS Molyko 
 
 
Parents (1) 
Teachers (1) 
Students (1) 
3 
2-GTHS Molyko 
Parents (1) 
Teachers (1) 
Students (1) 
3 
Tiko 
1-GHS Mutengene 
 
 
Parents (1) 
Teachers (1) 
Students (1) 
3 
2-GTHS Ombe 
Parents (1) 
Teachers (1) 
Students (1) 
3 
 
Total 
 
12 
 
N.B: Each focused group discussion will be comprised of 5 to 8 
 
 
Table 3: Number of Participants to be chosen per school for the In-depth interviews 
Health 
District 
Schools 
Category of 
Participant 
Number per 
school 
Buea 
3- GHS Bokwango 
 
Parents (2) 
Teachers (2) 
School Admin (1) 
Students (2) 
7 
4-GHS Buea Town 
Parents (2) 
Teachers (2) 
School Admin (1) 
Students (2) 
7 
Tiko 
1-GHS Mutengene 
 
Parents (2) 
Teachers (2) 
School Admin (1) 
Students (2) 
7 
3-GHS Motombolombo 
Parents (2) 
Teachers (2) 
School Admin (1) 
Students (2) 
7 
 
Total 
 
28 
 
B) For the Quantitative or intervention phase 
To recruit participants and avoid spill over among initially recruited participants, it was 
more feasible to randomly choose one classroom from among the selected schools from 
which to train the students. Thus, instead of table 4 below, we will apply table 5. 

45 
 
Table 4: Initial plan of the YoFA training Prticipants. 
Buea 
N 
Tiko 
N 
GHS Bokwango 
15 
GHS Mutengene 
15 
GHS Bueatown 
15 
GTHS Ombe 
15 
BGS Molyko 
20 
GBHS Tiko 
20 
GTHS Molyko 
20 
GHS Motombolombo 
20 
TOTAL 
70 
 
Table 5: Number of students to train on YoFA Program 
Intervention group 
School Name 
Control 
School Name 
Buea 
BGS Molyko 
Tiko 
GHS Mutengene 
Number of 
Participants 
70 
 
70 
 
3.6 STUDY PROCEDURE 
The study will use the precede proceed planning model and the ecological model 
described in the review of Literature following the steps below from planning the 
research project, through implementing the intervention, and to the monitoring and 
Evaluation phases. 
Step 1: Preparatory/Planning Phase 
The planning model to use here will be the Ecological model in conjunction with 
aspects of the PRECEDE-PROCEED planning model (PPPM). 
The other steps of the planning phase include: 
- Preparing documents to apply for ethical clearance and administrative 
authorizations to perform the study.  
- Authorizations are needed from the Regional Delegation of Secondary Education 
for the SWR (1), the divisional delegates/inspectors of the aforementioned 
ministry (2), the School Principals (8) the Regional Delegation of Public Health 

46 
 
(RDPH) for the SWR (1), and the Chiefs of Health Districts (CHDs) (2) 
- Constitute and train a team of 4 trainers medical doctors/students and data 
collectors and interviewers. 
- Obtain a sample frame of students from the various classrooms of the various 
schools and proceed with the selection of participants as described above. 
- Enlist all potential teachers and stakeholders to be interviewed 
Step 2: Intervention Phase 
- 
Organize students to be trained in groups of 10. 
- 
Each training session will last 2.5 hours and each group will be trained for 2 days. 
That is a total of 5 hours. 
- 
Overall, it will take 6 weeks (1 month, 2 weeks) to train 3 groups of 25 students 
each as shown in Table 6 below. 
- 
The Sessions will begin with a 30-to-45-minute pretest followed by theory on day 
1. Then mixed theory, video, and practical sessions on days 1 and 2. Main contents 
Content include: 1. responding to emergencies (first aid) and on prevention of 
injuries: “Call for help”, fever and contents of a first aid kit, 2. controlling Life- 
threatening bleeds (LTBs) and immediate first aid in burn cases, fractures, and/or 
dislocations in the face of LTB [11,46]. It will include the use of cartoons, simple 
language and memory aids: 
(1) Video, (2) small group teaching, (3) demonstration manikin, (4) supervised practice. 
- Interviewing the teachers, principals and other stakeholders. Interviews will be done 
using interview guides and tape recorders. 
- For the control group, we will do a selection of the participants as described and there 

47 
 
will be a session for pretesting at the beginning of the intervention, at the immediate 
end, and 3 months after. During the 3 months follow up period, we will visit the 
schools during their Wednesday club days every 2 weeks for 30mins to 1hour, to 
document their experiences and challenges in real time and their use of the 
skills. 
The qualitative part will take place before the quantitative pretesting of both groups 
begins. 
Table 6: Plan of training and Evaluation of intervention groups 
 
HA 
School 
N 
Training Period in 
2024 
Date for Last 
Evaluation, 2024 
Molyko 
(Intervention) 
BGS Molyko 
25 
Nov 6th, and 13th 
Feb 5th 
25 
Nov 20th, and 27th 
Feb 19th 
25 
Dec 4th and 11th 
March 5th 
Mutengene 
(Control) 
GHS Mutengene 
70 
November 6th 
Feb 26th 
 
Total 
145 
 
 
 
 
Step 3: Evaluation Phase 
This comprises the evaluation of students’ perceptions, barriers, and challenges in 
learning and applying the skills and lessons learned. It will equally involve evaluating 
parents’ and stakeholders’ perceptions about the program and including FA training in 
school curricula. It will involve the use of evaluation forms. This will take place about 
the same time as the post-three-month evaluation. 
Knowledge will be assessed by evaluating whether the participants have ever heard of 
first aid or observed situations in which first aid was needed. They will be expected to 
have an increase in knowledge of first aid, especially regarding calling for help, 
stopping acute and life-threatening bleeds (LTB), and referrals after the training. 
Before the training, we expect people not to have practiced first acts ever or to have 

48 
 
done it in a wrong way or to be scared to carry out specific first aid acts. After the 
training, we expect them be more alert and identify situations needing first aid acts. 
Additionally, we expect their self-efficacy and confidence to perform first aid acts to 
increase and to effectively carry out first aid acts within their community or the school 
premises that will be documented using designed forms. 
We will consider criteria for success as the proportion of persons who made an 
emergency call to an adult, teacher, the emergency number of the regional hospital, to a 
medical professional or to the closest Health Facility to the incident. The proportion of 
people who received help. The proportion of persons whose bleeds or LTBs were 
alleviated or attended to or who were referred for better management. Furthermore, the 
intention to treat/carryout the desired first aid act in the phase of an acute incident 
requiring FA. Lastly, we would like to evaluate the number of students who perform 
well during the scenarios to evaluate the need for knowledge revamping/refresher 
course on the aspects of FA taught. And all these, we shall compare the outcomes 
between the intervention and control groups. 
3.7 STUDY VARIABLES AND TYPE 
Variables 
Outcome variables 
1. Knowledge Change: to determine whether or not there was an overall change in 
knowledge before and after the training (dichotomous). 
2. Test scores: to measure the educational efficacy of the first aid training before 
and after the intervention in comparison with the control group (continuous) 
3. Self-efficacy ratings: Participants' self-perceived efficacy in performing first aid 
skills or their confidence levels in “Stopping the bleed and/or calling for help” 
(dichotomous) 

49 
 
4. Response time: The time taken by participants to respond to simulated first-aid 
scenarios or emergencies that require them to either stop an LTB or call for help or 
refer (continuous). 
5. The number of participants who make use of the skills taught during the 3 months 
post-training but before the final assessment (Discrete). 
Exposure Variables 
The exposure variables include training on LTBs from injury first aid and the use of 
these services by the trained students (e.g., the number of persons assisted or referred 
during the follow up period of the training). 
 
 

50 
 
3.8 DATA COLLECTION TOOLS 
A) Questionnaire 
Pre- and Post-Implementation of a Young First Aiders (YoFA) Training 
Program Amongst Early Secondary School Children on Injury and Trauma 
First Aid in Fako Division. 
 
Health District_________________________ 
 
 
 
Date: _____________ 
Secondary School________________________  
 
 
Class: ____________ 
 
A) QUESTIONNAIRE 
Section 1 
Please answer the questions below by ENCIRCLING OR WRITING the right answer you 
think is correct. If you do not know an answer, please select the answer you think is correct. 
1.  Gender  
YES        or       NO  
2.  Age (in years):  
________________ 
3.  Parents’ Occupation:  
Father__________ 
Mother__________ 
4.  Do you have access to a mobile phone all the time? 
YES        or       NO 
5.  Have you heard the words First Aid? 
YES        or       NO 
6.  Have you ever seen a traumatic injury? 
(A traumatic injury is an injury you sustain when something outside your body causes 
you to lose function or render you unable to use part or all of your body because of 
pain, bleeding or the because it is very serious) 
YES        or       NO 
7.  A) Have you ever received any training in First Aid (formal or informal)? 
YES        or       NO 
B) If yes, briefly describe the training (where was it, what did you learn? How 
long ago was it?)  
Where? _____________________________________________________________ 
How long ago?  
a) < 6months ago 
b) 6 to less than12 months ago 
c) 1 to 3 years ago 
d) >3 years ago 
What you learnt?  
 
 
 
8.  Have you ever seen someone bleeding and tried to stop that bleed yourself at 
home, school, marketplace, or anywhere else? 
B) How many times has that happened? (Choose one) 
a) Never 
b) Just once 
c) 2 to 5 times 
d) >5 times 
YES        or       NO 
 
 
 
 
 
 

51 
 
 
C) What did you do to stop the bleeding? _________________________________ 
 
 
 
D) Did it work? 
 
YES        or       NO 
 
 
 
YES        or       NO 
9.  A) Do you remember watching other people do this in the past?  
B) Have you ever watched someone else offer such help in question 5? 
YES        or       NO 
YES        or       NO 
10.  If you find someone bleeding today,  
 A) Will you help them? 
 B) If ‘no’, why will you not help?  
a) I don’t know what to do 
b) I am afraid I will make it worse 
c) I am afraid I will get into trouble 
d) I am afraid of blood 
e) Other reason __________________________________________________ 
 C) If ‘yes’, why will you help? __________________________________________ 
____________________________________________________________________ 
D) What steps will you take to help if ‘yes’? 
a) Help by putting in toothpaste 
b) Help by applying pressure on the wound 
c) I will not help  
d) I will call an elderly person. 
 
B) If you would not help, what makes you not want to help? 
____________________________________________________________________ 
____________________________________________________________________ 
 
 
YES        or       NO 
11.  A) Is there a functional infirmary/dispensary/sickbay in your school? 
B) Do you know where the closest/nearest health centre/hospital/clinic is to your 
house?  
YES        or       NO 
YES        or       NO 
12.  What will motivate (encourage/push) you to carry out a First Aid act to help 
someone in need? (Select all that apply) 
a) Encouragement from your family to learn the FA skills and apply what is 
learnt  
b) Encouragement from your peers/friends/classmates  
c) What your neighbours, quarter head, or teachers think/say about you being a 
YoFA. 
d) You see it on social media or TV 
e) Getting more training 
f) You want to be a first responder 
g) Others.________________________________________________________ 
 
 
13.  A severe/serious accident happens in front of you, and you must call an 
ambulance. What do you have to do? The pictures below show the actions you 
need to take, but they are in disorder. Rearrange them in order according to 
which one you will do first. Write the numbers 1 to 3 in the images according to 
what you will do first to what you will do last.
 

52 
 
14.  What would you do if your friend hurts his/her head lightly? 
a) You immediately tell your friend to get up and continue your game. 
b) You put toothpaste on your friend’s wound. 
c) You help your friend sit on a chair and ask if he/she is dizzy. 
 
 
15.  What would you do if, while playing with your friend, he/she gets injured 
seriously/severely? 
a) You help your friend get up. 
b) You run away to avoid punishment. 
c) You call for help and do not move him/her. 
 
 
 
16.  What would you do if your friend injures his/her palm and the wound is slightly 
bleeding? 
a) You apply pressure to the wound with a gauze pad or clean cloth. 
b) You wipe the blood with your hand. 
c) You apply toothpaste to the wound. 
 
17.  When calling an ambulance, you must press/dial: 
a) 118 
b) 117 
c) 119 
 
18.  What should you say on the phone when you call an ambulance or call for help? 
a) Your name and description of the accident. 
b) Describe the accident. 
c) Your name, the location of the accident, a description of the accident, and the 
number of injured people 
 
Section 2:  
 “Life-threatening bleeding” (LTB) is an emergency. It is an injury or wound 
that should be cared for first because the loss of blood is great enough that the 
person will die if no first aid is given or delayed. Keep this in mind as you 
answer the following questions. 
Meaning of some difficult words: 
- 
Spurting: to flow out suddenly and with force, often in a fast stream andwith  
- 
Streaming: run or flow in a continuous current in a specified direction 
- 
Oozing or Trickling: For a small amount of liquid to flow slowly out of 
something through a small opening or hole 
- 
Gushing: flowing out suddenly, forcefully, or in large volume, as fluid that 
has been confined 
 
This section is about being able to identify LTB (Life Threatening Bleeding) 
from a variety of descriptions (You can choose more than one answer) 
 
 
 

53 
 
19.  Which of the following need immediate first aid to stop the bleeding: 
a) Illustration of Blood oozing from scraped/scratched knee 
b) Illustration of Blood spurting from arm 
c) Illustration of Blood pooling on the ground 
d) Illustration of Blood gushing from amputated foot 
 
 
20.  Which of the following does not need immediate first aid to stop the bleeding: 
a) Spurting/pulsating blood from the injury 
b) Streaming blood from the injury 
c) Oozing/trickling blood from injury 
d) Gushing blood from the injury 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

54 
 
21.  Which of the following need immediate first aid to stop the bleeding: 
a) Photo of Scrape from a fall 
 
b) Photo of full-thickness burn 
c) Photo of Cut to thigh 
 
d) Photo of Spurting blood from a 
forearm 
 
 
 
22.  Which of the following need immediate first aid to stop the bleeding: 
a) Blood spotting through one piece of gauze 
b) Blood-soaked clothing or bandages 
c) Bleeding that is not soaking through a bandage 
d) The overlying clothes are soaked in blood 
  
 
23.  Which of the following need immediate first aid to stop the bleeding: 
a) Pooling of blood on the ground 
b) Enough blood to fill 1/2 a soda can 
c) Two-tablespoons of blood from the injury on the ground 
d) A hole in the skin without flowing blood 
 

55 
 
  
24.  Which of the following need immediate first aid to stop the bleeding: 
a) Dripping blood from a cut 
b) Gushing blood that will not stop coming out, even with a hand pushing on it 
c) Flowing blood from an injury that you are pressing on 
d) Blood spotting through several layers of cloth 
  
 
25.  Rank the following: 1= at the top, most likely to die-- 4= at the bottom least 
likely to die  
a) Bleeding from a person who is now unconscious 
b) Bleeding from a person who is not alert/not fully awake anymore 
c) Bleeding from a person who is now confused/not acting normally 
d) Bleeding from a person who is now pale 
 
A tourniquet is a device that, when properly applied, stops blood from flowing 
by compressing blood vessels to a bone. [representative photos of a commercial 
Combat Application Tourniquet and an improvised tourniquet, both placed on a 
forearm]  
 
 
26.  A tourniquet can be applied to a LTB in which of the following areas? (More 
than one answer) 
a) Leg 
b) Arm 
c) Hand 
d) Stomach  
 
27.  Which of the following need a tourniquet applied to save the life (one answer 
ONLY): 
a) Scrape/scratch from a fall 
b) full-thickness burn 
c) Cut to thigh 
d) Spurting blood from leg 
 

56 
 
 
28.  A tourniquet may be required for an arm/leg that is partially or fully torn off. 
a) True 
b) False 
 
This next section is about the actions of using pressure and tourniquets to stop 
LTB. 
 
 
29.  Climbing over a fence, a person cuts their stomach; it is bleeding and 3-4 inches 
(7-10cm) long. To control bleeding from this wound, you should: 
a) Apply firm pressure with your hand directly where the bleeding seems to be 
coming from 
b) Apply a pressure dressing first, then apply manual pressure over the pressure 
dressing 
c) Apply an elastic bandage around the abdomen, ensuring that the wound is 
covered 
d) Apply a cold pack to the wound 
    
 
30.  If you are alone with somebody who is not awake and has LTB coming from an 
arm/leg, what best describes your first action(s)? 
a) Call for help on a cell phone 
b) Put a tourniquet on the injury 
c) Call for help while apply pressure or placing a tourniquet (i.e., speaker 
phone, yelling, activating alarm) 
 
 
31.  Put the tourniquet above the wound so that it is between the torso/body and the 
wound. 
a) True 
b) False 
 
 
32.  After placing the tourniquet above the injury, it is critically important to tighten 
it as much as possible before turning the stick/rod. 
a) True 
b) False 
 
 
 

57 
 
33.  You have applied a tourniquet to a LTB on a leg. The bleeding appeared to stop 
initially, but has now restarted. Which of the following should be the next step: 
a) Apply a second tourniquet above the first (between the first tourniquet and 
the torso) 
b) Check to see if the tourniquet has loosened and tighten the tourniquet by 
turning the windlass/rod more 
c) Loosen the tourniquet, then reapply closer to the wound 
d) Remove the tourniquet completely and apply a different type of tourniquet 
e) Apply a second tourniquet directly on top of the first tourniquet 
 
 
34.  If the person is in pain, the tourniquet is on too tight. 
a) True 
b) False 
 
35.  When should a tourniquet be removed? 
a) A tourniquet should never be removed unless instructed by a physician or 
EMS provider 
b) When the patient begins experiencing severe pain 
c) When a first responder arrives on scene 
d) When bleeding has stopped 
 
 
36.  When packing a bleeding injury, it is important to push material as close to the 
bleeding vessel as possible. 
a) True 
b) False 
 
37.  After packing an injury to stop bleeding, it is not necessary to apply pressure 
any more. 
a) True 
b) False 
 
38.  How exited are you about learning this training?  
a) Not excited at all 
b) A little excited 
c) Excited 
d) Very Excited 
 
 
 

58 
 
B) FGD and in-depth interview Guide for teachers, Parents and administrators 
Welcome dear parents/ teachers 
We just introduced a plan to implement a First Aid Training program designed to teach 10 to 14 
years old (forms 1 to 3) stop life threatening bleeds to avert complications and to build a first aid 
culture in them as they grow up. In order to improve this program and understand whether this 
will be a beneficial program in this community, we are asking you, the parents and teachers of 
the students at this level, to participate in a focus group discussion about the proposed project. 
We want to understand your thoughts and concerns and hear your reactions to the project and to 
one another. We will ask you to sign a permission slip allowing us to record and transcribe the 
discussion, however, there will be no way to link what was said to you and your opinions will 
have no effect on your you or child, their grades, or any other consequence. We will use the data 
to strengthen the program and to help us decide whether training students is a good way to 
improve care for bleeding. This research is being done in conjunction with the University of 
Buea and University of California Los Angeles as well as the National Institutes of Health.  Are 
there any questions? If you have any questions or concerns, please contact Dr. Vanessa Tabe at 
+237672631065 anytime during or after the study. 
I am turning the tape recorder on [CLICK] 
Does everybody agree to participate in this interview? 
1. First, what are your general impressions of the YOFA program as described? 
2. What do you see as the benefits for children this age? 
3. What do you see as the shortcomings of this program for children this age? 
4. What do you see as the benefits or shortcomings of YOFA on the broader community? 
How likely is it that a program using children this age will make the community safer / 
more prepared to face traumatic injuries? 
Possible Barriers and Concerns 
5. Are there any practical barriers or concerns to bringing the bringing YoFA training into 
schools among 10- to 14-year-olds? If yes, what are some of them? (That may be 
parental consent, curriculum integration, teacher training and student involvement). 

59 
 
6. How do you suggest these barriers/concerns might be overcome or improved? 
Program design and delivery 
7. What practical training parameters are important to you as a parent or teacher to make 
this training easy and safe to conduct? (Length, frequency & type of ttraining)? 
8. What role do you think parents and teachers should play in the implementation and 
ongoing support of the program? 
Closing 
Thank the participants for their valuable feedback and input. 
Reiterate the importance of their perspectives in shaping the development of the "Stop the 
Bleed" young first aiders program. 
Provide information on next steps and how the feedback will be used. 
 
 
 

60 
 
Interview Guide and FGD Guide for students  
Opening of the interview with an ice-breaker question to put the students at ease, such as:"What 
are your thoughts on first aid training in schools? 
1. What are your thoughts and feelings about starting a "stop the bleed" program for young 
first aiders in your school? 
2. How do you think a program like this could help students your age, and what makes 
you feel that way? 
3. What are some ways you think having classmates trained in basic bleeding control 
techniques could be helpful for everyone? 
4. What worries or questions do you have about starting this program, and how do you 
think we could work together to solve them? 
5. How do you imagine your friends would feel about the chance to become young first 
aiders, and what do you think might encourage or stop them from wanting to join? 
6. In your view, what skills or information do you think are really important to include in 
the "stop the bleed" training for students like you? 
7. What ideas do you have for making the program fun and interesting so that everyone 
wants to participate and learn? 
8. How do you think having a "stop the bleed" program could change how your school 
thinks and acts about being prepared for emergencies? 
 
 
 
 

61 
 
C) ADAPTED SYSTEM USABILITY SCALE FOR THE YOFA TRAINING 
PROGRAM 
Kindly indicate with the smileys below whether you think you will use the 
YoFA Skills learnt  
1 = Strongly 
Disagree with 
the statement 
made 
2 = Disagree 
with the 
statement made 
 
3 = Neutral you 
neither agree nor 
disagree to the 
statement made 
 
4 = Agree 
with the 
statement 
made 
 
5 = Strongly 
agree with the 
statement made 
 
 
 
 
 
 
 
ITEM 
Value per 5-point Likert scale response, n (%) 
 
1 
2 
3 
4 
5 
1. I feel that I can know what to do with the YoFA 
skills if I see someone in need  
 
 
 
 
 
2. I found the skills taught too complicated to use. 
 
 
 
 
 
3. I thought the skills were easy to use. 
 
 
 
 
 
4. I think that I would need help from the staff to 
be able to use these skills. 
 
 
 
 
 
5. I found the training topics in the YoFA skill set 
to be strongly related/closely associated to each 
other. 
 
 
 
 
 
6. I thought there were too many changes/ups and 
downs in the skill set taught 
 
 
 
 
 
7. I would imagine that most other children of my 
age would learn to use these skills very quickly. 
 
 
 
 
 
8. I thought the skills were really hard to use. 
 
 
 
 
 
 
9. I felt very confident using the skill set. 
 
 
 
 
 
10. I needed to learn a lot of things before I could 
start applying the skill set 
 
 
 
 
 

62 
 
3.9 DATA COLLECTION PROCEDURE 
The qualitative data will be collected through FGD and in-depth interviews of the 
students and a simulation exercise. Interviews will be done using an interview guide 
until we reach a point of saturation. Each interview will last about 30 minutes. 
Quantitative data will be collected on three first aid variables: first aid knowledge, 
practical skills, and helping behaviour (attitude) using pre and posttest questionnaires 
composed of multiple-choice questions. This will be done using an adapted evidence- 
based pretested tool called “Stop the Bleed” Education Assessment Tool (SBEAT)[20] 
in adaptation with the LFRs training tools. 
3.10 DATA MANAGEMENT AND ANALYSIS 
Quantitative data will be collected using interview-administered questionnaires in Kobo 
collect, then stored in coded excel sheets to be analyzed using R software. 
Qualitative data will be transcribed and coded into transcripts to be analyzed using 
codes in Atlasti. 
3.11 DATA ANALYSIS PLAN 
A difference-in-difference analysis would be done to assess the change in KAPs before 
and after the intervention in. The posttest would be done immediately after the 4 days 
of training for each pool and 3 months after the training to assess the need for refresher 
course planning. 
The exposure variables include training on LTBs from injury first aid and the use of 
these services by the trained students (e.g., the number of persons assisted or referred during 
the follow-up period of the training). 
We will analyze survey data using R Software with a combination of descriptive statistics 
and parametric and non-parametric tests to establish statistically significant differences 
between pre- and post-test results and between the intervention and control groups. 

63 
 
Table 7: Objectives and their Indicators 
Objective 
Activities/process 
Data collection tools 
Data Source 
Indicators 
1. To understand the perspectives 
of stakeholders on YoFA training 
program among SSC 
- 
In-depth interviews 
-In-depth interview guides 
School teachers, administrators, 
parents, community leaders and 
students 
- 
2. To assess school children's KAP 
(willingness and self-efficacy on 
trauma/injury FA via the built 
YoFA training to stop LTBs. 
- 
survey 
-Questionnaire  
- students 
 
- Obtain baseline KAP Scores 
3. To evaluate the effectiveness 
and usability of the YoFA training 
program for SSC to respond to 
LTBs safely and promptly in their 
environs. 
-Training 
following 
a 
specific STB and LFRs 
program 
-Training 
students 
on 
specific modules of LTB 
FA 
- Pre and post test 
-Simulation exercises 
- Use adapted 
tools 
from the SBEAT 
- Questionnaires  
- Evaluation form with 
questions 
 
how? What was the 
situation?where, and 
how?  
Stakeholders, teachers, parents, 
students 
- Change in knowledge scores 
-At least 50% of stakeholders rate 
the program as good/ expectations 
met 
- 70% of students rate the program 
as good/expectations met 
- Number of children who made use 
of the FA skills taught 
4. To determine the barriers 
associated 
with 
implementing 
theYoFA program among early 
SSC in the Fako Division. 
- 
Interviews 
- 
Survey 
-Interview guides 
- Questionnaires 
- Stakeholders, 
- Teachers, 
students 
- Perceived reasons and 
challenges that hinder FA 
training in schools. 
 
 

64 
 
3.12 ETHICAL CONSIDERATIONS 
This research will prioritize the ethical principles of informed consent, confidentiality, 
and respect for participants. All participants will be informed about the purpose of the 
study and their right to withdraw at any time. Parental consent will also be obtained 
from the students before carrying on with the trainings. Confidentiality of information 
obtained from participants will be strictly maintained, and ethical approval will be 
sought from the institutional review board of the Faculty of Health Sciences of the 
University of Buea. 
NB: Following the research study, all the children within the various schools will be 
retrained on the program to ensure equity. 
Potential risks and Mitigation Strategies 
Risks 
Mitigation Strategies 
Breech in confidentiality 
No names on the pre and post-tests, only initials to be 
able to measure the degree of KAP change, no other 
potential respondent will come in contact with the 
filled questionnaires 
Loss of time 
-The tests are administered by data collectors using 
filling will be faster Duration: 30mins only. 
-For the qualitative part, the participants will be 
informed ahead of time so that their convenience is 
met. 
Psychologic risks related to filling of 
the questionnaires or taking tests and 
responding.  
Questions in the tests will be simply focused on what 
will/has been taught and in very simple languages with 
explanations given to the entire group at once if 
clarifications needed.  
Respondents will be counselled prior to the interviews 
and be given liberty to back out at any moment. 
Difficulty interacting during interviews 
since some people are not used to being 
recorded. 
Interviews will be performed at convenience of the 
interviewee. The interviewees will also be allowed to 
ask questions and the research team will answer all 
questions in line with the study. 
 

65 
 
Potential Benefits 
For the Participants: 
• They will be first in the secondary schools in the Southwest to benefit from such 
knowledge and skill set. 
• They will have the opportunity to apply the knowledge and skills learnt among 
their peers and the communities where they live. 
• They shall each benefit from a transport for the evaluation phase. 
The population: 
• They shall be the first to benefit from such services in the advent of traumatic 
injuries and these will be free of charge. 
• They will contribute ideas to help improve on the YoFA program. 
The country: 
• The educational and health systems can leverage on this program to build a 
comprehensive FA curriculum for schools and other institution to raise a FA 
culture and alleviate adverse outcomes of traumatic injuries.  
Measures taken for data confidentiality and respect for the private lives of the 
participants 
• There are no names on the questionnaires, and no other parents will have access 
to the questionnaires.  
• Questions posed will solely be related to the study.  
• We will use codes to input and analyse the data and only the data mangers (2) 
will have full access to the coded file where data is managed. 

66 
 
• Informed and parental consent will be obtained from participants prior to the 
study 
• Informed consent will be obtained from interviewees in person before the 
interview.  
• Administrative approval will be obtained from the various schools, regional 
delegations, and districts and ethical clearance from the ethical committee of the 
University of Buea. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

67 
 
CHAPTER FOUR 
EXPECTED RESULTS 
Overall, we expect to be able to determine perceptions of stakeholders regarding 
introducing a YoFA training program in early secondary schools, determine 
effectiveness of the program and usability of the skills taught, as well as identify 
challenges in implementing the program. The study will equally help us to reasonably 
and measurably improve KAP of early SSC on injury and trauma first aid basics, 
particularly in life threatening bleeds. We equally hope to determine the outcomes of 
this intervention and propose solutions as to how we can overcome the barriers 
identified.  
The results will inform policymakers, educators, and healthcare professionals about the 
need for targeted interventions in first-aid training programs in schools. Additionally, 
the study will contribute to the existing literature on first aid training in low-resource 
settings, particularly focusing on the Sub-Saharan African context. 
The expected results will be used to determine the scalability of the intervention and its 
incorporation into public health and educational policies in Cameroon to foster 
intersectoral collaboration and overall, lower morbidity and mortality from 
injury/trauma events. 
4.1 LIMITATIONS 
Data source (DHIS 2) to enable the choosing of the districts with the highest number of 
trauma and injury cases may not be accurate due to the poor and incomplete reporting of 
trauma and injury cases in the system. 
Private schools were not involved in the study given that they have slightly different 
school programs from the rest of the public schools.  

68 
 
INFORMATION NOTICES version 1.0_15/11/2024 
I. 
FOR PARENTS and Teachers of form 1 to 3 students (10 to 14 year-olds) 
Title of the Study: Pre- and Post-Implementation of a Young First Aiders (YoFA) 
Training Program Amongst Early Secondary School Children on Injury and Trauma 
First Aid in Fako Division 
By Vanessa Tabe Orock-Benem, MD; MPH (See address and tell below) 
This notice is an invitation to participate in research that will enable children in early secondary 
school (form 1 to 3) be trained on basic first aid skills to identify and stop or refer life 
threatening bleeds (LTB) from traumatic injuries around them at school or their neighborhoods.  
Research objective: To gain insights into the perceptions and barriers surrounding a Young 
First Aiders' (YoFA) training program on trauma/injury first aid in both the school setting and 
the community in the Fako Division. Also, it wants to assess and measurably improve 
Knowledge, Attitudes and Practices (KAP) of early Secondary School Children (SSC) on 
trauma/injury FA using the YoFA training program. The research aims to determine the 
Knowledge, attitudes and practices (KAP) of FA, identify the challenges of implementing first 
aid training, evaluate its effectiveness, and usability of skills learnt among the SSC and the 
community among children aged in Fako division, Cameroon. 
Period of the study: A 10-month study from November 2024 to September 2024. 
Study population: Secondary school children aged 10 to 14 years old (Form 1 to 3), Parents 
and school administrators/teachers and some community members. 
Procedure: The research team will meet with parents during PTA meetings organised by the 
school. Here, the content of the intervention will be explained in more detail to parents and 
school administrators/teachers.  
During this meeting, appointments will be taken with parents to perform in-depth interviews 
regarding their perceptions about introduction of a YoFA program and their ideas of the content 
of such a program for children. Following the selection of specific children randomly in the 
classes concerned, and after obtaining from their parents using the ascent forms, they will be 
trained for 8 hours on 4 consecutive days decided upon with the school.  Then, after 3 months, 
the children shall equally be evaluated to see the amount of knowledge they still retained and 
whether or not they used the YoFA skills learnt during the three months.  
No human specimens will be collected. 
Refusal to Participate: Participating in this research is voluntary. All participants have the right 
to refuse to participate and the right to withdraw consent from the study at any time, without 
retaliation.  
Ethical considerations:  
Measures taken for data confidentiality and respect for the private lives of the participants 
• 
There are no names on the questionnaires, and no other parents will have access to the 
questionnaires.  
• 
Questions posed will solely be related to the study.  
• 
We will use codes to input and analyse the data and only the data mangers (2) will have 
full access to the coded file where data is managed. Data will be and stored for up to 
6months after the study, then destroyed. 
• 
Informed and parental consent will be obtained from participants prior to the study 

69 
 
• 
Informed consent will be obtained from interviewees in person before the interview 
Potential risks and Mitigation Strategies: 
Risks 
Mitigation Strategies 
Breech in confidentiality 
No names on the pre and post-tests, only initials to be able 
to measure the degree of KAP change, no other potential 
respondent will come in contact with the filled 
questionnaires 
Loss of time 
-The tests are administered by data collectors using filling 
will be faster Duration: 10mins only. 
-For the qualitative part, the participants will be informed 
ahead of time so that their convenience is met. 
Psychologic risks related to filling of the 
questionnaires or taking tests and responding.  
Questions in the tests will be simply focused on what 
will/has been taught and in very simple languages with 
explanations given to the entire group at once if 
clarifications needed.  
Respondents will be counselled prior to the interviews and 
be given liberty to back out at any moment. 
Difficulty interacting during interviews since 
some people are not used to being recorded. 
Interviews will be performed at convenience of the 
interviewee. The interviewees will also be allowed to ask 
questions and the research team will answer all questions 
in line with the study. 
 
Potential Benefits 
For the Participants: 
We will raise a future of conscious children into adults who will have a heart to render 
First Aid services in the simplest way possible such as staying safe, calling for help or 
referring a patient who needs urgent care to prevent complications 
They will be first in the secondary schools in the Southwest and probably all over 
Cameroon to benefit from such knowledge and skill set. 
They will have the opportunity to apply the knowledge and skills learnt among their 
peers and the communities where they live. 
They shall each benefit from a transport for the evaluation phase. 
There will be an open career path to some of these children for the future in emergency 
medicine and other fields of medicine and community service. 
The population: 
The Community’s awareness on the need to invest in First Aid (FA) will be increased.  
They shall be the first to benefit from such services in the advent of traumatic injuries  
and these will be free of charge. 
They will contribute ideas to help improve on the YoFA program. 
The country: 
The educational and health systems can leverage on this program to build a 
comprehensive FA curriculum for schools and other institution to raise a FA culture 
and alleviate adverse outcomes of traumatic injuries.  
Compensation: No compensation will be given to participants except the transportation of the 
students during the evaluation. 
ADDRESSE  
• 
Principal Investigator: Vanessa T.O.B.; MD, MPH 
• 
Bonduma Gate; Buea – Cameroon. 

70 
 
• 
Email: vanessatob@gmail.com Tel: 658005255, 672631065 
CONSENT FORMS 
version 1.00_15/11/2024 
PARENTAL CONSENT for children to be included in the study (10 – 14 years) 
I, the undersigned, Mr / Mrs / Miss 
(Surname(s))____________________________________    and First name (s) 
__________________________________, Mother/Father/Carer/Tutor of 
Mr/Ms________________________________________________________________. 
Having been invited to participate in the research work entitled "Pre- and Post-
Implementation of a Young First Aiders (YoFA) Training Program Amongst Early 
Secondary School Children on Injury and Trauma First Aid in Fako Division ", whose 
Principal Investigator is Vanessa Tabe Orock-Benem, from the Faculty of Health 
Sciences, University of Buea. 
 
• I have understood the information notice given to me concerning this study.  
☐ 
• I have been read and explained the information leaflet relating to this study.  
☐  
• I have understood the purpose and objectives of this study. 
☐ 
• I received all the answers/explanations to the questions I asked physically via 
phone calls. The risks and benefits were presented and explained to me.  
☐ 
• I have understood that my child is free to accept or refuse to participate in it.  
☐ 
• His/her Ascent does not relieve the research investigators of their 
responsibilities, my child preserves all of his/her rights given by the law.  
☐ 
• I retain all my rights guaranteed by law.  
☐ 
 
I freely agree to give ascent of my child in this study under the conditions specified in 
the information notice, that is to say (for example):  
• Allow my child to be a Young First Aider (YoFA) on basic First aid skills to 
identify and manage or refer life threatening bleeds.  
 
                Done at……………………..…on the……/……/…… 
 
 
 
The Principal Investigator (names and address)                                The Participant (name and address) 
Tabe Orock-Benem Vanessa; 672631065  
 
 
 
 
 
 
 
vanessatob@gmail.com 
 
     

71 
 
              
INFORMED CONSENT FOR PARENTS/Administrators/Teachers 
version 1.00_15/11/2024 
I, the undersigned, Mr / Mrs / Miss (Surname(s)) _______________________ and First 
name(s) ___________________________________. 
Having been invited to participate in the research work entitled "Pre- and Post-
Implementation of a Young First Aiders (YoFA) Training Program Amongst Early 
Secondary School Children on Injury and Trauma First Aid in Fako Division ", whose 
Principal Investigator is Vanessa Tabe Orock-Benem, from the Faculty of Health 
Sciences, University of Buea. 
 
• I have understood the information leaflet given to me concerning this study.  
☐ 
• I have been read and explained the information leaflet relating to this study.  
☐ 
• I have understood the purpose and objectives of this study.  
☐ 
• I received all the answers/explanations to the questions I asked physically 
via phone calls. The risks and benefits were presented and explained to me. 
☐ 
• I have understood that I am free to accept or refuse to participate in it.  
☐ 
• My consent does not relieve the research investigators of their 
responsibilities.  
☐ 
• I retain all my rights guaranteed by law  
☐ 
 
I freely agree to participate in this study under the conditions specified in the notice of 
information, that is to say (for example): 
• Participate in the in-depth interview with the research team which will be 
recorded or not. 
 
Done at……………on the……/……/… 
 
 
The Principal Investigator (names and address)                           The Participant (name and address) 
Tabe Orock-Benem Vanessa; 672631065  
 
 
 
 
 
 
 
vanessatob@gmail.com 
 
 
 
 

72 
 
Result Dissemination Plan 
The results of the research will be shared with the wide public particularly the 
community of researchers in various journals, the institutions that granted 
administrative authorization and the Ministry of Public health through its Health 
Districts. 
This will specifically be shared through publication in Scientific Journals and Reports. 
International spread will be important to enable philanthropists see the felt need of first 
aid in our setting and act accordingly to bolster overall health care in the world. 
It will also be shared with the Ministries of Education so that they can consider 
incorporating First aid in the regular curriculum of schools. 
Specific measures for vulnerable participants 
Vulnerable participants will be attended to base on their vulnerability and resources 
available. For example, parents who are not literate cane make a phone call to the 
principal investigator before giving consent. Also, children who are blind will be read 
the questions. However, the schools selected are less like to have blind students there in 
Alongside the school, the research team will determine ways to manage vulnerable 
participants without giving room for biases of any kind. 
Procedure and framework for soliciting informed consent  
Informed consent will be obtained from parents via two main ways: 
- During Parents’ Teachers Association (PTA) meetings where the consent forms will 
be read together with the parents before they can give their consent. OR 
- Via mails (Letters in envelops) sent to parents through the children with a specific 
date of return. The envelops will contain the information notices and the consent 
forms where in the contact and address of the PI will be noted in case parents needed 
more clarity.  
 
 

73 
 
TIMELINE 
 
Table 5: Timeline 
 
 
2024 
2025 
Program Activities 
Nov Dec 
Jan 
Feb Mar Apr May Jun July  
Ethical 
& Administrative Approvals 
and parental consents 
 
 
 
 
 
 
 
 
 
Preparation and validation of curriculum 
 
 
 
 
 
 
 
 
 
Training of trainers 
 
 
 
 
 
 
 
 
 
Training data collectors  
 
 
 
 
 
 
 
 
 
Training of Students  
 
 
 
 
 
 
 
 
 
Qualitative 
 
 
 
 
 
 
 
 
 
Quantitative 
 
 
 
 
 
 
 
 
 
Data 
management 
and Analysis 
 
 
 
 
 
 
 
 
 
Monitoring and Evaluation 
 
 
 
 
 
 
 
 
 
Reports Writing/Presentation 
 
 
 
 
 
 
 
 
 
Positioning for Publication (Manuscript)  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

74 
 
REFERENCES 
1. Zideman DA, Singletary EM, Borra V, Cassan P, Cimpoesu CD, De Buck E, Djärv T, 
Handley AJ, Klaassen B, Meyran D, Oliver E, Poole K. European Resuscitation 
Council Guidelines 2021: First aid. Resuscitation. 2021;161:270–90. 
2. Global First Aid Reference Centre, IFRC. International First Aid Resuscitation and 
Education Guidelines [Internet]. globalfirstaidcentre.org. 2020. 
3. OSHA. Medical and First Aid - What is First Aid? | Occupational Safety and Health 
Administration [Internet]. 
4. Bollig G, Myklebust AG, Østringen K. Effects of first aid training in the kindergarten - 
a pilot study. Scandinavian Journal of Trauma, Resuscitation and Emergency 
Medicine. 2011;19(1):13. 
5. Plischewski H, Kucirkova N, Anda Haug I, Tanum I, Lea S. Children save lives: 
evaluation of a first aid training in Norwegian kindergartens. European Early 
Childhood Education Research Journal. 2021;29(6):813–27. 
6. Mould-Millman N-K, Dixon JM, Sefa N, Yancey A, Hollong BG, Hagahmed M, 
Ginde AA, Wallis LA. The State of Emergency Medical Services (EMS) Systems in 
Africa. Prehospital and Disaster Medicine. 2017;32(3):273–83. 
7. World Bank. The State of Emergency Medical Services in Sub-Saharan Africa 
[Internet]. Washington, DC: World Bank; 2021 Feb. 
8. Delaney PG, Bamuleke R, Lee YJ. Lay First Responder Training in Eastern Uganda: 
Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency 
Care Training Program. World Journal of Surgery. 2018;42(8):2293–302. 
9. Bandyopadhyay L, Manjula M, Paul B, Dasgupta A. Effectiveness of first-aid training 
on school students in Singur Block of Hooghly District, West Bengal. Journal of 
Family Medicine and Primary Care. 2017;6(1):39. 
10. 
Hawks SR, Egan M. The Impact of Three Different First Aid Curricula on 
Emergency Helping among College Students. Journal of Health Education. 
1998;29(5):289–93. 
11. 
De Buck E, Van Remoortel H, Dieltjens T, Verstraeten H, Clarysse M, Moens O, 
Vandekerckhove P. Evidence-based educational pathway for the integration of first 

75 
 
aid training in school curricula. Resuscitation. 2015;94:8–22. 
12. 
Morris J. The Importance of First Aid Training for Young People [Internet].  
SWHELPER - Social Work Helper. 2018. 
13. 
Tse E, Plakitsi K, Voulgaris S, Alexiou GA. The Role of a First Aid Training 
Program for Young Children: A Systematic Review. Children. 2023;10(3):431. 
14. 
Buck ED. An educational pathway and teaching materials for first aid training of 
children in sub-Saharan Africa based on the best available evidence. BMC Public 
Health. 2020; 
15. 
Winthrop R. Improving access to quality public education in Africa [Internet]. 
Brookings. 2022. 
16. 
UNESCO. The persistent teacher gap in sub-Saharan Africa is jeopardizing 
education recovery | UNESCO [Internet]. 
17. 
Young Kids Learn to “Stop the Bleed,” Program Catches CNN’s Eye [Internet]. 
Vitals. 2023. 
18. 
Joseph N, Kumar G, Babu Y, Nelliyanil M, Bhaskaran U. Knowledge of First Aid 
Skills Among Students of a Medical College in Mangalore City of South India. 
Annals of Medical and Health Sciences Research. 2014;4(2):162–6. 
19. 
American Red Cross. First Aid Training | Train in First Aid [Internet]. Red Cross. 
20. 
Pellegrino JL, Charlton N, Goolsby C. “Stop the Bleed” Education Assessment Tool 
(SBEAT): Development and Validation. Cureus. 2020;12(9):e10567. 
21. 
Pellegrino LJ, Charlton NP, Jestin C. Part 8: First Aid [Internet]. cpr.heart.org. 
2020. 
22. 
Olmos-Gómez M del C, Ruiz-Garzón F, Pais-Roldán P, López-Cordero R. Teaching 
First Aid to Prospective Teachers as a Way to Promote Child Healthcare. Healthcare. 
2021;9(4):367. 
23. 
Scerbo MH, Holcomb JB, Taub E, Gates K, Love JD, Wade CE, Cotton BA. The 
trauma center is too late: Major limb trauma without a pre-hospital tourniquet has 
increased death from hemorrhagic shock. Journal of Trauma and Acute Care 
Surgery. 2017;83(6):1165. 

76 
 
24. 
Pais-Roldán P, del Carmen Olmos-Gómez M, Cuevas-Rincón JM, Luque-Suárez M. 
Study on the Attitudes and Knowledge of Teachers and Future Teachers about 
Immediate Health Care Measures at School. European Journal of Investigation in 
Health, Psychology and Education. 2022;12(7):854–69. 
25. 
A T, R H, J M, Er H, A Z, Cn M. Prehospital and Emergency Care [Internet]. 
PubMed. 2015. 
26. 
Riggs M, Franklin R, Saylany L. Associations between cardiopulmonary 
resuscitation (CPR) knowledge, self-efficacy, training history and willingness to 
perform CPR and CPR psychomotor skills: A systematic review. Resuscitation. 
2019;138:259–72. 
27. 
González-Salvado V, Rodríguez-Ruiz E, Abelairas-Gómez C, Ruano-Raviña A, 
Peña-Gil C, González-Juanatey JR, Rodríguez-Núñez A. Training adult laypeople in 
basic life support. A systematic review. Revista Espanola De Cardiologia (English 
Ed). 2020;73(1):53–68. 
28. 
Yeung J, Okamoto D, Soar J, Perkins GD. AED training and its impact on skill 
acquisition, retention and performance--a systematic review of alternative training 
methods. Resuscitation. 2011;82(6):657–64. 
29. 
He Z, Wynn P, Kendrick D. Non-resuscitative first-aid training for children and 
laypeople: a systematic review. Emergency medicine journal: EMJ. 2014;31(9):763–
8. 
30. 
Velde SV de, Buck ED, Vandekerckhove P, Volmink J. Evidence-Based African 
First Aid Guidelines and Training Materials. PLOS Medicine. 2011;8(7):e1001059. 
31. 
Suryanto null, Plummer V, Boyle M. EMS Systems in Lower-Middle Income 
Countries: A Literature Review. Prehospital and Disaster Medicine. 2017;32(1):64–
70. 
32. 
Malsy M, Leberle R, Graf B. Germans learn how to save lives: a nationwide CPR 
education initiative. International Journal of Emergency Medicine. 2018;11(1):9. 
33. 
Reveruzzi B, Buckley L, Sheehan M. School-Based First Aid Training Programs: A 
Systematic Review. Journal of School Health. 2016;86(4):266–72. 

77 
 
34. 
Finke S-R, Schroeder DC, Ecker H, Wingen S, Hinkelbein J, Wetsch WA, Köhler D, 
Böttiger BW. Gender aspects in cardiopulmonary resuscitation by schoolchildren: A 
systematic review. Resuscitation. 2018;125:70–8. 
35. 
Adugna MB, Nabbouh F, Shehata S, Ghahari S. Barriers and facilitators to 
healthcare access for children with disabilities in low and middle income sub- 
Saharan African countries: a scoping review. BMC Health Services Research. 
2020;20(1):15. 
36. 
Brouhard R. Basic First Aid You Should Know [Internet]. Verywell Health. 2023. 
37. 
Horriar L, Rott N, Semeraro F, Böttiger BW. A narrative review of European public 
awareness initiatives for cardiac arrest. Resuscitation Plus. 2023;14:100390. 
38. 
Hoque DME, Islam MI, Sharmin Salam S, Rahman QS, Agrawal P, Rahman A, 
Rahman F, El-Arifeen S, Hyder AA, Alonge O. Impact of First Aid on Treatment 
Outcomes for Non-Fatal Injuries in Rural Bangladesh: Findings from an Injury and 
Demographic Census. International Journal of Environmental Research and Public 
Health. 2017;14(7):762. 
39. 
Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, 
Juillard C. Key findings from a prospective trauma registry at a regional hospital in 
Southwest Cameroon. PLOS ONE. 2017;12(7):e0180784. 
40. 
Juillard C, Dicker R, Nwanna-Nzewunwa OC, Christie SA, Carvalho M, Motwani G, 
Delon FND, Ngamby MK, Mballa GAE, Nsongoo P, Saidou A, Mekolo D. Analysis 
of a National Trauma Registry in Cameroon: Implications for Prehospital Care 
Strengthening. Panamerican Journal of Trauma, Critical Care & Emergency Surgery. 
2018;7(2):133–42. 
41. 
Chichom-Mefire A, Palle-Ngunde J, Fokam PG, Mokom-Awa A, Njock R, Ngowe- 
Ngowe M. Injury patterns in road traffic victims comparing road user categories: 
Analysis of 811 consecutive cases in the emergency department of a level I 
institution in a low-income country. International Journal of Surgery Open. 
2018;10:30–6. 
42. 
Panduragan S. Community First Aid Training for Disaster Preparedness: A Review 
of Education Content. KnE Life Sciences. 2022; 
43. 
Hassanzadeh A, Vasili A, Zare Z. Effects of two educational method of lecturing and 

78 
 
role playing on knowledge and performance of high school students in first aid at 
emergency scene. Iranian Journal of Nursing and Midwifery Research. 
2010;15(1):8–13. 
44. 
Khan A, Shaikh S, Shuaib F, Sattar A, Samani SA, Shabbir Q, Rasheed AZ. 
Knowledge attitude and practices of undergraduate students regarding first aid 
measures. JPMA The Journal of the Pakistan Medical Association. 2010;60(1):68– 
72. 
45. 
Hammett E. Accidents in schools - First Aid for Life [Internet]. 2018. 
46. 
Buck ED. An educational pathway and teaching materials for first aid training of 
children in sub-Saharan Africa based on the best available evidence. BMC Public 
Health. 2020; 
47. 
DHIS2, Ministry of Public Health. Road Traffic Accidents in Fako Division 
[Internet]. 2024. 
48. 
Binkley CJ, Johnson KW. Application of the PRECEDE-PROCEED Planning Model 
in Designing an Oral Health Strategy. Journal of theory and practice of dental
 
public 
health. 
2013;1(3):http://www.sharmilachatterjee.com/ojs-
2.3.8/index.php/JTPDPH/article/view/89. 
49. 
Porter C. Revisiting Precede-Proceed: A leading model for ecological and ethical 
health 
promotion. 
Health 
Education 
Journal. 
2015;75.

79