Effectiveness of Bystander Knowledge through Community-Based Training on Responsiveness of Prehospital Emergency Care in Nairobi County, Kenya

Abstract

Purpose: Most of the emergencies occur outside heath care setting and prehospital emergency care is vital in reducing preventable deaths and disabilities. In Nairobi, emergency response remains fragmented, and bystander involvement is limited due to low knowledge and training. To assess the effect of bystander Knowledge through community-based training on responsiveness of pre-hospital emergency care. Methodology: This quasi-experimental pre-post intervention in Mama Lucy Kibaki Hospital's catchment area trained 128 Community Health Promoters (CHPs) to educate 64,000 households on emergency notification and response. Baseline and end-line data collected via questionnaires were analyzed using SPSS v26.0. Findings: Training bystanders dramatically improved their emergency response knowledge and efficiency. Knowledge scores significantly increased (p=0.001), with notable gains in knowing the emergency number (55% to 83%), saving the tollfree number (16% to 73%), and recognizing 1508 (4% to 48%)— all p<0.0001. The percentage of individuals knowing what to do in an emergency rose from 85% to 94% (p<0.001), and the mean knowledge score increased from 6.39 to 7.30 (p<0.001). Improvements were observed across all demographic groups. Post-secondary educated respondents showed the strongest gains (+13.7 percentage points to 96.5%, p<0.001). Males experienced greater improvement (+14.4 points to 93.7%) than females (+9 points to 82.2%). The training was most effective for interior residents (achieving 100% knowledge) and those near major roads (+21.3 points to 78.9%, p<0.001). Casual labourers demonstrated the largest gains (+40.9 points to 90.9%). Workingage participants, specifically those aged ≤30 and 31-40 years, also showed significant knowledge increases (+11.4 and +10.9 points, respectively). These knowledge gains led to faster emergency responses, with 87% of reports occurring within 0-5 minutes postintervention, compared to 0% at baseline. Delays exceeding 15 minutes plummeted from 80.4% to 4.1% (p<0.001). The strongest predictors of knowledge were post-secondary education (OR=5.64, p<0.001) and interior residence (OR=7.32, p<0.001). Casual labourers showed reduced odds of knowledge (OR=0.24, p=0.017), while respondents aged 31-40 years had 74% higher odds (OR=1.74, p=0.039). Gender, most employment statuses, and age >50 years did not significantly affect knowledge Unique Contribution to Theory, Practice and Policy: Community-based training significantly improves bystander knowledge and emergency response times, offering a vital solution for strengthening pre-hospital emergency systems in Low- and Middle-Income Countries (LMICs). This highlights the critical need for diverse bystander training strategies. The study recommends; developing a specialized pre-hospital emergency care training model for the elderly. Conducting further research on how marital status influences knowledge acquisition from training. Revising the WHO Emergency Care System Framework (ECSF) to explicitly incorporate bystander training.