Epidemiology of childhood burn: Yield of largest community based injury survey in Bangladesh

Electrical injuries in urban children in New Delhi

AIM

The objective of this study was to analyze the epidemiology, presentation, management, and complications of electrical burn injuries in urban children.

METHODS

Data from records and clinical data were collected retrospectively and prospectively during 2008 to 2010.

RESULTS

Of 41 children enrolled, the mean age of children enrolled was 8.1 ± 4.5 years. Low-voltage injury was seen in 28 (68.2%), and 13 (31.8%) had high-voltage injuries. Low-voltage injuries were most commonly (52.45%) secondary to direct contact with live wire, whereas high-voltage injuries in 70% were due to direct contact with broken wires lying in fields/rooftops. Fourteen children of the 41 enrolled had associated injuries. Low-voltage injuries were associated with minor burns, seizures, tibial fracture, eyelid burn, scalp hematoma, and speech and visual impairment, whereas high-voltage injuries were associated with cardiac arrest, extradural hematoma, visceral burns, pulmonary hemorrhage and hypoxic encephalopathy, and postelectrocution acute respiratory distress syndrome. Surgical interventions done included split-thickness skin grafting, fasciotomy, and amputation procedures. The mean duration of hospital stay of all the children enrolled was 9.02 days with 35 children discharged, 71.4% of them having low-voltage injuries. Four children died, 75% of them having high-voltage injury, whereas 2 children left without medical advice, both having low-voltage injuries.

CONCLUSIONS

Children are a major group susceptible to electrical injuries in our country. Most of the mechanisms leading to them are easily preventable, but occur because of lack or awareness among the children and their guardians. Burn prevention program should be implemented incorporating these epidemiological data.

Epidemiology of operative burns at Kijabe Hospital from 2006 to 2010: pilot study of a web-based tool for creation of the Kenya Burn Repository

INTRODUCTION

In order to implement effective burn prevention strategies, the WHO has called for improved data collection to better characterize burn injuries in low and middle income countries (LMIC). This study was designed to gather information on burn injury in Kenya and to test a model for such data collection.

METHODS

The study was designed as a retrospective case series study utilizing an electronic data collection tool to assess the scope of burn injuries requiring operation at Kijabe Hospital from January 2006 to May 2010. Data were entered into a web-based tool to test its utility as the potential Kenya Burn Repository (KBR).

RESULTS

174 patients were included. The median age was 10 years. There was a male predominance (59% vs. 41%). Findings included that timing of presentation was associated with burn etiology (p=0.009). Length of stay (LOS) was associated with burn etiology (p<0.001). Etiology differed depending on the age group, with scald being most prominent in children (p=0.002).

CONCLUSIONS

Burn injuries in Kenya show similarities with other LMIC in etiology and pediatric predominance. Late presentation for care and prolonged LOS are areas for further investigation. The web-based database is an effective tool for data collection and international collaboration.

Characteristics of fatal and hospital admissions for burns in Fiji: a population-based study (TRIP Project-2)

BACKGROUND

Over 95% of burn deaths are estimated to occur in low-and-middle-income countries. However, the epidemiology of burn-related injuries in Pacific Island Countries is unclear. This study investigated the incidence and demographic characteristics associated with fatal and hospitalised burns in Fiji.

METHODS

This cross-sectional study utilised the Fiji Injury Surveillance in Hospital database to estimate the population-based incidence and contextual characteristics associated with burns resulting in death or hospital admission (≥12h) during a 12-month period commencing 1st October 2005.

RESULTS

116 people were admitted to hospital or died as a result of burns during the study period accounting for an overall annual incidence of 17.8/100,000 population, and mortality rate of 3.4/100,000. Most (92.2%) burns occurred at home, and 85.3% were recorded as unintentional. Burns were disproportionately higher among Fijian children compared with Fijian-Indian children with the converse occurring in adulthood. In adults, Indian women were at particularly high risk of death from self-inflicted burns as a consequence of 'conflict situations'.

CONCLUSION

Burns are a significant public health burden in Fiji requiring prevention and management strategies informed by important differences in the context of these injuries among the major ethic groups of the country.

Medical management of paediatric burn injuries: best practice

Burns commonly occur in children and their first aid remains inadequate despite burn prevention programmes. While scald injuries predominate, contact and flame burns remain common. Although typically less severe injuries overall than those in adults, hypertrophic scarring complicating both the burn wound and even donor sites occur more frequently in children. The heterogeneous nature of burn wounds, coupled with the difficulties associated with the early clinical assessment of burn depth, has stimulated the application of novel technologies to predict burn wound outcome. This review explores current best practice in the management of paediatric burns, with a focus on prevention, optimal first aid, resuscitation, burn wound prediction and wound management strategies.

Pediatric burns in Khuzestan Province, Iran

BACKGROUND

Burn injuries are the most frequently occurring injuries among pediatric populations worldwide, and they are significant pediatric injuries in Iran.

AIM

This study was conducted to analyze the pattern of pediatric burns in Khuzestan province in the south-west of Iran from April 2006 to March 2007.

PATIENTS AND METHODS

The location of the study was Taleghani Hospital, a sole center for burn patients in Khuzestan province. The number of patients with burns admitted to the center in 1 year (from April 2006 to March 2007) was 211. Data were obtained by reviewing the medical records of patients hospitalized at the center.

RESULTS

Of the patients, 85 (40.3%) were female and 126 (59.7%) were male. Of the 85 female patients, 50 were from urban areas and 35 were from rural areas. Of the 126 male patients, 68 (54%) were from urban areas and 58 (46%) were from rural areas. The mean ± SE age of the children ranging between 0 and 11 years was 3.20 ± 0.188. Scalding was the predominant cause of burns and caused 86.7% of the burns. The age of the patients with scald injuries (2.95 ± 2.56 years) was significantly lower than that of patients with flame injuries (4.28 ± 3.3 years) (P=0.007). Correlation analysis showed that younger children and urban residents are more vulnerable to scald injuries. The mean body surface area of burns was 20.5 ± 10.26 cm in all patients.

CONCLUSION AND RECOMMENDATIONS

Scalding was the most common cause of burns. Age <4 years and residency in urban areas were the major factors increasing the risk of burn accidents in children in Khuzestan. An appropriate burn prevention program, with focus on education, is needed to prevent this injury.

Risk factors of burns among children in Mongolia

Burn is one of the leading causes of under-5 childhood injuries. Identification of risk factors and awareness level of caregivers could help reduction of burn-related morbidity. The objectives of this study were to identify general perceptions of risk factors of childhood burns, prevalence of burns among under-five Mongolian children, and to assess knowledge and practice of burn care and care seeking behaviors for care givers of those children. A household-based cross-sectional survey was conducted from September to October 2010 including 865 households with 1154 under-5 children. Data were collected by face-to-face interview using semi-structured questionnaire. Of total 1154 children, 291 (25.2%) had burn injury in their life-time. Above half of them had suffered a scald. Majority of burns occurred at home and urban children were at higher risk. The age up to 36 months, boys, and fewer children (<3) in the household were found as significant risk factors for childhood burns. Caregivers' knowledge and practices on childhood burns were generally insufficient; most of them indicated the importance of physical environment at home. We concluded that burns were common among under-5 children, and caregivers' knowledge and practices on burns was inadequate. Specific interventions like "Caregivers education program" encouraging safe domestic environmental conditions should be undertaken to increase their awareness on burn-related issues to reduce childhood burns in Mongolia.

Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania

BACKGROUND

Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome.

METHODS

A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0.

RESULTS

A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001).

CONCLUSION

Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced.

Epidemiology of burns throughout the world. Part I: Distribution and risk factors

Globally in 2004, the incidence of burns severe enough to require medical attention was nearly 11 million people and ranked fourth in all injuries, higher than the combined incidence of tuberculosis and HIV infections. Fortunately, although burns and fires account for over 300,000 deaths each year throughout the world, the vast majority of burns are not fatal. Nonetheless, fire-related burns are also among the leading causes of disability-adjusted life years (DALYs) lost in low- and middle-income countries (LMIC). Morbidity and mortality due to fire and flames has declined worldwide in the past decades. However, 90% of burn deaths occur in LMIC, where prevention programs are uncommon and the quality of acute care is inconsistent. Even in high-income countries, burns occur disproportionately to racial and ethnic minorities such that socioeconomic status--more than cultural or educational factors--account for most of the increased burn susceptibility. Risk factors for burns include those related to socioeconomic status, race and ethnicity, age, and gender, as well as those factors pertaining to region of residence, intent of injury, and comorbidity. Both the epidemiology and risk factors of burns injuries worldwide are reviewed in this paper.

Training and burn care in rural India

Burn care is a huge challenge in India, having the highest female mortality globally due to flame burns. Burns can happen anywhere, but are more common in the rural region, affecting the poor. Most common cause is flame burns, the culprit being kerosene and flammable flowing garments worn by the women. The infrastructure of healthcare network is good but there is a severe resource crunch. In order to bring a positive change, there will have to be more trained personnel willing to work in the rural areas. Strategies for prevention and training of burn team are discussed along with suggestions on making the career package attractive and satisfying. This will positively translate into improved outcomes in the burns managed in the rural region and quick transfer to appropriate facility for those requiring specialised attention.

Burn mortality in Bangladesh: findings of national health and injury survey

OBJECTIVE

The study was designed to explore the epidemiology of burn mortality in Bangladesh.

METHODS

A population-based cross-sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429.

RESULTS

Overall mortality burn rate was 2.2 per 100,000 populations per year. The rate was higher amongst females. Most of the deaths were accidental in nature, only 5% of deaths were from self-inflected burn. The rate was higher amongst the rural population compared to the urban population. About 90% of the burn incidences were at home with the kitchen the most frequent place at home for burn incidence to occur. A majority, 89%, of the deaths were caused by flame burn. Cooking fire, heating fire and fire from kerosene lamps were the major sources of flames. The majority of burn deaths occurred during winter season.

CONCLUSION

Burn is a considerable cause of death in Bangladesh. Females, rural dwellers and populations of low socioeconomic condition are more vulnerable to burn injury. With simple intervention many of the deaths due to burn can be prevented. Considering the magnitude of the problem it is very important to address it as a public health problem and develop a national burn prevention program.

Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics

OBJECTIVE

The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries.

METHODS

A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0-18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information.

RESULTS

About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children.

CONCLUSION

Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parent's education a national burn prevention program needs to be developed to combat the devastating child injury, burn.

Determinants of childhood burns in rural Bangladesh: A nested case-control study

BACKGROUND

Burn is one of the major causes of childhood illnesses in Bangladesh and is the third leading cause of illness of 1- to 4-year-old children. Rural children are more at risk compared to urban-dwelling children.

OBJECTIVE

The study was designed to identify the risk factors of childhood burn in rural Bangladesh.

METHODS

This nested case-control study was conducted in rural Bangladesh. The study population was children of less than 10 years old in three sub-districts of Bangladesh.

RESULTS

Children of families who did not have a household with a separate kitchen, a common occurrence in rural areas, were at significantly higher risk of burn (OR 1.65; 95% CI 1.22-2.24). A kitchen without a door was also found to create a more hazardous environment compared to a kitchen with a door. The traditional kerosene lamp (kupi bati) was found to be one of the major determinants of childhood burn in rural Bangladesh (OR 3.16; 95% CI 1.58-6.35). No use or restricted use of kupi bati significantly reduces the risk of childhood burn. Children of nuclear families were at significantly higher risk of burn compared to combined families.

CONCLUSION

Cooking in an open place and use of the traditional kerosene lamp are the major determinants of childhood burn in rural Bangladesh. A combined family environment reduces the risk of childhood burn. Childhood burn can be reduced by prohibiting use of kupi bati and limiting children's access to the cooking area. Promoting combined family could be an initiative of childhood burn prevention program.

The year in burns 2008

For 2008, approximately 1200 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns). As in the previous year's review, articles were divided into the following topic areas: epidemiology, wound characterisation, critical care physiology, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain management, rehabilitation, and burn reconstruction. Each selected article is mentioned briefly with editorial comment.

Burn prevention mechanisms and outcomes: pitfalls, failures and successes

Burns are responsible for significant mortality and morbidity worldwide and are among the most devastating of all injuries, with outcomes spanning the spectrum from physical impairments and disabilities to emotional and mental consequences. Management of burns and their sequelae even in well-equipped, modern burn units of advanced affluent societies remains demanding and extremely costly. Undoubtedly, in most low and middle income countries (LMICs) with limited resources and inaccessibility to sophisticated skills and technologies, the same standard of care is obviously not possible. Unfortunately, over 90% of fatal fire-related burns occur in developing or LMICs with South-East Asia alone accounting for over half of these fire-related deaths. If burn prevention is an essential part of any integrated burn management protocol anywhere, focusing on burn prevention in LMICs rather than treatment cannot be over-emphasized where it remains the major and probably the only available way of reducing the current state of morbidity and mortality. Like other injury mechanisms, the prevention of burns requires adequate knowledge of the epidemiological characteristics and associated risk factors, it is hence important to define clearly, the social, cultural and economic factors, which contribute to burn causation. While much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs) such as the United States due to sustained research on the epidemiology and risk factors, the same cannot be said for many LMICs. Many health authorities, agencies, corporations and even medical personnel in LMICs consider injury prevention to have a much lower priority than disease prevention for understandable reasons. Consequently, burns prevention programmes fail to receive the government funding that they deserve. Prevention programmes need to be executed with patience, persistence, and precision, targeting high-risk groups. Depending on the population of the country, burns prevention could be a national programme. This can ensure sufficient funds are available and lead to proper coordination of district, regional, and tertiary care centres. It could also provide for compulsory reporting of all burn admissions to a central registry, and these data could be used to evaluate strategies and prevention programmes that should be directed at behavioural and environmental changes which can be easily adopted into lifestyle. Particularly in LMICs, the emphasis in burn prevention should be by advocating change from harmful cultural practices. This needs to be done with care and sensitivity. The present review is a summary of what has already been accomplished in terms of burn prevention highlighting some of the successes but above all the numerous pitfalls and failures. Recognizing these failures is the first step towards development of more effective burn prevention strategies particularly in LMICs in which burn injury remains endemic and associated with a high mortality rate. Burn prevention is not easy, but easy or not, we have no options; burns must be prevented.

Unintentional injuries in the rural population of Twiserkan, Iran: a cross-sectional study on their incidence, characteristics and preventability

BACKGROUND

Knowledge is sparse concerning injuries affecting rural populations in low and middle-income countries in general and in Iran in particular. This study documents the incidence and characteristics of severe injuries affecting rural people in the Iranian district of Twiserkan and it investigates these people's suggestions for injury prevention and control.

METHODS

An interview-based investigation was undertaken that comprised all unintentional injuries leading to hospitalization (more than 6 hours) or death that had occurred within a twelve month period and that were identified in the files of the 62 "health houses" of the Twiserkan district. For each case, semi-structured interviews were conducted at the households of the injured people (134 injuries affecting 117 households were identified).

RESULTS

The incidence rates of fatal and non-fatal injuries were respectively 4.1 and 17.2 per 10 000 person-years and, as expected, men were more affected than women (77.6% of all injury cases). Traffic injuries (in particular among motorcyclists) were as common as home-related injuries but they were far more fatal. Among common suggestions for prevention, people mentioned that the authorities could work on the design and engineering of the infrastructure in and around the village, that the rural health workers could contribute more with local information and education and that the people themselves could consider behaving in a safer manner.

CONCLUSION

Not only domestic injuries but also those in traffic are an important cause of severe and fatal injury among rural people. Health workers may play an important role in injury surveillance and in identifying context-relevant means of prevention that they or other actors may then implement.