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Blears E, Kuo SCE, Tiongco RFP, Suresh R, Cooney CM, Caffrey J. Associations of urban versus rural patient residence on outcomes after burn: A national inpatient sample database study. Burns 2024; 50:1463-1474. [PMID: 38584006 DOI: 10.1016/j.burns.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Burn patients in rural areas may encounter poorer outcomes associated with barriers to care; however, residence has not been studied in a large sample. The association between rural-versus-urban residence and outcomes after burn was examined using the National Inpatient Sample (NIS) database. METHODS Using the 2019 NIS database, patients over 18 years with a primary diagnosis of burn or corrosive injury were included. Level of urbanization was categorized into six groups. Outcomes after burn such as in-hospital mortality, multifactorial shock, prolonged mechanical ventilation, length of stay, and total costs were analyzed after adjusting for demographic factors and hospital characteristics. RESULTS We included 4671 records, which represented a weighted population of 23,085 patients. Rural residence was associated with higher percentage of prior transfer but not in-hospital mortality. Compared to the most urbanized counties, encounters from the most rural counties were associated with higher odds of shock (aOR:2.62, 99% CI: 1.04-6.56, p = 0.007). CONCLUSION Burn encounters from less urbanized counties did not experience differences in mortality, rates of skin grafting, prolonged mechanical ventilation, length of stay, or overall costs. However, odds of shock were higher among the least urbanized counties. Despite improved triage and transportation systems across the US, disparities and challenges exist for burn patients from rural residence.
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Affiliation(s)
- Elizabeth Blears
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Shih-Chiang Edward Kuo
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Rafael Felix P Tiongco
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rachana Suresh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Carisa M Cooney
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julie Caffrey
- Bayview Burn Center, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Martin T, Nanjebe D, Atwine D. Assessment of the proportion of households with burn victims, associated risk factors and knowledge of burn injury prevention strategies in South Western Uganda. A population based cross sectional survey. Burns 2023; 49:1756-1764. [PMID: 37032274 DOI: 10.1016/j.burns.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Burn injuries are a major cause of morbidity and mortality within Low- and Middle-income countries (LMICs). Most of these burn injuries occur at home with children most at risk. The majority of burn related deaths and disability in LMICs have been described as preventable. Burns prevention requires adequate knowledge of the epidemiological characteristics and associated risk factors. The aim of this study was to assess the proportion of households with burn victims, the associated risk factors and knowledge of prevention strategies of burn injuries in Kakoba division, Mbarara city. METHODS We did a population based cross sectional survey of households in Kakoba division. This is the most populous division in Mbarara city. Face-to-face interviews were conducted using a pretested structured questionnaire. Descriptive analysis was performed to establish prevalence and knowledge of preventive strategies for household burns. Univariate and multivariate logistic regression models were fitted to establish the factors influencing burn injuries at household level. RESULTS Of the households in Kakoba Division, 41.2% had individuals who had previously sustained burn injuries within the household. Children were the most affected population with scald burns the most common type. The highest risk of burn injuries was associated with overcrowding in the households. Electricity as a light source was found to be protective. Candles and Kerosene lamps were the commonest alternative light sources. Majority 98% of the individuals in the households knew at least one burns prevention strategy with 93% practicing at least one. CONCLUSION Burns within the household are still high despite knowledge of risk factors with children being the most affected. Overcrowding still plays a significant role in household burn injuries. We therefore recommend closer supervision of children within the households. Cooking areas need to be properly designated and secured to limit access. Safer alternative light sources need to be explored such as solar lamps. Political leaders need to be involved in setting up and monitoring community-based fire safety practices to ensure compliance.
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Affiliation(s)
- Tungotyo Martin
- Department of Surgery, Mbarara University of Science and Technology (MUST), P.O. Box 1410, Uganda.
| | | | - Daniel Atwine
- Soar Research Foundation, P.O. Box 1596, Mbarara, Uganda
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3
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Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MPD, Pires-Dias PRT, Marques-Portela C, Figueira I, Mendlowicz MV. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med 2023; 53:132-139. [PMID: 33849680 DOI: 10.1017/s0033291721001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
| | - Maria Luiza Garcia-Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
| | - Marcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires de Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Carla Marques-Portela
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
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Rojas-Contreras C, De la Cruz-Ku G, Eyzaguirre-Sandoval ME, Chambergo-Michilot D, Torres-Roman JS. Fire burns matter: A case-control study of severe accidental burns in pediatric patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
<b>Objective: </b>We aimed to identify factors associated with severe accidental burns in patients ≤12 years old.<br />
<b>Materials and methods: </b>We conducted a matched case-control study, in which we retrospectively reviewed the medical records of children treated in a single institution from 2014-2016. We classified the cases (patients with severe burns) and controls (patients with non-severe burns) according to the criteria of the American Burn Association. We used multivariate conditional logistic regression analysis to identify the relationship between the etiology of burns and their severity.<br />
<b>Results: </b>We reviewed 180 cases and 90 controls. The most common etiology of burns was boiling water in both cases (65.6%) and controls (83.3%). Most burns occurred inside the home (84.1%) and in the afternoon (37.4%). Multivariate analysis identified that severe burns were mainly due to exposure to fire (odds ratio [OR]: 3.22, 95% confidence interval [CI]: 1.53-6.81). Similarly, these patients were more likely to live in a rural area (OR: 2.96, 95% CI: 1.17-6.19).<br />
<b>Conclusions: </b>In pediatric patients ≤12 years of age severe accidental burns are more likely to be caused by fire compared to boiling water. Public health interventions should focus on populations located in rural areas.
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Affiliation(s)
| | | | | | | | - J Smith Torres-Roman
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, PERU
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Mulatu D, Zewdie A, Zemede B, Terefe B, Liyew B. Outcome of burn injury and associated factor among patient visited at Addis Ababa burn, emergency and trauma hospital: a two years hospital-based cross-sectional study. BMC Emerg Med 2022; 22:199. [PMID: 36494642 PMCID: PMC9733383 DOI: 10.1186/s12873-022-00758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Burn is one of the critical health problems worldwide. Developing countries with sub-Saharan and Asian populations are affected more. Its mortality and non-fatal complications depend on several factors including age, sex, residency, cause, the extent of the burn, and time and level of care given. OBJECTIVE The purpose of this study was to assess the outcome of burn injury and its associated factor among patients who visited Addis Ababa burn emergency and trauma hospital. METHODS The institutional-based, retrospective cross-sectional study design was conducted from April 1, 2019, to March 30, 2021. After checking the data for its consistency the data were entered and analyzed by using SPSS version 25. A total of 241 patients who had visited Addis Ababa burn, emergency and trauma Hospitals after sustained burn injury were recruited through convenience sampling method for final analysis. Model goodness-of-fit was checked by Hosmer and Lemeshow test (0.272). After checking multi-collinearity both the bi-variable and multivariable logistic regression model was fitted and variables having a p-value less than or equal to 0.05 at 95% CI in the multivariable analysis were considered statistically significant. RESULT Adults (age 15 to 60 years) are the most affected groups accounting for 55.2% followed by pediatric age groups (age <15 years) (43.6%) and the elderly (age > 60 years) (1.2%). Scald burn was the major cause accounting for 39 % followed by Flame burn (33.6%), Electrical burn (26.6%), and chemical burn (0.8%). The mean TBSA% was 15.49%, ranging from1% to 64%. Adult males are more affected by electrical burns while adult females and the elderly encounter flame burn. 78.4% of patients were discharged without complications, 14.9% were discharged with complications and 6.6% died. The commonest long-term complication is the amputation of the extremity (19, 7.9%). Age greater than 60 years and TBSA% greater than 30% is a strong predictors of mortality with odds of 2.2 at 95% CI of [1.32, 3.69] and 8.7 at 95% CI of [1.33, 57.32] respectively. CONCLUSION AND RECOMMENDATION The mortality rate show decrement from previous studies. Overall scald burn is common in all age groups but electrical burns and flame burns affected more adult and elderly age groups. Extremities were by far, the commonest affected body parts. The extent of burn injury and the age of the patient independently predict mortality. Early intervention will reduce mortality and complications.
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Affiliation(s)
- Damena Mulatu
- grid.59547.3a0000 0000 8539 4635Department of internal medicine, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayalew Zewdie
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruktawit Zemede
- grid.460724.30000 0004 5373 1026Department of Emergency Medicine and Critical Care, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bewuketu Terefe
- grid.59547.3a0000 0000 8539 4635Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bikis Liyew
- grid.59547.3a0000 0000 8539 4635Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, P.O.BOX 196, Gondar, Ethiopia
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Tusiime M, Musoke D, Muneza F, Mutto M, Kobusingye O. Prevalence, risk factors and perceptions of caregivers on burns among children under 5 years in Kisenyi slum, Kampala, Uganda. Inj Epidemiol 2022; 9:18. [PMID: 35689273 PMCID: PMC9188101 DOI: 10.1186/s40621-022-00382-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background Globally, burn related deaths are disproportionately higher among children below 5 years of age compared to other age groups. Although rarely fatal, most burns in this group occur within homes specifically in kitchens. This study assessed the prevalence, risk factors and perceptions of caregivers regarding burns among children under 5 years in an urban slum in Kampala, Uganda.
Methods The study used an analytic cross-sectional design with quantitative and qualitative techniques. Quantitative data were collected using a structured questionnaire and observational checklist, while qualitative data involved use of a key informant interview guide. A total of 426 children were involved in the study, while 6 key informants namely an adult mother, teenage mother, community health worker, health practitioner, father and local leader were interviewed. A modified Poisson regression model was used to determine the correlates of burn injuries, prevalence rate ratios and 95% confidence intervals, while thematic analysis was used for qualitative data. Results The prevalence of burns among under-fives was 32%, highest among those aged 24 to 35 months (39%), and least in those below 12 months (10%). Children with single parents (adj PR = 1.56 95% CI 1.07–2.29) and those from households in the middle and least poor wealth quintile (adj.PR = 1.72; 95% CI 1.02–2.89 and adj.PR = 1.77; 95% CI 1.02–3.05, respectively) were more likely to get burns compared to their counterparts in other quintiles. In households where flammables were safely stored, children were less likely to suffer from burn injuries (adj.PR = 0.61; 95% CI 0.44–0.83). Congestion, negligence of caregivers, and use of charcoal stoves/open cooking were the commonest determinants of burns. Although many caregivers offered first aid to burn patients, inadequate knowledge of proper care was noted. Crawling children were perceived as being at highest risk of burns. Conclusion The prevalence of burns among children under 5 years was high, with several household hazards identified. Health education, household modification and applicable public health law enforcement are recommended to reduce hazards and minimise burn risks among children.
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Affiliation(s)
- Marcia Tusiime
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fiston Muneza
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Milton Mutto
- Chronic Trauma, Injury and Disability Program (TRIAD), School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,Pincer Training and Research Institute, Kampala, Uganda
| | - Olive Kobusingye
- Chronic Trauma, Injury and Disability Program (TRIAD), School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Myers JG, Nwakibu UA, Hunold KM, Wangara AA, Kiruja J, Mutiso V, Thompson P, Aluisio AR, Maingi A, Dunlop SJ, Martin IBK. Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya. Pediatr Emerg Care 2022; 38:e378-e384. [PMID: 34986590 DOI: 10.1097/pec.0000000000002294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population. METHODS Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups. RESULTS Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves. CONCLUSIONS Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.
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Affiliation(s)
- Justin G Myers
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Uzoma A Nwakibu
- From the Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, OH
| | - Ali Akida Wangara
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Jason Kiruja
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Vincent Mutiso
- University of Nairobi School of Medicine, Nairobi, Kenya
| | - Peyton Thompson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Alice Maingi
- Accident and Emergency Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Stephen J Dunlop
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Ian B K Martin
- Department of Emergency Medicine at the Medical College of Wisconsin, Milwaukee, WI
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8
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What is Known About Burns in East Africa? A Scoping Review. J Surg Res 2021; 266:113-124. [PMID: 33989890 DOI: 10.1016/j.jss.2021.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/27/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Burns are a global public health concern, with the majority of the disease burden affecting low- and middle-income countries. Yet, as suggested by previous publications, there is a widespread belief that literature about burns in low- and middle-income countries is lacking. Therefore, we aimed to assess with a scoping review, the extent of the literature output on burns in East Africa, and to investigate patient demographics, injury characteristics, treatment and outcomes, as reported from the existing publications. METHODS Studies discussing burns in East Africa were identified by searching PubMed / Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO), and Global Index Medicus on December 12, 2019. Controlled vocabulary terms (i.e., MeSH, EMTREE, Global Health thesaurus terms) were included when available and appropriate. No year restrictions were applied. RESULTS A total of 1,044 records were retrieved from the database searches, from which 40 articles from 6 countries published between 1993 and 2019 were included in the final review. No studies were found from five East African countries with the lowest GDP. Most papers focused on pediatric trauma patients or tertiary hospital settings. The total number of burn patients recorded was 44,369, of which the mean proportion of males was 56%. The most common cause of injury was scalds (61%), followed by open flame (17%). Mortality rate ranged from 0-67%. The mean length of stay in hospital was between 9-60 d. CONCLUSIONS Burn data is limited in the East African region, with socio-economically weak countries being particularly underrepresented. This scoping review has identified the largest set of literature on burns in East Africa to date, indicating the importance of reviewing data at a regional or local level, as "global" studies tend to be dominated by high-income country data. Data collection in specific registries is needed to better characterize the exact burden of burn injuries in East Africa.
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Hunter MA, Sylvester K, White RE, Harrington DT, Vivier PM, Parker RK. Referral Patterns of Burn Injury in Rural Kenya. J Burn Care Res 2021; 42:454-458. [PMID: 33095863 DOI: 10.1093/jbcr/iraa187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Burn injury represents a substantial burden of disease in resource-limited settings. Kenya has no formal trauma system and referral practices for burn injuries are not well understood. The purpose of this study was to determine the factors associated with burn injury referrals in rural Kenya. A retrospective chart review was conducted for patients with burn injury from January 1, 2014 to December 31, 2017 at a 300-bed faith-based, teaching hospital in southwest Kenya. Bivariate analysis compared referred and non-referred patients. Multivariable logistic regression was used to assess the association between burn severity and odds of referral adjusting for age, sex, insurance, time from injury to arrival, and estimated travel time from home to hospital. The study included 171 patients with burn injury; 11 patients were excluded due to missing referral data. Of the 160 patients, 31.9% (n = 51) were referred. Referral patients had higher average total body surface area burn (23.1 ± 2.4% vs 11.1 ± 1.2%, P < .001), were more likely to have full-thickness burns (41.3% vs 25.5%, P = .05), and less likely to present to the referral hospital within 24 hours after injury (47.8% vs 73.0%, P = .005). Referral patients had longer travel time to hospital (90+ min: 52.9% vs 22.0%, P < .001). Odds of referral increased 1.62 times (95% confidence interval: 1.19-2.22) for every 10% increase in total body surface area burn. Without a coordinated trauma system, referrals represent a substantial portion of burn injury patients at a hospital in rural Kenya. Referred patients present with more severe burns and experience delays to presentation.
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Affiliation(s)
- Mary A Hunter
- Department of Surgery, Brown University/Rhode Island Hospital, Providence.,Hassenfeld Child Health Innovation Institute/Brown University, Providence, Rhode Island
| | | | - Russell E White
- Department of Surgery, Brown University/Rhode Island Hospital, Providence.,Department of Surgery, Tenwek Hospital, Bomet, Kenya
| | - David T Harrington
- Department of Surgery, Brown University/Rhode Island Hospital, Providence
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute/Brown University, Providence, Rhode Island
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, Bomet, Kenya.,Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
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10
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Blom L. mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments. Glob Health Action 2021; 13:1802951. [PMID: 32814518 PMCID: PMC7480586 DOI: 10.1080/16549716.2020.1802951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.
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Affiliation(s)
- Lisa Blom
- Department of Global Public Health, Karolinska Institutet , Stockholm, Sweden
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11
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Trindade Fortes J, Giordani Cano F, Alcoforado Miranda V, Chung Kang H, Fontenelle LF, Mendlowicz MV, Garcia-Rosa ML. PTSD Predicts Smoking Cessation Failure in a Trauma-Exposed Population. J Dual Diagn 2020; 16:392-401. [PMID: 32643580 DOI: 10.1080/15504263.2020.1786615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population. Methods: Participants were 310 smokers who attempted quitting smoking, either successfully (quitters, n = 213) or not (relapsers, n = 97), who lived in slums and were attending a family doctor program. Measurements included a general questionnaire covering sociodemographic characteristics, clinical status and life habits, and the Posttraumatic Stress Disorder Checklist - Civilian Version. Differences in sociodemographic, clinical and lifestyle characteristics between quitters and relapsers were compared using a chi-square test. Because of the small sample size, full and partial PTSD were collapsed into a single category. Results: Significant differences (p ≤ .15) between quitters and relapsers were found in age, body mass index (BMI), income, alcohol consumption, and in the presence of full/partial PTSD diagnosis and of all three symptom clusters separately. Four logistic regression models predicting smoking cessation were modeled to control for confounding factors and included as independent variables a full/partial PTSD diagnosis and the three posttraumatic symptom clusters. The avoidance/numbing cluster presented the strongest association with relapse status (ORa 2.04, 95% CI [1.15, 3.63], p = .015), followed by the full/partial PTSD (ORa 1.80, 95% CI [1.04, 3.14], p = .038). The re-experiencing and the hyperarousal clusters were non-significantly associated with smoking cessation (ORa 1.34, 95% CI [0.80, 2.31], ns and ORa 1.65, 95% CI [0.96, 2.84], ns, respectively). Conclusions: Full/partial PTSD and posttraumatic symptom clusters uniquely predict risk for smoking relapse and thus may be a useful therapeutic target in trauma-exposed smokers.
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Affiliation(s)
| | - Fabiola Giordani Cano
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niteroi, Brazil
| | | | - Hye Chung Kang
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niteroi, Brazil
| | - Leonardo F Fontenelle
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niteroi, Brazil.,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niteroi, Brazil.,Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Luiza Garcia-Rosa
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niteroi, Brazil
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Access to Operative Intervention Reduces Mortality in Adult Burn Patients in a Resource-Limited Setting in Sub-Saharan Africa. World J Surg 2020; 44:3629-3635. [PMID: 32666267 DOI: 10.1007/s00268-020-05684-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Early excision and grafting remains the standard of care after burn injury. However, in a resource-limited setting, operative capacity often limits patient access to surgical intervention. This study sought to describe access to excision and grafting for adult burn patients in a sub-Saharan African burn unit and its relationship with burn-associated mortality. METHODS We analyzed patients recorded in the Kamuzu Central Hospital Burn Registry in Lilongwe, Malawi from 2011-2019. We examined patient characteristics, interventions, and outcomes for adults aged ≥16 years. Modified Poisson regression modeling was used to identify risk factors for mortality. RESULTS Five hundred and seventy-three patients were included. Median age was 30 years (IQR 23-40) with a male preponderance (63%). Median percent total body surface area burned (%TBSA) was 15% (IQR 8-26) and 68% of burns were caused by flame. 27% (n = 154) had burn excision with skin grafting, with a median time to operation of 18 days (IQR 9-38). When adjusted for age, %TBSA, and time to presentation, operative intervention conferred a survival benefit for patients with flame burns with a RR 0.16 (95% CI 0.06, 0.42). CONCLUSIONS In a resource-limiting setting, access to the operating room is inadequate, and burn patients are not prioritized. While many scald burn patients may be managed with wound care alone, patients with flame burn require surgical intervention to improve clinical outcomes. Burn injury in this region continues to confer a high risk of mortality, and more investment in operative capacity is imperative.
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Sex dimorphism in pediatric burn mortality in Malawi: A propensity matched analysis. Burns 2020; 47:228-233. [PMID: 33280955 DOI: 10.1016/j.burns.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/20/2020] [Accepted: 05/11/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is increasing evidence that sex differences may influence pathophysiology after thermal injury and affect clinical outcomes. This study aimed to assess the relationships between sex, thermal injury, and inpatient mortality in a pediatric burn cohort in a resource-limited setting. METHOD This is a retrospective analysis of data collected from the Kamuzu Central Hospital Burns Unit, in Lilongwe, Malawi, from May 2011 to December 2019 on all pediatric patients (≤12 years). We performed a bivariate analysis by sex comparing demographics, burn characteristics, surgical intervention, and mortality. Standardized estimates were adjusted using the inverse probability of treatment weights to account for confounding. Following weighting, odds of mortality based on sex were obtained via logistic regression modeling. RESULTS A total of 1904 children were admitted with a male preponderance (n = 1065, 55.9 %). Overall, the median age was 3 years (IQR1-4). Females had a higher percent total body surface area (%TBSA) burn than males, 15 % vs. 13 % (p = 0.03), respectively. Flame burns were more frequent in females compared to males, 32 % and 23 %, respectively (p < 0.001). There were higher rates of surgical intervention in females than males (20.9 % vs. 16.7 %, p = 0.02). The propensity score weighted logistic regression predicting mortality revealed no difference in the odds of mortality based on sex (OR 1.12, 95 % CI 0.82-1.52, p = 0.5). CONCLUSION We show males are just as likely to die from burns compared to females with similar injuries in this propensity-matched analysis. A lack of difference in mortality may be attributable to the similarities in the hormonal profile in the prepubescent child.
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Concepcion T, Mohamed M, Dahir S, Adan Ismail E, Poenaru D, Rice HE, Smith ER. Prevalence of Pediatric Surgical Conditions Across Somaliland. JAMA Netw Open 2019; 2:e186857. [PMID: 30646203 PMCID: PMC6484554 DOI: 10.1001/jamanetworkopen.2018.6857] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Although surgical conditions are increasingly recognized as causing a significant health care burden among adults in low- and middle-income countries (LMICs), the burden of surgical conditions among children in LMICs remains poorly defined. OBJECTIVE To estimate the prevalence of pediatric surgical conditions across Somaliland using a nationwide community-based household survey. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted through a national community-based sampling survey from August through December 2017 in Somaliland. Participants were 1503 children surveyed using the Surgeons OverSeas Assessment of Surgical Need (SOSAS). MAIN OUTCOMES AND MEASURES The SOSAS survey contains 2 components, including a section on household demographics, deaths, and financial information and sections querying children's history of surgical conditions. RESULTS In this cross-sectional study that included 1503 children (55.6% male; mean [SE] age, 6.4 [0.1] years), 221 surgical conditions were identified among 196 children, yielding a mean (SE) prevalence of pediatric surgical conditions of 12.2% (1.5%). Only 53 of these 221 surgical conditions (23.7%) had been surgically corrected at the time of the survey. The most common conditions encountered were congenital anomalies (33.8%) and wound-related injuries (24.6%). Nationally, an estimated 256 745 children have surgical conditions, with an estimated 88 345 to 199 639 children having unmet surgical needs. CONCLUSIONS AND RELEVANCE Using national sampling, this study found that children have a high burden of surgical conditions in Somaliland. These data highlight the need for a scale-up of pediatric surgical infrastructure and resources to provide the needed surgical care for children in LMICs.
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Affiliation(s)
- Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
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Burns and fires in South Africa's informal settlements: Have approved kerosene stoves improved safety? Burns 2018; 44:969-979. [PMID: 29395395 DOI: 10.1016/j.burns.2017.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/22/2022]
Abstract
This study is a follow-on to an intervention project that implemented South African Bureau of Standards approved kerosene stoves and safety education in 150 households of a Johannesburg informal settlement. An investigation conducted 12 months later established that 43 stoves had operational defects, yet 23 households continued using the faulty appliances. This study focuses on (1) the psychological and behavioural factors associated with continued use of faulty stoves by the 23 households, and (2), the specific technical failures of these stoves. The study involved one-on-one recall interviews with the households using defective stoves (N=21) and laboratory-based stove tests for seven of the affected appliances. The results indicate that the stoves had defects in critical safety features such as flame control and the self-extinguishing mechanism. Four stove malfunctions of minor burn affect were reported in the study. Continued use of the damaged stoves was significantly associated with the time from receipt of the stove to detection of first failure: stoves that failed later on were more significantly likely to remain in use as compared to those that failed sooner. The findings point to the need for strengthening enforcement of appliance standards, public education on kerosene stove use, and structural change for the energy-poor.
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Sanyang E, Peek-Asa C, Young T, Fuortes L. Child Supervision and Burn Outcome among Admitted Patients at Major Trauma Hospitals in the Gambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080856. [PMID: 28758942 PMCID: PMC5580560 DOI: 10.3390/ijerph14080856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/22/2017] [Accepted: 07/26/2017] [Indexed: 11/20/2022]
Abstract
Burn-related injuries are a significant burden in children, particularly in low- and middle-income countries (LMICs), where more than 90% of burn-related pediatric deaths occur. Lack of adult supervision of children is a major risk for pediatric burn injuries. The goal of this paper was to examine the general characteristics of burns and identify burn injury outcomes among adult-supervised children compared to those who were not supervised. The study examined burn injury and clinical characteristics among all burn patients admitted to two trauma hospitals in The Gambia, West Africa. At intake in the emergency room, the treating physician or nurse determined the need for admission based on body surface area burned (BSAB), depth of burn, and other clinical considerations such as co-occurring injuries and co-morbidities. During the study period of 1 April 2014 through 31 October 2016, 105 burn patients were admitted and data were collected by the treating physician for all of them. Information about supervision was only asked for children aged five years or less. More than half (51%) of the burn patients were children under 18 years, and 22% were under 5 years. Among children under five, most (86.4%) were supervised by an adult at the time of burn event. Of the 19 supervised children, 16 (84.2%) had body area surface burned (BSAB) of less than 20%. Two of the three children without adult supervision at the time of burn event had BSAB ≥ 20%. Overall, 59% of the patients had 20% + BSAB. Females (aOR = 1.25; 95% CI = 0.43–3.62), those burned in rural towns and villages (aOR = 2.29; 95% CI = 0.69–7.57), or burned by fire or flames (aOR = 1.47; 95% CI = 0.51–4.23) had increased odds of having a BSAB ≥ 20%, although these differences were not statistically significant. Children 0–5 years or 5–18 years (aOR = 0.04, 95% CI = 0.01–0.17; aOR = 0.07, 95% CI = 0.02–0.23, respectively) were less likely to have BSAB ≥ 20% than adults. Those burned in a rural location (aOR = 9.23, 95% CI = 2.30–37.12) or by fire or flames (aOR = 6.09, 95% CI = 1.55–23.97) were more likely to die. Children 0–5 years or 5–18 years (aOR = 0.2, 95% CI = 0.03–1.18; aOR = 0.38; 95% CI = 0.11–1.570, respectively) were less likely to die. Children constitute a significant proportion of admitted burn patients, and most of them were supervised at the time of the burn event. Supervised children (compared to unsupervised children) had less severe burns. Programs that focus on burn prevention at all levels including child supervision could increase awareness and reduce burns or their severity. Programs need to be designed and evaluated with focus on the child development stage and the leading causes of burns by age group.
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Affiliation(s)
- Edrisa Sanyang
- Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA 52240, USA.
- Department of Public & Environmental Health, School of Medicine & Allied Health Sciences, University of The Gambia, Brikama, PO Box 3530 Serrekunda, The Gambia.
| | - Corinne Peek-Asa
- Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA 52240, USA.
| | - Tracy Young
- Injury Prevention and Research Center, College of Public Health, University of Iowa, Iowa City, IA 52240, USA.
| | - Laurence Fuortes
- Center for International Rural and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA 52240, USA.
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Environmental, Spatial, and Sociodemographic Factors Associated with Nonfatal Injuries in Indonesia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2017; 2017:5612378. [PMID: 28473861 PMCID: PMC5394409 DOI: 10.1155/2017/5612378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 11/17/2022]
Abstract
Background. The determinants of injuries and their reoccurrence in Indonesia are not well understood, despite their importance in the prevention of injuries. Therefore, this study seeks to investigate the environmental, spatial, and sociodemographic factors associated with the reoccurrence of injuries among Indonesian people. Methods. Data from the 2013 round of the Indonesia Baseline Health Research (IBHR 2013) were analysed using a two-part hurdle regression model. A logit regression model was chosen for the zero-hurdle part, while a zero-truncated negative binomial regression model was selected for the counts part. Odds ratio (OR) and incidence rate ratio (IRR) were the measures of association, respectively. Results. The results suggest that living in a household with distant drinking water source, residing in slum areas, residing in Eastern Indonesia, having low educational attainment, being men, and being poorer are positively related to the likelihood of experiencing injury. Moreover, being a farmer or fishermen, having low educational attainment, and being men are positively associated with the frequency of injuries. Conclusion. This study would be useful to prioritise injury prevention programs in Indonesia based on the environmental, spatial, and sociodemographic characteristics.
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Das I, Jagger P, Yeatts K. Biomass Cooking Fuels and Health Outcomes for Women in Malawi. ECOHEALTH 2017; 14:7-19. [PMID: 27800583 PMCID: PMC5357447 DOI: 10.1007/s10393-016-1190-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/05/2016] [Accepted: 09/26/2016] [Indexed: 05/05/2023]
Abstract
In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.
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Affiliation(s)
- Ipsita Das
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH), Campus Box #3435, Abernethy Hall, Chapel Hill, NC, 27599-3435, USA
| | - Pamela Jagger
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH), Campus Box #3435, Abernethy Hall, Chapel Hill, NC, 27599-3435, USA.
- Curriculum for the Environment and Ecology, UNC-CH, Campus Box #3435, Abernethy Hall, Chapel Hill, NC, USA.
- Carolina Population Center, UNC-CH, Chapel Hill, NC, USA.
| | - Karin Yeatts
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
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Rybarczyk MM, Schafer JM, Elm CM, Sarvepalli S, Vaswani PA, Balhara KS, Carlson LC, Jacquet GA. A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region. Afr J Emerg Med 2017; 7:30-37. [PMID: 30456103 PMCID: PMC6234151 DOI: 10.1016/j.afjem.2017.01.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined. METHODS We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included. RESULTS The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies. DISCUSSION While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
| | - Jesse M. Schafer
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Courtney M. Elm
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
| | - Shashank Sarvepalli
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Pavan A. Vaswani
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Kamna S. Balhara
- Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Lucas C. Carlson
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
- Boston University School of Medicine, Boston, MA, United States
- Boston University Center for Global Health and Development, Boston, MA, United States
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Ezeh A, Oyebode O, Satterthwaite D, Chen YF, Ndugwa R, Sartori J, Mberu B, Melendez-Torres GJ, Haregu T, Watson SI, Caiaffa W, Capon A, Lilford RJ. The history, geography, and sociology of slums and the health problems of people who live in slums. Lancet 2017; 389:547-558. [PMID: 27760703 DOI: 10.1016/s0140-6736(16)31650-6] [Citation(s) in RCA: 274] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.
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Affiliation(s)
- Alex Ezeh
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Oyinlola Oyebode
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | | | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Robert Ndugwa
- Global Urban Observatory Research and Capacity Development Branch, United Nations Human Settlements Programme, UN Avenue Gigiri, UN Complex, GPO Nairobi, Kenya
| | - Jo Sartori
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Blessing Mberu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - G J Melendez-Torres
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Tilahun Haregu
- African Population and Health Research Centre, Manga Cl, Nairobi, Kenya
| | - Samuel I Watson
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK
| | - Waleska Caiaffa
- School of Medicine, Federal University of Minas Gerais, Brazil
| | | | - Richard J Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, UK.
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Gathecha GK, Githinji WM, Maina AK. Demographic profile and pattern of fatal injuries in Nairobi, Kenya, January-June 2014. BMC Public Health 2017; 17:34. [PMID: 28056893 PMCID: PMC5217327 DOI: 10.1186/s12889-016-3958-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022] Open
Abstract
Background Violence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. Approximately five million people die from injuries each year, accounting 9% of all deaths worldwide. In Kenya, injuries are increasingly becoming a cause of hospital admissions and mortality where they account for 10% of all the deaths. The objective of this study was to determine the magnitude, demographic profile and pattern of fatal injuries in Nairobi. Methods Retrospective review of death certificates from the Department of Civil Registration was done for deaths caused by injuries that occurred in Nairobi during the period, January to June 2014. Data was collected using a standardized form. Data entry, cleaning and analysis was done using Epi info version 7.0. Results A total of 11,443 records were reviewed. From this data, deaths resulting from injuries were 1,208 accounting for 10.6% of all recorded deaths. Majority of the deaths resulting from injuries occurred in persons aged 25 to 44 years (48.1%). Males accounted for 85% of all the injuries. The leading cause of injury was assault by blunt force at 30.5%, followed by road traffic injuries at 25.9% and fire arm injuries at 15%. Pre-hospital deaths accounted for 51.4% of all the deaths. Nineteen percent of the deaths resulting from injuries had autopsies performed on them. Conclusion Our study found that injuries are an important cause of fatality in Nairobi, accounting for one in ten deaths. There is need for multisectoral collaboration as some of the preventive measures that target the most prevalent injuries such as assault and road traffic injuries lie outside the health sector. There exists information gaps on the death certificates hence there is need to adequately capacity build both clinicians and death certifiers. There is also a need to revise the death certificates and to improve the pre-hospital care system for the injured persons. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3958-0) contains supplementary material, which is available to authorized users.
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Blom L, Klingberg A, Laflamme L, Wallis L, Hasselberg M. Gender differences in burns: A study from emergency centres in the Western Cape, South Africa. Burns 2016; 42:1600-1608. [PMID: 27262931 DOI: 10.1016/j.burns.2016.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Little is known about gender differences in aetiology and management of acute burns in resource-constrained settings in South Africa. METHOD This cross-sectional study is based on burn case reports (n=1915) from eight emergency centres in Western Cape, South Africa (June 2012-May 2013). Male/female rate ratios by age group and age-specific incidence rates were compiled for urban and rural areas along with gender differences in proportions between children and adults for injury aetiology, burn severity, length of stay and patient disposition. RESULTS Children 0-4 years in urban areas had the highest burn incidence but only among adults did male rates surpass females, with fire burns more common among men 20-39 years and hot liquid burns among men 55+ years. Men had a higher proportion of burns during weekends, from interpersonal violence and suspected use of alcohol/other substances, with more pronounced differences for hot liquid burns. Despite similar Abbreviated Injury Scale (AIS) scores, men were more often transferred to higher levels of care and women more often treated and discharged. CONCLUSION Burns were far more common among children although gender differences arose only among adults. Men sustained more injuries of somewhat different aetiology and were referred to higher levels of care more often for comparable wound severity. The results suggest different disposition between men and women despite similar AIS scores. However, further studies with more comprehensive information on severity level and other care- and patient-related factors are needed to explore these results further.
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Affiliation(s)
- Lisa Blom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Anders Klingberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; University of South Africa, Pretoria, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Wong JM, Cosmas L, Nyachieo D, Williamson JM, Olack B, Okoth G, Njuguna H, Feikin DR, Burke H, Montgomery JM, Breiman RF. Increased Rates of Respiratory and Diarrheal Illnesses in HIV-Negative Persons Living With HIV-Infected Individuals in a Densely Populated Urban Slum in Kenya. J Infect Dis 2015; 212:745-53. [PMID: 25722292 DOI: 10.1093/infdis/jiv107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prolonged pathogen shedding and increased duration of illness associated with infections in immunosuppressed individuals put close human immunodeficiency virus (HIV)-negative contacts of HIV-infected persons at increased risk of exposure to infectious pathogens. METHODS We calculated incidence and longitudinal prevalence (number of days per year) of influenzalike illness (ILI), diarrhea, and nonspecific febrile illness during 2008 from a population-based surveillance program in the urban slum of Kibera (Kenya) that included 1830 HIV-negative household contacts of HIV-infected individuals and 13 677 individuals living in exclusively HIV-negative households. RESULTS For individuals ≥5 years old, incidence was significantly increased for ILI (risk ratio [RR], 1.47; P < .05) and diarrhea (RR, 1.41; P < .05) in HIV-negative household contacts of HIV-infected individuals compared with exclusively HIV-negative households. The risk of illness among HIV-negative persons was directly proportional to the number of HIV-infected persons living in the home for ILI (RR, 1.39; P < .05) and diarrhea (RR, 1.36; P < .01). We found no increased rates of illness in children <5 years old who lived with HIV-infected individuals. CONCLUSIONS Living with HIV-infected individuals is associated with modestly increased rates of respiratory and diarrheal infections in HIV-negative individuals >5 years old. Targeted interventions are needed, including ensuring that HIV-infected persons are receiving appropriate care and treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia
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Rahman N, Sinha I, Husain F, Shah A, Patel A. The incidence of burns among sex-trafficking victims in India. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2014; 87:263-7. [PMID: 25191142 PMCID: PMC4144281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease.
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Affiliation(s)
| | - Indranil Sinha
- Cents of Relief, Inc., New Haven, Connecticut,Section of Plastic Surgery, Department of Surgery, Harvard Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ajul Shah
- Cents of Relief, Inc., New Haven, Connecticut,Yale School of Medicine, Section of Plastic and Reconstructive Surgery, New Haven, Connecticut
| | - Anup Patel
- Cents of Relief, Inc., New Haven, Connecticut,Yale School of Medicine, Section of Plastic and Reconstructive Surgery, New Haven, Connecticut,To whom all correspondence should be addressed: Anup Patel, MD, MBA, Cents of Relief, Co-Founder, Yale School of Medicine, Section of Plastic and Reconstructive Surgery, 330 Cedar St., New Haven, CT 06520; Tele: 203-785-2570; Fax: 203-785-5714;
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