Prehospital care of burn injuries in Africa: A review, 1990-2018

Prevalence and Severity of Burn Scars in Rural Mozambique

Background

Burn injuries are common in low- and middle-income countries (LMICs) and their associated disability is tragic. This study is the first to explore burn scars in rural communities in Mozambique. This work also validated an innovate burn assessment tool, the Morphological African Scar Contractures Classification (MASCC), used to determine surgical need.

Methods

Using a stratified, population-weighted survey, the team interviewed randomly selected households from September 2012 to June 2013. Three rural districts (Chókwè, Nhamatanda, and Ribáuè) were selected to represent the southern, central and northern regions of the country. Injuries were recorded, documented with photographs, and approach to care was gathered. A panel of residents and surgeons reviewed the burn scar images using both the Vancouver Scar Scale and the MASCC, a validated visual scale that categorizes patients into four categories corresponding to levels of surgical intervention.

Results

Of the 6104 survey participants, 6% (n = 370) reported one or more burn injuries. Burn injuries were more common in females (57%) and most often occurred on the extremities. Individuals less than 25 years old had a significantly higher odds of reporting a burn scar compared to people older than 45 years. Based on the MASCC, 12% (n = 42) would benefit from surgery to treat contractures.

Conclusion

Untreated burn injuries are prevalent in rural Mozambique. Our study reveals a lack of access to surgical care in rural communities and demonstrates how the MASCC scale can be used to extend the reach of surgical assessment beyond the hospital through community health workers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-022-06682-y.

Duration of cooling with water for thermal burns as a first aid intervention: A systematic review

BACKGROUND

Cooling thermal burns with running water is a recommended first aid intervention. However, guidance on the ideal duration of cooling remains controversial and inconsistent across organisations.

AIM

To perform a systematic review of the evidence for the question; Among adults and children with thermal burn, does active cooling using running water as an immediate first aid intervention for 20 min or more, compared with active cooling using running water for any other duration, change the outcomes of burn size, burn depth, pain, adverse outcome (hypothermia) or complications?

METHOD

We searched Medline, Embase, Cochrane Database of Systematic Reviews and used ROBINS-I to assess for risk of bias. We used Grading of Recommendations, Assessment, Development and Evaluation methodology for determining the certainty of evidence. We included all studies that compared the selected outcomes of the duration of cooling of thermal burns with water in all patient ages. (PROSPERO registration number: CRD42021180665). From 560 screened references, we included four observational studies. In these studies, 48% of burns were cooled for 20 min or more. We found no benefit for a duration of 20 min or more of cooling when compared with less than 20 min of cooling for the outcomes of size and depth of burn, re-epithelialization, or skin grafting. The evidence is of very low certainty owing to limitations in study design, risk of bias and indirectness.

CONCLUSION

The optimal duration of cooling for thermal burns remains unknown and future prospective research is indicated to better define this treatment recommendation.

Quantifying Inequitable Access to Rapid Burn and Reconstructive Care through Geospatial Mapping

Time-critical pathologies, such as the care of burn-injured patients, rely on accurate travel time data to plan high-quality service provision. Geospatial modeling, using data from the Malaria Atlas Project, together with census data, permits quantification of the huge global discrepancies in temporal access to burn care between high-income and low-resource settings. In this study, focusing on the United Kingdom and Ghana, we found that a 3-fold population difference exists with, respectively, 95.6% and 29.9% of the population that could access specialist burn care within 1-hour travel time. Solutions to such inequalities include upscaling of infrastructure and specialist personnel, but this is aspirational rather than feasible in most low- to middle-income countries. Mixed models of decentralization of care that leverage eHealth strategies, such as telemedicine, may enhance quality of local burns and reconstructive surgical care through skills transfer, capacity building, and expediting of urgent transfers, while empowering local healthcare communities. By extending specialist burn care coverage through eHealth to 8 district hospitals in rural Ghana, we demonstrate the potential to increase specialist population coverage within 1-hour travel time from 29.9% to 45.3%—equivalent to an additional 5.1 million people.

Saudi parents awareness regarding burn, choking, and drowning first aid in children

Background:

Children are the most affected age group by home and traffic accidents. Parents, as the primary caregiver to their children, play an important role in saving their lives during an accident, therefore, more attention should be focused to assess and improve the parents' knowledge and skills of first aid (FA).

Aim:

Determining the parent's awareness level regarding choking, drowning, and burn FA, their readiness to attend an FA course and solutions from their perspective to improve the awareness level regarding FA for children.

Methodology:

Cross-sectional analysis was conducted by using a simple random sampling that includes 300 parents attending a well-baby clinic in Wazarat primary health care center in Riyadh through self-administered questionnaires. Multiple variables were evaluated to assess their effect on the outcome.

Results:

Only 6% of the parents have a high and acceptable awareness level regarding choking, drowning, and burn FA. A lot of myths and incorrect practices are prevalent among parents regarding these injuries' management. Fortunately, two-thirds of the participants (78%) are willing to attend an FA course and 79% of them think that adding FA to school subjects is the solution for awareness improvement.

Conclusions:

Parents' knowledge level regarding FA methods of major home injuries are insufficient, therefore, more attention should be focused to improve the parents' knowledge and skills of FA in order to reduce morbidity, mortality from these injuries.