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Adhikari S, Gurung R, Bastakoti S, Alrasheedy AA, KC B. Burn pain management in a female patient with severe burn injuries in Nepal: a case study and review. Pain Manag 2024; 14:323-329. [PMID: 39101437 PMCID: PMC11340753 DOI: 10.1080/17581869.2024.2382072] [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: 04/24/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Burn injuries in low-resource settings like Nepal present significant public health challenges, leading to substantial morbidity, mortality and severe pain. This paper assesses burn pain management in Nepal, emphasizing the need for enhanced strategies. A case study of a female patient with severe burn injuries from a rural village in Western Nepal illustrates current challenges. Reviewing studies on burn pain management in Nepal shows limited access to specialized facilities, inadequate palliative care, medication shortages and insufficient healthcare professionals. Pharmacological interventions are impacted by financial constraints and a lack of protocols, while nonpharmacological approaches have not been explored and contextualized for the Nepalese context due to similar financial issues. Comprehensive burn pain management requires addressing resource constraints through collaborative health-aid partnerships.
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Affiliation(s)
- Sundar Adhikari
- Department of Pharmacy, Fishtail Hospital and Research Center, Pvt. Ltd., Gairapatan-4, Pokhara, Nepal
| | | | - Suresh Bastakoti
- Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Kathmandu, Nepal
| | | | - Bhuvan KC
- Discipline of Pharmacy, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns 2024; 50:1160-1173. [PMID: 38472005 PMCID: PMC11116054 DOI: 10.1016/j.burns.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Enteral resuscitation (EResus) is operationally advantageous to intravenous resuscitation for burn-injured patients in some low-resource settings. However, there is minimal guidance and no training materials for EResus tailored to non-burn care providers. We aimed to develop and consumer-test a training flipbook with doctors and nurses in Nepal to aid broader dissemination of this life-saving technique. MATERIALS AND METHODS We used individual cognitive interviews with Nepali (n = 12) and international (n = 4) burn care experts to define key elements of EResus and specific concepts for its operationalization at primary health centers and first-level hospitals in Nepal. Content, prototype illustrations, and wireframe layouts were developed and revised with the burn care experts. Subsequently, eight consumer testing focus groups with Nepali stakeholders (5-10 people each) were facilitated. Prompts were generated using the Questionnaire Appraisal System (QAS) framework. The flipbook was iteratively revised and tested based on consumer feedback organized according to the domains of clarity, assumptions, knowledge/memory, and sensitivity/bias. RESULTS AND DISCUSSION The flipbook elements were iterated until consumers made no additional requests for changes. Examples of consumer inputs included: clarity-minimize medical jargon, add shrunken organs and wilted plants to represent burn shock; assumptions-use locally representative figures, depict oral rehydration salts sachet instead of a graduated bottle; knowledge/memory-clarify complex topics, use Rule-of-9 s and depict approximately 20% total body surface area to indicate the threshold for resuscitation; sensitivity/bias-reduce anatomic illustration details (e.g. urinary catheter placement, body contours). CONCLUSION Stakeholder engagement, consumer testing, and iterative revision can generate knowledge translation products that reflect contextually appropriate education materials for inexperienced burn providers. The EResus Training Flipbook can be used in Nepal and adapted to other contexts to facilitate the implementation of EResus globally.
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Affiliation(s)
| | - Kajal Mehta
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Raslina Shrestha
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Diwakar Phuyal
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Das Bikash
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Manish Yadav
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Kiran Nakarmi
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Shankar Rai
- Kirtipur Hospital Phect Nepal Cleft and Burn Center, Kathmandu, Nepal
| | - Sam Sharar
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - Gary Fudem
- Department of Surgery, University of Washington, Seattle, WA, USA
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Gerstl JVE, Ehsan AN, Lassarén P, Yearley A, Raykar NP, Anderson GA, Smith TR, Sabapathy SR, Ranganathan K. The Global Macroeconomic Burden of Burn Injuries. Plast Reconstr Surg 2024; 153:743-752. [PMID: 37093034 DOI: 10.1097/prs.0000000000010595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Standardized estimates of global economic losses from burn injuries are lacking. The primary objective of this study was to determine the global macroeconomic consequences of burn injuries and their geographic distribution. METHODS Using the Institute of Health Metrics and Evaluation database (2009 and 2019), mean and 95% uncertainty interval (UI) data on incidence, mortality, and disability-adjusted life-years (DALYs) from injuries caused by fire, heat, and hot substances were collected. Gross domestic product (GDP) data were analyzed together with DALYs to estimate macroeconomic losses globally using a value of lost welfare approach. RESULTS There were 9 million global burn cases (95% UI, 6.8 to 11.2 million) and 111,000 deaths from burns (95% UI, 88,000 to 132,000 deaths) in 2019, representing a total of 7.5 million DALYs (95% UI, 5.8 to 9.5 million DALYs). This represented welfare losses of $112 billion (95% UI, $78 to $161 billion), or 0.09% of GDP (95% UI, 0.06% to 0.13%). Welfare losses as a share of GDP were highest in low- and middle-income countries (LMICs) of Oceania (0.24%; 95% UI, 0.09% to 0.42%) and Eastern Europe (0.24%; 95% UI, 0.19% to 0.30%) compared with high-income country regions such as Western Europe (0.06%; 95% UI, 0.04% to 0.09%). Mortality-incidence ratios were highest in LMIC regions, highlighting a lack of treatment access, with southern sub-Saharan Africa reporting a mortality-incidence ratio of 40.1 per 1000 people compared with 1.9 for Australasia. CONCLUSIONS Burden of disease and resulting economic losses because of burn injuries are substantial worldwide and are disproportionately higher in LMICs. Possible effective solutions include targeted education, advocacy, and legislation to decrease incidence and investing in existing burn centers to improve treatment access.
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Affiliation(s)
- Jakob V E Gerstl
- From the Departments of Neurosurgery
- University College London Medical School
| | - Anam N Ehsan
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | | | - Nakul P Raykar
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | - Geoffrey A Anderson
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
| | | | - S Raja Sabapathy
- Department of Plastic Surgery, Hand, Reconstructive, and Burn Surgery, Ganga Hospital
| | - Kavitha Ranganathan
- Surgery, Brigham and Women's Hospital, Harvard Medical School
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School
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Daher RP, Gause E, Sterwart BT, Gragnani A. Preparing for a burn disaster in Brazil: Geospatial modelling to inform a coordinated response. Burns 2022:S0305-4179(22)00234-0. [DOI: 10.1016/j.burns.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/02/2022]
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Quinn L, Ahmed T, Falk H, Miranda Altamirano A, Muganza A, Nakarmi K, Nawar A, Peck M, Man Rai S, Sartori J, Philipe Molina Vana L, Wabwire B, Moiemen N, Lilford R. Burn Admissions Across Low- and Middle-income Countries: A Repeated Cross-sectional Survey. J Burn Care Res 2022; 44:320-328. [PMID: 35802351 PMCID: PMC9981866 DOI: 10.1093/jbcr/irac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 11/12/2022]
Abstract
Burn injuries have decreased markedly in high-income countries while the incidence of burns remains high in Low- and Middle-Income Countries (LMICs) where more than 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional survey was completed for 2014 and 2019 in eight burn centers across Africa, Asia, and Latin America: Cairo, Nairobi, Ibadan, Johannesburg, Dhaka, Kathmandu, Sao Paulo, and Guadalajara. The information summarised included demographics of burn patients, location, cause, and outcomes of burns. In total, 15,344 patients were admitted across all centers, 37% of burns were women and 36% of burns were children. Burns occurred mostly in household settings (43-79%). In Dhaka and Kathmandu, occupational burns were also common (32 and 43%, respectively). Hot liquid and flame burns were most common while electric burns were also common in Dhaka and Sao Paulo. The type of flame burns varies by center and year, in Dhaka, 77% resulted from solid fuel in 2014 while 74% of burns resulted from Liquefied Petroleum Gas in 2019. In Nairobi, a large proportion (32%) of burns were intentional self-harm or assault. The average length of stay in hospitals decreased from 2014 to 2019. The percentage of deaths ranged from 5% to 24%. Our data provide important information on the causes of severe burns which can provide guidance in how to approach the development of burn injury prevention programs in LMIC.
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Affiliation(s)
- Laura Quinn
- Address correspondence to Laura Quinn, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B152TT, UK.
| | - Tanveer Ahmed
- Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Henry Falk
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Adelin Muganza
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Kiran Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal
| | - Ahmed Nawar
- Plastic Surgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Michael Peck
- University of Arizona College of Medicine, Phoenix, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, phect-NEPAL, Kirtipur Hospital, Kathmandu, Nepal,National Academy of Medical Science, Kathmandu, Nepal
| | - Jo Sartori
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Luiz Philipe Molina Vana
- Department of Plastic Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK,University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
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Yamamoto R, Sato Y, Sasaki J. Sparsity of burn centers and prolonged length of hospital stay: A nationwide study. Burns 2021; 47:1478-1485. [PMID: 34465508 DOI: 10.1016/j.burns.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes. PATIENTS AND METHODS A retrospective study was conducted using the Japanese Society of Burn Injury registry (2011-2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity. RESULTS We included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0-23] vs 11 [0-23] vs 8 [0-22] days; p < 0.001). CONCLUSIONS Low burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Yukio Sato
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
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