Article Text

Download PDFPDF
Health systems research in burn care: an evidence gap map
  1. Vikash Ranjan Keshri1,2,
  2. Margaret Peden1,3,
  3. Pratishtha Singh2,
  4. Robyn Norton1,3,
  5. Seye Abimbola4,
  6. Jagnoor Jagnoor1,2
  1. 1 The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 Injury Division, The George Institute for Global Health India, New Delhi, Delhi, India
  3. 3 The George Institute for Global Health UK, Imperial College London, London, UK
  4. 4 School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Vikash Ranjan Keshri, The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales 2052, Australia; vrkeshri{at}


Background Burn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent of health systems research (HSR) in burn care is unknown. This review aimed to systematically map the global HSR related to burn care.

Methods An evidence gap map (EGM) was developed based on the World Health Organization health systems framework. All major medical, health and injury databases were searched. A standard method was used to develop the EGM.

Results A total of 6586 articles were screened, and the full text of 206 articles was reviewed, of which 106 met the inclusion criteria. Most included studies were cross-sectional (61%) and were conducted in hospitals (71%) with patients (48%) or healthcare providers (29%) as participants. Most studies were conducted in high-income countries, while only 13% were conducted in low-and middle-income countries, accounting for 60% of burns mortality burden globally. The most common health systems areas of focus were service delivery (53%), health workforce (33%) and technology (19%). Studies on health policy, governance and leadership were absent, and there were only 14 qualitative studies.

Conclusions Major evidence gaps exist for an integrated health systems response to burns care. There is an inequity between the burden of burn injuries and HSR. Strengthening research capacity will facilitate evidence-informed health systems and policy reforms to sustainably improve access to affordable, equitable and optimal burn care and outcomes.

  • Burn
  • Systematic Review
  • Global
  • Public Health
  • Health Services
  • Policy

Data availability statement

All data relevant to the study are included in the article.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article.

View Full Text


  • Twitter @docVRK, @margiepeden

  • Contributors VRK conceptualised the study with inputs from MP and JJ. VRK did the literature search. VRK and PS screened the literature, with support from JJ and MP. VRK did data extraction, and PS verified the data. VRK conducted the analysis and PS, JJ, MP and SA provided inputs. VRK wrote the manuscript. MP, JJ, RN and SA provided critical comments to revise the manuscript. All authors reviewed and approved the final manuscript. VRK has access to all data and act as guarantor.

  • Funding VRK is supported by Tuition Fees Scholarship from the University of New South Wales (UNSW), Sydney, Australia. JJ is supported by Emerging Leadership level-2 fellowship by the National Health and Medical Research Council, Australia.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.