Paediatric burn injuries in Sub Saharan Africa—an overview

doi:10.1016/j.burns.2005.12.004

Burns

Volume 32, Issue 5, August 2006, Pages 605-612

https://doi.org/10.1016/j.burns.2005.12.004 Get rights and content

Abstract

Paediatric burn injuries in Sub Saharan Africa are common and often lead to devastating consequences. Unfortunately relevant and accurate data regarding these injuries is sketchy and incomplete. This paper reviews the available information on the epidemiology of paediatric burns in Africa, associated health problems and contributing environmental factors responsible for these burns. The current status of burn care, the lack of infrastructure, and traditional methods of treatment, further contribute to the unsatisfactory status of overall burn management, prevention, and rehabilitation of burn survivors. A strategy for improving burn care in Africa has been formulated. The management of childhood burns will only be successful if educational, social, fiscal and infrastructure standards are improved. Traditional beliefs and methods cannot be discarded as they play an important role in the management of these children. It is furthermore essential that local and central government organisations support these initiatives. Clearly, the children of Africa deserve better burn care.

Introduction

Burns are on the increase throughout Africa. Poverty, mass illiteracy, migration to urban areas with development of slum areas and shanty towns are some of the factors that have led to an increase in burns during the past decade [1]. From a purely human perspective, there is nothing more tragic than a preventable burn that leaves a child permanently disfigured for life [2]. Despite this growing problem little attention has been given to the burden of burns amongst African children [3]. This paper reviews the available information on the epidemiology of paediatric burns in Africa, the environmental factors contributing to the high incidence and the current status of burn care. A strategy for improving burn care in Africa is outlined. Because the South African health care system is more developed than the rest of Sub Saharan Africa their approach to paediatric burn care is only briefly mentioned.

Section snippets

Epidemiology

Incidence and prevalence data are incomplete [4]. Available and more recent information is depicted in Table 1. Most of the large burn series reported from Africa are hospital based, making it impossible to infer the rate of paediatric burns in the community [5]. Statistical information obtained from the South African Medical Research Council has indicated that 3.2% of the South African population are burned annually, 50% of which are younger than 20 years of age. Burd and Yuen [4] reporting on

Associated health problems

Underlying health problems can both increase the risk of burns and effect outcome. Existing health problems such as epilepsy and those conditions leading to febrile seizures (e.g., pneumonia, meningitis, gastroenteritis and tuberculosis) can increase the risk of falling into an open fire during convulsive episodes. Twenty-two percent of epilepsy patients in the Semokwe district in Zimbabwe had suffered a burn [17].

A poor understanding of epilepsy may contribute to non-compliance with anti

Environmental factors contributing to burns

In Africa, paediatric burns occur mostly in and around the home. Most are accidental, and therefore, preventable. Some of the environmental factors that increase the risk paediatric burns are listed below.

The design of traditional dwellings and mud huts contribute to burn incidents. In many instances, the space inside the dwelling is used for both cooking and sleeping. In rural African homes, the charcoal stove (Jiko) is often the only method of cooking or heating, other than an open unguarded

Current status of burn care in Africa

Burn care in Africa is very dependent on the availability of financial resources, equipment and expertise. However, despite the lack of resources excellent burn care is provided. Under sometimes difficult circumstances, many African countries often combine traditional and western management principles. Born out of need, this combination provides an intricate partnership between the classical health system inherited from the West and the purely traditional medicine provided by traditional

Improving burn care in Africa

The current unsatisfactory attitudes and management of burns in Africa should not continue. Many factors have been identified that have devastating consequences. Burn care not only places a great strain on the available financial resources at all levels of care, but also on the patient's family. Estimates have indicated that the provision of adequate burn care could reduce the time spent in hospital by 35% and the overall mortality rate by an estimated 30%. The improvement of burn care is

Conclusion

Childhood burns are largely preventable. This survey has highlighted the important factors contributing to the high prevalence of burns and the reasons for the high prevalence of burns and the reasons for the significant incidence of morbidity and mortality. Active social and medical intervention must be initiated. Standard protocols and public policies around prevention, education and research must become an integral part of public health.

The challenge does not lie in the successful treatment

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En dépit de l’utilisation de la greffe de peau totale dans le traitement des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied, les données publiées dans la littérature des résultats à long terme chez les patients à peau noire sont inexistantes.
La présente étude comblant cette lacune, a utilisé les données d’une cohorte prospective de 123 greffes de peau totale réalisées auprès de 93 patients noirs africains ayant bénéficié des greffes de peau plantaire versus greffes de peau des zones velues pour couvrir des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied. Cette étude couvre une période de 163 mois.
Soixante-quatre greffes des zones velues ont été réalisées auprès de 52 patients dont 29 du sexe masculin et 23 du sexe féminin soit un sex ratio H/F de 1,3 ; et 59 greffes de peau plantaire chez 41 patients dont 21 du sexe masculin et 20 du sexe féminin, sex ratio H/F de 1. La face palmaire digitale a été la plus receveuse de la greffe plantaire, soit 35,5 % de cas. Après un recul post-opératoire d’au moins 12 mois, les patients ou leur entourage ont jugé meilleurs et acceptables les résultats fonctionnels et esthétiques des greffes de peau plantaire, contrairement aux résultats des greffes des zones velues. La texture et la couleur sont d’autant meilleures que la greffe de peau totale est prise dans une zone histologique identique.
Au vu de ces résultats, nous conseillons pour les patients à peau noire une greffe de peau plantaire pour couvrir des pertes de substances cutanées de la face palmaire des doigts, de la paume de main et de la plante du pied, si elle est indiquée.
Despite the use of total skin grafting in the treatment of loss of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, the data published in the literature on long-term results in black-skinned patients are non-existent.
The present study, filling this gap, used data from a prospective cohort of 123 total skin grafts performed on 93 black African patients who benefited from plantar skin grafts versus skin grafts from hairy areas to cover loss of skin substances. of the palmar surface of the fingers, the palm of the hand and the sole of the foot. This study covers a period of 163 months.
Sixty-four grafts of hairy areas were carried out in 52 patients, 29 of whom were male and 23 female, for a M/F sex ratio of 1.3; and 59 plantar skin grafts in 41 patients including 21 males and 20 females, M/F sex ratio of 1. The digital palmar surface was the most recipient of the plantar graft, i.e. 35.5% of cases. After a post-operative follow-up of at least 12 months, patients or their entourage judged the functional and aesthetic results of plantar skin grafts to be better and acceptable, unlike the results of hairy area grafts. The texture and color are even better if the total skin graft is taken from an identical histological area.
In view of these results, we recommend a plantar skin graft for black-skinned patients to cover losses of skin substances on the palmar surface of the fingers, the palm of the hand and the sole of the foot, if indicated.
PATTERNS AND OUTCOMES OF PEDIATRIC BURN INJURIES IN A TERTIARY HOSPITAL's BURN UNIT
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Burn is skin and tissue damage caused by various agents such as fire, scalds, electricity, chemicals, or radiation injuries. Globally, burn injuries pose a substantial public health challenge, with a high risk of mortality and morbidity, accounting for over 310,000 annual deaths. Nearly 75 % of burns in young children result from scald burns and infants have the highest mortality rates. Factors such as large surface area of burn, inhalational injury, poverty, and the presence of sepsis contribute significantly to mortality and morbidity in burns.
To assess the pattern of presentation of pediatric burn injuries and their management outcomes.
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Among the 218 paediatric burn patients admitted to the Addis Ababa Burn, Emergency and Trauma Hospital’s burn unit, 71.1 % had sustained scald burns due to hot water splashes, while 20.2 % of the patients were admitted due to flame burns. Superficial partial thickness burns occurred in 53.6 % of the patients, with the upper extremity and trunk being the most commonly affected sites. Approximately 38.2 % of the patients developed acute complications, with sepsis of the wound focus being the most common. Chronic complications occurred in 30.7 % of patients, primarily in the form of post-burn contractures. A mortality rate of 3.2 % was observed during the admission period with 2.3 % of deaths occurring in children under 5 years and those with major burns.
The primary causes of burns in the pediatric age group are predominantly preventable scalds. Children, especially when unsupervised at home, particularly in kitchens, demand meticulous attention and care to mitigate the risk of burn injuries.
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An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality.
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Children are uniquely vulnerable to injury because of near-complete dependence on caregivers. Unintentional injury is leading cause of death in children under the age of 14. Burns are one of the leading causes of accidental and preventable household injuries, with scald burns most common in younger children and flame burns in older ones. Education is a key tool to address burn prevention, but unfortunately these injuries persist. Critically, there is a paucity of literature investigating adult comprehension with respect to potential risks of household burns. To date, no study has been performed to assess management readiness for these types of injuries without seeking medical care.
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Of the 467 respondents, the mean age was 36.57 years, and was 59.7% (279) male. Only 3.2% of respondents were able to correctly identify all 20 potential risks listed in our survey. Additionally, only 4.5% of respondents correctly identified all three appropriate initial management options (cool water, sterile gauze, and over-the-counter analgesics) without misidentifying incorrect options. However, 56.1% of respondents were able to select at least one correct management option. For image-based injury classification, the most common response was incorrectly second-degree with 216 responses (42.2%) and the second-most common response was correctly first-degree with 146 responses (31.3%). Most respondents claimed they would not seek medical attention for the injury presented in the photograph (77.7%). When comparing the responses of individuals with children to those without, there were no statistically significant differences in ability to assess household risks for pediatric burns. For the entire population of respondents, the mean score for correctly identifying risks was 38%.
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