ReviewBurns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention
Introduction
Burns are among the most devastating of all injuries, with outcomes spanning the spectrum from physical impairments and disabilities to emotional and mental consequences [1], [2]. Most burns are caused by thermal energy including scalding and fires, with the minority caused by exposure to chemicals, electricity, ultraviolet radiation, and ionizing radiation. Globally, fire-related burns are responsible for about 265,000 deaths annually [3]. Over 90% of fatal fire-related burns occur in developing or low- and middle-income countries (LMICs) with South-East Asia alone accounting for over half of these fire-related deaths [3]. Like other injury mechanisms, the prevention of burns requires adequate knowledge of the epidemiological characteristics and associated risk factors. However, while much has been accomplished in the areas of primary and secondary prevention of fires and burns in many developed or high-income countries (HICs) such as the United States due to sustained research on the epidemiology and risk factors, the same cannot be said of many LMICs [4], [5], [6].
The purpose of this paper was to review and summarize available data on the descriptive epidemiology of burns in LMICs, along with identified risk factors, treatment, and attempted preventive measures in terms of potential and effectively proven interventions. LMICs or developing nations are defined in this paper according to a classification used by the World Bank for the World Development Report 1993 [7]. This classification was based on the level of socio-economic development, epidemiological homogeneity, and geographic location [7]. The countries include all those in Sub-Saharan Africa, Latin America and the Caribbean, and the Middle East crescent, India, China as well as other countries in Asia and adjoining Islands. Countries with established market economies such as the United States, United Kingdom, Canada, Australia, New Zealand, Japan, those in Western Europe, and most of those in the formerly socialist economies of Europe were, therefore, excluded.
Section snippets
Methods
Available literature on burns in LMICs published in English for the 30-year period 1974–2003 was accessed using MEDLINE (www.pubmed.gov) and reviewed. Publications from earlier years were not included since they may no longer inform us about current burn epidemiology and treatment. Search terms and key words used included burns, wounds, injury, burn injury, burn accident, risk factors for burns, burn prevention, burn treatment, burn intervention, and developing countries as well as individual
Results
The literature search identified 139 studies from 34 different LMICs including Algeria, Angola, Bangladesh, Brazil, China, Cote d’Ivoire, Egypt, Ethiopia, Ghana, Hong Kong, India, Iran, Israel, Jordan, Kenya, Kuwait, Liberia, Libya, Malawi, Morocco, Mozambique, Nigeria, Pakistan, Papua New Guinea, Peru, Saudi Arabia, Singapore, South Africa, Sri Lanka, Taiwan, Turkey, Vietnam, Yemen, and Zimbabwe, of which 117 met the criteria for inclusion [8], [9], [10], [11], [12], [13], [14], [15], [16],
Discussion
This project has revealed that many published studies from several LMICs have contributed to our understanding of the epidemiological characteristics, risk factors, treatment, and prevention of burns in these LMIC settings. However, most of the studies focused on childhood burns [10], [11], [12], [16], [25], [26], [27], [28], [29], [30], [31], [32], [47], [48], [49], [50], [88], [100], [104], [105], [106], [110] probably because fires and burns are the leading cause of injury death in the home
Conclusions
It is time for researchers in LMICs to move from generating more data on the descriptive epidemiology and risk factors of burns to testing and evaluating proven and promising interventions in specific settings. However, there is no need to reinvent the wheel, although due attention ought to be paid to cultural sensitivities, among others [6], [129], [130], [131]. For example, lowering hot water heater temperatures, which is an intervention used in many HICs, makes little sense in LMIC
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