This report describes the epidemiology of burn injuries and quantifies the appropriateness of use of available interventions at Kamuzu Central Hospital, Malawi, between July 2008 and June 2009 (370 burn patients). Burns accounted for 4.4% of all injuries and 25.9% of all burns presenting to the hospital were admitted. Most patients (67.6%) were < 15 years old and 56.2% were male. The most frequent cause was scalding (51.4%). Burns occurred most frequently in the cool, dry season and in the evening. The mean burn surface area (second/third degree) was 14.1% and most burns (74%) presented within 8 h. The commonest procedure was debridement and/or amputation. The mean hospital stay was 21.1 days, in-hospital mortality was 27% and wound infection rate was 31%. Available interventions (intravenous fluids, nutrition therapy, physiotherapy) were misapplied in 59% of cases. It is concluded that primary prevention should address paediatric and scald burns, and secondary prevention should train providers to use available interventions appropriately.

Burn assessment with digital photography is a valid and affordable alternative to direct clinical exam, alleviating access issues to burn care in developing countries.

Background This study sought to establish appropriate timing of burn wound excision and grafting in a resource-poor setting in sub-Saharan Africa. Methods All burn patients (905 patients) admitted to Kamuzu Central Hospital (KCH) Burn Unit in Lilongwe, Malawi over three years (2011–2014) were studied. Results 275 patients (30%) had an operation during their admission. In patients who received an operation, median age was 5 years (IQR, 2.7–19) and median total body surface area burn was 15% (IQR, 8–25). 91 patients (33%) had early excision (≤5 days) and 184 patients (67%) had late excision (>5 days). Mortality was significantly greater in the early group (25.3% vs. 9.2%, p = 0.001). Controlling for total body surface area burn and age, the adjusted predictive probability of mortality were 0.256 (CI 0.159–0.385) and 0.107 (CI 0.062–0.177) if operated ≤5 and >5 days, respectively ( p = 0.0114). The odds ratio for mortality if operated >5 days is 0.34 (CI 0.15–0.79, p < 0.000). Conclusions Early excision and grafting in a resource-poor area in sub-Saharan Africa is associated with a significant increase in mortality. Delaying the timing of early excision and grafting of burn patients in a resource-poor setting past burn day 5 may confer a survival advantage.

Our study has demonstrated that comprehensive burn care is possible at a cost much lower than found in other burn centers in low or middle-income countries and can be sustained with moderate funding.

The results of this study demonstrate the year-round phenomenon of burns treated at our institution, and highlights the slight predominance of burns during the cold season. These data can be used to guide prevention strategies, with special attention to the implications of the increased burn incidence during the cold season. Though burn severity and mortality remain relatively unchanged between seasons, recognizing the seasonal variability in incidence of burns is critical for resource allocation in this low-income setting.