Burn injuries in KwaZulu-Natal Province, South Africa: Quantifying the healthcare burden

Abstract

Background. Most burn injuries occur in low- and middle-income countries (LMICs) and affect those of lower socioeconomic status disproportionally. A multifaceted approach is needed to improve burn outcomes. Healthcare strategies and reform should be data driven, but South Africa (SA) currently lacks sufficient baseline data related to burn injuries. The absence of local data is compounded by a global lack of published data from LMIC settings. The Pietermaritzburg Burn Service Registry (PBSR) is the only established registry for burn injuries in SA. Objectives. To use the high-quality, detailed data from the PBSR to estimate the KwaZulu-Natal (KZN) provincial burden of burns in terms of length of stay, need for surgery and mortality. Our broader aim is to quantify the magnitude of the problem to highlight the need for specific burn care strategies in SA. Methods. We conducted an observational, retrospective review of burns data from two databases, the District Health Information System (DHIS) between 2013 and 2018, and the more detailed PBSR between 2016 and 2019. We compared the distribution of mild, moderate and severe injuries as well as the distribution of adult and paediatric admissions between the DHIS and PBSR data sets. We then assumed that outcomes for the province would follow similar patterns to the Pietermaritzburg Burn Service and applied the proportions to the DHIS data set to estimate the annual provincial burden. Results. In the DHIS, there was an annual mean (standard deviation (SD)) of 4 807 (760) children (age ≤12 years) and 3 622 (588) adults (age >12 years) admitted to hospitals in KZN with burn injuries. Annual average injury severity was 76.0% mild (mean (SD) n=5 539 (1 112.4)), 19.8% moderate (n=1 441 (148.8)) and 4.2% severe (n=312 (24.5)). These proportions were similar in the PBSR. Projections estimate that 2 967 patients would need surgery, with 212 500 hospital days required annually in the province. Additionally, provincial mortality would be 586 patients, including 84% with burns of mild and moderate severity. These deaths are potentially preventable. Conclusion. There is a significant, unquantified burden of burn injury in KZN, highlighting the urgent need for development of specialised surgical services for burns. Collection of more robust national data to verify our projections is required to confirm the need and guide required healthcare reform.