Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey

Abstract

Purpose Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. Methods A two-stage, cluster randomized, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. Results Nine-hundred households, totaling 5,148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2,340 serious burn injures (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burn injuries generally increased post-invasion to 8,780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn injury than children aged less than 13 years (aOR 2.42; 95%CI 1.08 – 5.44). Nineteen burns (35%) involved ≥20% body surface area. Death (16% of burn injuries), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn injury. Conclusion Civilian burn injury in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn injury. Ongoing conflict will directly and indirectly generate more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.

Accidents in Iraq during the period of conflict (2003–2016)

“…36 This high rate could be described as an epidemic. It arose from the security instability all over the country, 37 added to the status of thousands of displaced families where 16% had no ordinary facilities for cooking and personal warming, a situation that increased the risk of burn accidents. 38…”

The Epidemiology of Burn and Lethal Area of Fifty Percentage (LA50) in Children in Shiraz, Southern Iran

“…The findings in our burn center when compared with developed countries showed that LA50 and survival of burn patients were less denoting to an urgent necessity for prompt attention to promote current policies in public health issue and to decrease the mortality rate 25 . In Baghdad, Iraq, burn injury is still a prevalent health issue with an increasing trend imposing a household financial load, high mortality rate and disability occurring after burn injury mandating the need for planning burn prevention and care program 26 .…”

Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

“…While we are unable to infer the epidemiology of injury in the population from these hospital-based data, the findings support other studies from Iraq that suggest unintentional injuries predominate in populations affected by prolonged insecurity. [19][20][21] A population-based survey of injuries in Baghdad from 2003-2014 reported that falls, road traffic crashes, and mechanical injuries were more common than all violence-related injuries combined. 20 The authors concluded that deterioration of infrastructure, changes in safe behavior, and a lack of injury prevention and control programs contribute to this epidemiology.…”