Survival after burn in a sub-Saharan burn unit: Challenges and opportunities

Abstract

Background Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. Methods This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. Results A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age—17% for 0–18 year olds, 24% for 19–60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0–18 years old, 79% in patients 19–60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. Discussion Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative.

Gender differences in burns: A study from emergency centres in the Western Cape, South Africa

“…The higher risk among adult men that has been observed in previous studies from the area regarding severe and fatal burns [8][9][10][11][12]20] was in this setting found in fire burns in younger adult men and in hot liquid burns in older men. The reasons for these gender differences are likely to be multifaceted and connected to different exposures where environment and behaviour interact, falling hardest on men in this resource-constrained setting.…”

“…Studies using mortality data [8,9] and those based on inpatient data [10][11][12][13][14] indicate that men are a risk group for burns, as are boys [9,[15][16][17][18]. Inpatient data present gender similarities in Total Body Surface Area (TBSA) burned [11,12,16] and studies considering in-and out-patient data reveal gender similarity in patients of all ages [19][20][21] with a preponderance of boys [22]. On the other hand, studies including all severity levels of burns show higher risks for young and middle-aged women [23] and similar incidence for children [23][24][25] and all ages aggregated [26].…”

Profile of Moderate and Severe Burns: Turkish Experience In A Tertiary Care Burn Unit

“…In developed areas, an organized multidisciplinary approach including early hospitalization, proper fluid resuscitation and nutrition and infection control increases the survival (7,8). But unfortunately, the majority of the burn traumas occur in the middle and low-income countries (9) in which low education, limited health service inhibits adequate treatment and rehabilitation for these patients (10,11).…”

Qualitative analysis of a psychological supportive counseling group for burn survivors and families in Malawi

“…The mortality rate from burn injury in Malawi is high, ranging from 11% in a hospital with a burn unit [8] to 27% in a hospital without one [4]. The strongest predictor of mortality for these patients is the total body surface area of the burn.…”