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83 Burn Injuries in Sub-Saharan Africa: A Global Burden of Disease Study
Abstract
Introduction
Over 1 million burns occur in Sub-Saharan Africa (SSA) each year leading to significant morbidity and mortality. Financial constraints, social stigma, political strife, inaccessible healthcare facilities, limited perioperative resources, and low workforce capacity results in steep barriers to obtaining timely and effective burn care. This study set out to better define the burn burden as well as the age and gender-related disparities within SSA, to identify specific sub-regions and countries that would benefit most from targeted interventions to enhance burn care.
Methods
Data for all 46 SSA countries were acquired from the 2017 Global Burden of Disease (GBD17) database of the Global Health Data Exchange. Information regarding fire, heat, and hot substance-related injuries was derived from 17,792 data sources to estimate burn-related incidence, deaths, and Disability Adjusted Life Years (DALYs) by year, sex, age, and location from 1990 to 2017. Summative statistics were created for burn incidence, deaths, DALYs, and mortality ratio (deaths: incidence; %). Spatial mapping was performed to identify burn burden for specific regions and countries.
Results
An estimated 28,127,199 burns occurred in SSA from 1990–2017. On average, SSA accounted for 16% of worldwide burns, 21% of burn deaths, and 25% of DALYs. Furthermore, the mortality rate was 2.2 times the global average and remained nearly double the entire 27-year period. While all SSA regions had higher incidence, deaths, and DALYs compared to the global cohort, the Southern SSA region consistently had the highest incidence (211 cases per 100,000), deaths (7 per 100,000), and DALYs (355 years per 100,000) throughout the time period, with Lesotho, Swaziland, and Zimbabwe having the highest rates. In contrast to gender similarities globally for burn indicators, all regions within SSA showed higher incidence rates (144 vs 136 cases per 100,000), deaths (5.4 vs 4.7 deaths per 100,000), and DALYs (289 vs 272 years per 100,000) for men than women when age standardized.
Conclusions
With an estimated 1.4 million burn injuries in 2017, SSA accounted for over 15% of all worldwide burns and 20% of global burn deaths. Although all trended rates improved over the years for each country, they were consistently worse and slower to improve in all regions of SSA compared to the rest of the world. While both Central and Southern SSA regions had the greatest burn burden, burns in Central SSA more significantly impacted those under 5 years whereas Southern SSA saw the greatest burden on the 15–49-year age group.
... To date, chronic wounds are reported to affect 40 million patients globally, significantly reducing the workforce (Le et al. 2023). In sub-Saharan Africa, over one million burn wound injuries are recorded annually thereby increasing the global burden of wounds (Collier et al. 2021). These statistics highlight the significant impact of wounds on public health and the need for effective wound care strategies. ...
Background: Wound healing is an important occurrence consisting of a myriad biochemical processes. The recent introduction of phytochemical-based dressings to expedite wound healing uses a multi-targeted approach including antimicrobial, anti-inflammatory and antioxidant activity.Aim: The review aimed to conduct an exhaustive search of the existing literature on plant-based hydrocolloid dressings for wound healing and to evaluate the dressing efficacy in comparison to standard dressings.Setting: The review offers a worldwide overview of plant-based hydrocolloid dressings and their use.Methods: A systematic search using keywords was done to identify clinical and randomised control trials from 2019 to 2024. The following databases were queried: Cochrane Library, Embase, PubMed, Scopus, Science Direct and Web of Science. Data appraisal was done by an analysis of the data quality by the authors.Results: Of a total of 866 records identified, 4 qualified for further assessment. The data retrieved showed that the use of phytochemical-based hydrocolloids is more effective compared to non-plant-based hydrocolloids.Conclusion: The data analysis revealed that there are few research studies on plant-based hydrocolloids, and there is a need for further research in the area. In addition, the dressings significantly expedite wound healing offering a multifaceted approach because of the different mechanisms of action including antioxidant, anti-inflammatory and cell proliferation.Contribution: This study highlights the need for further studies on hydrocolloids produced from plant extracts for effective wound healing.
... 6 Burn injury is very common in LMICs countries, especially in Africa, where over 1 million burns occur each year in sub-Saharan Africa (SSA), leading to significant morbidity and mortality. [7][8][9] Understanding the epidemiology of burns in Ethiopia and the treatment infrastructure available is crucial for gaining insight into the challenges and opportunities for improving patient outcomes in this context. In Ethiopia, burns constitute 1.5% to 9% of injuries across all age groups and 4% to 15% of injuries among children. ...
Introduction
Burn injuries impose a substantial burden globally, particularly in low- and middle-income countries like Ethiopia, where the impact is pronounced. Despite existing studies on individual patient data, there 's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals.
Methods
A systematic search of various databases yielded 11 relevant studies, which were included in the analysis. Data extraction and quality assessment were conducted using Microsoft Excel 2021 and the Newcastle-Ottawa Scale, respectively. Statistical analyses were performed using STATA version 17 software.
Result
The pooled mortality rate among burn patients in Ethiopian hospitals was determined to be 6.99% (95% CI: 4.8, 9.41). Factors significantly associated with mortality included inadequate resuscitation (Adjusted Odds Ratio (AOR) 3.73, 95% CI: 1.31, 10.58), pre-existing illness (AOR: 5.26, 95% CI: 2.12, 13.07), age <5 or >60 (AOR: 2.22, 95% CI: 1.45, 3.40), and burn injury >20% total body surface area (AOR: 5.17, 95% CI: 2.47, 10.80).
Conclusion
The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, with inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury identified as key determinants. Collaboration among healthcare stakeholders and policymakers is imperative to improve burn care services and mitigate the impact of these injuries. This study was registered with PROSPERO (CRD42023494159), providing a comprehensive overview of burn injury mortality in Ethiopia.
Lay Summary
Burn injuries are a significant health concern globally, particularly in low- and middle-income countries like Ethiopia. Despite the existing studies on burn injuries, there's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals.
The study systematically reviewed 11 relevant studies and conducted a meta-analysis to determine the prevalence of burn injury mortality and associated factors. The pooled mortality rate among burn patients in Ethiopian hospitals was found to be 6.99%. Factors significantly associated with mortality included inadequate resuscitation, pre-existing illness, age <5 or >60, and burn injury >20% total body surface area.
The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, highlighting the need for comprehensive and effective treatment approaches. Inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury were identified as key determinants of mortality. Addressing these factors is crucial for improving burn care outcomes and reducing the burden of burn injuries in Ethiopian hospitals.
This study provides valuable insights for healthcare professionals, policymakers, and researchers working towards improving burn injury outcomes in Ethiopia. By understanding the factors influencing treatment outcomes, healthcare stakeholders can refine treatment protocols, enhance resource allocation, and implement preventive measures to reduce the burden of burn injuries in Ethiopian hospitals.
... [2] More than 1 million burns occur in Africa each year, causing significant morbidity and mortality. [3][4][5] In addition, burn injuries are responsible for 6.7% of medically associated fatalities and 4.8% of trauma deaths in Nigeria, with flame burns accounting for "65%-71%" of burn injuries in Southwest Nigeria. [6] Different infections have been commonly reported among burn patients, with pneumonia, cellulitis, and urinary tract infections being the most common clinical complications reported in patients admitted to a burn center over the last decade. ...
Burn injury is a major public health concern, with an estimated 180,000 deaths each year associated with burn-related infections. The majority of these occur in low- and middle-income countries, and almost two-thirds occur in the World Health Organization African and South-East Asia Regions. There is a risk of an escalation of burn injury site infections if nurses who are directly involved in burn care do not develop a mechanism to mitigate this risk in the coming years. Hence, this study aims at explaining what burn injuries are and how nurses can prevent the occurrence of infection among burn victims. This review analyzed published studies using keywords such as burn injury, infection in burn patients, and nurses’ involvement in infection prevention and control (IPC) on search engines such as PubMed, Science Direct, and Google Scholar. The literature was retrieved and reviewed for eligibility to capture just the variables indicated in this seminar objective; the date range chosen in the literature search was from 2015 to 2023. The study found that many patients die from burn injuries as a result of exposure to infection and most nurses are not adequately informed about infection control. The study also found that nurses’ responsibilities include proper hand hygiene, wound care, the use of personal protective equipment, antibiotic medication, cleaning the patient’s surroundings, and preventing patient cross-contamination. Burn injuries pose a significant risk to patients, necessitating infection control and prevention. Therefore, nurses in burn units should be informed on IPC practices and also educate patients, families, and coworkers on their importance.
... C ooking-related burns create a major public health burden in low-and middle-income countries (LMICs), where over 95% of burn deaths occur [1], and this type of injury carries greater long-term morbidity than burns of any other type [2]. The global burn registry report by the World Health Organization (WHO) shows that, burn injury incidence is excessively concentrated in LMICs [3,4]. Children, especially those under five years of age, are more vulnerable to experienc-ing pediatric burns [5], and several studies have revealed that most pediatric burn injuries occur below the age of 4 years [6][7][8]. ...
Objective:
To investigate the prevalence and risk factors of cooking-related child burn injury.
Methods:
A cross-sectional community-based study was conducted among a total of 5830 children with their respective caretakers in randomly selected 100 clusters. Data were collected through face-to-face interviews using a structured questionnaire. Logistic regression was used to identify the risk factors and adjusted odds ratios were used as measures of effect.
Results:
The prevalence of cooking-related child burn injury was 6.2% (95% CI: 5.5-6.8). This burden was linked with risk factors such as lower literacy of caretaker, family size, using traditional cook stove, long cooking time, and presence of extra indoor burning events as well as lack of separate kitchen, child supervision, and injury prevention awareness.
Conclusion:
Children experience a high burden of burn injury. Thus, stakeholders should work to reduce this burden by controlling the aforementioned risk factors.
... C ooking-related burns create a major public health burden in low-and middle-income countries (LMICs), where over 95% of burn deaths occur [1], and this type of injury carries greater long-term morbidity than burns of any other type [2]. The global burn registry report by the World Health Organization (WHO) shows that, burn injury incidence is excessively concentrated in LMICs [3,4]. Children, especially those under five years of age, are more vulnerable to experienc-ing pediatric burns [5], and several studies have revealed that most pediatric burn injuries occur below the age of 4 years [6][7][8]. ...
Background
Globally, burn related deaths are disproportionately higher among children below 5 years of age compared to other age groups. Although rarely fatal, most burns in this group occur within homes specifically in kitchens. This study assessed the prevalence, risk factors and perceptions of caregivers regarding burns among children under 5 years in an urban slum in Kampala, Uganda.
Methods
The study used an analytic cross-sectional design with quantitative and qualitative techniques. Quantitative data were collected using a structured questionnaire and observational checklist, while qualitative data involved use of a key informant interview guide. A total of 426 children were involved in the study, while 6 key informants namely an adult mother, teenage mother, community health worker, health practitioner, father and local leader were interviewed. A modified Poisson regression model was used to determine the correlates of burn injuries, prevalence rate ratios and 95% confidence intervals, while thematic analysis was used for qualitative data.
Results
The prevalence of burns among under-fives was 32%, highest among those aged 24 to 35 months (39%), and least in those below 12 months (10%). Children with single parents (adj PR = 1.56 95% CI 1.07–2.29) and those from households in the middle and least poor wealth quintile (adj.PR = 1.72; 95% CI 1.02–2.89 and adj.PR = 1.77; 95% CI 1.02–3.05, respectively) were more likely to get burns compared to their counterparts in other quintiles. In households where flammables were safely stored, children were less likely to suffer from burn injuries (adj.PR = 0.61; 95% CI 0.44–0.83). Congestion, negligence of caregivers, and use of charcoal stoves/open cooking were the commonest determinants of burns. Although many caregivers offered first aid to burn patients, inadequate knowledge of proper care was noted. Crawling children were perceived as being at highest risk of burns.
Conclusion
The prevalence of burns among children under 5 years was high, with several household hazards identified. Health education, household modification and applicable public health law enforcement are recommended to reduce hazards and minimise burn risks among children.
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