|Year : 2014 | Volume
| Issue : 1 | Page : 83-87
Epidemiological study of burn patients admitted in a District Hospital of North Karnataka, India
Gowri Shankar1, Vijaya Ashok Naik2, Rajesh Powar3
1 Department of Community Medicine, S. N. Medical College, Bagalkot, India
2 Department of Public Health, KLE University, Belgaum, Karnataka, India
3 Department of Plastic Surgery, KLE Hospital, Belgaum, Karnataka, India
|Date of Web Publication||15-Dec-2014|
Associate Professor, Department of Community Medicine, S. N. Medical College, Bagalkot, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Burns are among the most devastating of all injuries and a major global public health crisis. The objective of this study was to record and to evaluate the epidemiology and mortality of burn cases as they vary widely in different regions and then bring about a prevention program designed according to the needs of the region. Materials and Methods: Prospective data was collected after informed consent from all burn patients admitted to the Government District Hospital during the study period. The District Hospital is a 750 bedded Government Hospital with the burns ward of 20 beds under the Surgery Department. Information about patients socio-demographic profile, mode and cause of burn, total burn surface area, place of burn, material of clothing worn by the victim at the time of the incident and outcome were recorded on a pre-designed and pre-tested questionnaire from the patients themselves if they were well enough or from their caretakers. Results: Out of 240 burn patients admitted during the study period, 134 (55.83%) were females. Majority (54.58%) were between 21 and 40 years of age. Flames caused 83.75% injuries (P = 0.001163). Maximum number (81.66%) were accidental followed by 9.58% alleged suicidal and 8.75% alleged homicidal injuries. At the time of injury, 48.75% victims were wearing synthetic clothes (P = 0.0000001). It was observed that the majority of the males (55.66%) recovered, whereas mortality was 51.47% in females (P = 0.0000001). The overall mortality rate was 37.50%. Conclusions: Utmost attention should be given by all concerned for prevention of burns and education regarding safety measures should be implemented in schools and colleges to decrease morbidity and mortality.
Keywords: Burn epidemiology, outcome
|How to cite this article:|
Shankar G, Naik VA, Powar R. Epidemiological study of burn patients admitted in a District Hospital of North Karnataka, India. Indian J Burns 2014;22:83-7
|How to cite this URL:|
Shankar G, Naik VA, Powar R. Epidemiological study of burn patients admitted in a District Hospital of North Karnataka, India. Indian J Burns [serial online] 2014 [cited 2019 May 20];22:83-7. Available from: http://www.ijburns.com/text.asp?2014/22/1/83/147014
| Introduction|| |
Burn injuries are among the most devastating of all injuries and a major global public health crisis.  Almost 95% of global burn deaths and disabilities are estimated to occur in low and middle income countries of the world.  Burn injuries even to this day are a major public health problem in India. They destroy the physique and psyche of the injured individual permanently. An accurate estimate of the incidence of burns is difficult to obtain in a huge and diversely composed population of the country.  The objective of this study was to record and to evaluate the epidemiology and mortality of burn cases as they vary widely in different regions and therefore a successful preventive program should be designed according to the needs of each region. 
| Materials and methods|| |
Prospective data regarding patients age, gender, mode of burn, cause of burn, total burn surface area, place of burn, material of clothing worn by the victim at the time of the incident, socio-economic status, type of housing and outcome were collected after informed consent from the patients themselves if they were able enough or from their attendants on a pre-designed and pre-tested questionnaire. Ethical clearance was obtained from Institutional review board. 240 burn patients were admitted between 1 st April, 2004 and 31 st March, 2005 to the Government District Hospital burns ward, Belgaum, Karnataka, India which is the only government referral center for major burns in the district of Belgaum. Statistical analysis was carried out using percentages and Chi-square test.
| Results|| |
Out of 240 burn patients admitted during the study period, 134 (55.83%) were females. The male to female ratio was 0.8:1. The age range was from 6 months to 70 years. Majority (54.58%) were between 21 and 40 years of age followed by 31.26% less than 20 years of age [Table 1]a and b. Majority (71.25%) were hailing from rural areas and 52.50% of the injured were from nuclear families. Maximum number (63.34%) were married at the time of injury and 29.59% were housewives followed by 27.92% unskilled workers (P = 0.0000001). Regarding education in the female patients, it was observed that 55 (41.04%) were illiterate followed by 36 (26.87%) with primary education (1 st to 7 th standard) and 31 (23.14%) with secondary education (8 th to 10 th standard). Majority (80%) belonged to class IV and V under modified B.G. Prasad classification (Annexure 1). [Additional file 1] Regarding the housing condition, 55.42% of the victims were living in Kutcha (thatched) homes and in 77.08% the injury occurred indoors (P = 0000001). Maximum numbers of injuries (81.66%) were accidental followed by 9.58% alleged suicidal and 8.75% alleged homicidal injuries. Initially, due to medico legal issues, the mode of burn injury stated by the victim and also by the family members would differ. Later on, by frequent visits to the ward by the first author, the victims would reveal the actual truth of the incident. About the type of burn, 83.75% were due to flames [Table 2]a, followed by 10% scald injuries and 4.58% electrical injuries (P = 0.001163). In pediatric burns, the most common source was kerosene contributing to 14.67% of the total injuries in this group [Table 2]b. About electrical injuries, 4 (36.36%) was due to a short circuit and 7 (63.64%) was due to a live wire. It was observed that the majority of injuries occurred between 8 pm and 12 midnight [Table 3]. At the time of injury, 48.75% victims were wearing synthetic clothes (P = 0.0000001) [Table 4]. It was observed that after an injury in pediatric victims, 41.34% did not receive any first aid and 28% were doused with water and 18.67% were doused with cloth. Majority of the males (55.66%) suffered less than 20% total burn surface area whereas in females, more than 45% suffered more than 40% total burn surface area (P = 0.000000577) [Graph 1]. [Additional file 2] It was observed that the majority of the males (55.66%) recovered, whereas 51.47% of females succumbed to their injuries (P = .00000001) [Graph 2]. [Additional file 3] The overall mortality rate was 37.50%. In the pediatric age group, recovery was 34.67%, recovery with a disability was 20% and death was 25.33% respectively. It was observed that 20% of the pediatric patients had to be discharged against medical advice.
|Table 4: Distribution according to material of clothing worn at the time of burn|
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| Discussion|| |
Burn injuries and their related morbidity, disability and mortality represent a public health problem of increasing importance in developing countries even to this day. The risk factors associated with burn injuries vary between different regions and so epidemiological studies in each region is needed before an adequate prevention program can be implemented.
Demographic data analysis showed that the age group between 21 and 40 years is the most vulnerable to burn injuries for both genders, which is consistent with findings from other studies. ,,
The results showed that females were more likely to be at risk of burn injuries especially between 21 and 40 years of age due to their domestic chores and invariably using unsafe equipment's due to their low socio-economic status and this is comparable with other studies. ,, The commonly used equipment that is used for cooking or warming water is the kerosene pressure stove. It is explosive due to the quality and also the inexperience in handling it efficiently.
In men, the most common source of burn injury in this study was an inflammable liquid stored in a home which exploded and caused a mass casualty. All the alleged suicidal and homicidal cases were due to kerosene immolation in both males and females and policy makers should ban kerosene use in rural households and bring in safer equipment such as electric stoves and solar cookers.
It was observed that the number of burn injuries decreased with the rise in economic status of the individual. Inverse relationship of the socio-economic status and the incidence of serious burns are now universally known. This could be due to the use of cheap equipment's, open fires, adulterated kerosene, financial problems, floor level cooking and kerosene lamp/bottle.
Moreover, most of the injuries occurred in the victims thatched home residing in the rural areas. This finding is similar to other studies conducted in India , and suggests there is a long way to go to provide suitable housing conditions for the rural population.
In this study, an unintentional flame injury was more common and is similar to another report from India and other countries. ,, This finding highlights the need for educational programs targeting the community to handle equipment's safely at home. Most of the injured in this study were from rural areas where they still use firewood and kerosene stoves for cooking and warming water for bath. They keep the stoves on the floor as they do not have a platform. In the rural areas, due to electricity shut downs they use lamps which are kept on the floor. They do not have LPG connections. This is again due to the low standard of living and economic status. They can at least replace the pressure stoves with wick stoves and also use safe new designs for using wood fuel which are available in India.
It was observed that the majority of injuries occurred between 8 pm and 12 midnight which is the time to use cooking and lighting equipment. The other risk factor noted was the wearing of synthetic, long and loose traditional Indian clothes at home which can flare up easily when it catches fire leading to extensive burns. The affected population had been interrogated about the fabric being at fault and ignition of clothing was found to be the risk factor in the majority of burn injury patients. It is associated with ignorance on how to extinguish the fire. Associated clothing ignition was identified in 83% of flame cases in another study.  Clothing ignition has been identified as a major cause of burns in both industrialized and developing countries. However, in industrialized countries, a change to more closely fitting styles of clothing, together with decreased fabric flammability has resulted in a significant decrease in deaths from clothing ignition, which represented only 5% of all burn deaths in the USA.  This study revealed the overall mortality at 37.50% and also alarming was that 50% of the females injured succumbed to their injuries as it was observed that total burn surface area was more than 40% in them compared to male patients. These findings could be attributed to females being more exposed to risk factors such as cooking on the kerosene stove, gas or Chulha and lack of knowledge regarding safety measures while handling fire - related equipment's. A higher number of suicidal and homicidal burns in females lead to extensive burns. This indicates the enormity of the issue regarding young women dying due to ignorance and carelessness at home while handling equipment which can cause burns.
Regarding pediatric burn injuries, elders at home should be vigilant at all times for safety of their young children and elder children should be informed about the hazards of burn injuries and their sources.
| Conclusion|| |
This study indicated the socio-demographic features, factors associated with burn injuries and their outcome. Furthermore, most of the injuries have occurred at home revealing that women and children are the most vulnerable group in this setting. Utmost attention should be given to this aspect and educational programs in schools and colleges should be implemented at the earliest to decrease the morbidity and mortality due to this public health crisis. It is high time that non-flammable garments should be promoted to be worn at home and safer equipment be introduced into rural households. Right now, Project Surya based in Lucknow has brought out Annapurna Unnat Chulha [Figure 1] (TERI SPT 0610 Stove)  marketed by Milagrow which is a safe technology and can also decrease indoor air pollution and thereby respiratory disorders in women. Furthermore, Greenway smart furnace  has been introduced in India and can help in decreasing burn injuries. Flame retardant kitchen aprons can also be used when women are wearing flammable fabrics at home.
| Preventive strategies|| |
The most common sources of burn injury in this setting are kerosene and kerosene pressure stoves. These two should be banned and alternate safe technology like LPG or electric stoves or solar cookers and even the new technologies mentioned should be made easily available in rural households. Health education regarding safety while handling these equipment's should be introduced into schools and colleges especially to girl students. First aid should be taught in the community through Anganwadi centers.
| Limitations of the study|| |
The truth can never be known in some alleged accidental injuries for medico-legal reasons and in severe injuries the patients could not be questioned due to their incapability and had to rely on their care takers history.
| Acknowledgments|| |
The authors would like to acknowledge the District Surgeon, Dr. Khanagavi for granting permission to conduct the study during the period. The authors are grateful to all patients for their co-operation and also their relatives for providing the required information without which this study could not have been done.
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[Table 1], [Table 2], [Table 3], [Table 4]