|Year : 2016 | Volume
| Issue : 1 | Page : 36-40
Etiology and characteristics of burn injuries in patients admitted at Burns Center, Civil Hospital Karachi
Muhammad Osama Anwer1, Muhammad Uzair Abdul Rauf1, Noorulain Chishti1, Sanam Anwer2
1 Students of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
2 Department of Neurology, SUNY Upstate Medical University, Syracuse, New York
|Date of Web Publication||12-Dec-2016|
Muhammad Osama Anwer
B-77, Block 13-D, Gulshan-e-Iqbal, Karachi 75300
Source of Support: None, Conflict of Interest: None
Background: Morbidity and mortality by burns are alarmingly high among the developing countries due to inadequate care facilities. Among these nations, Pakistan has one of the highest burn-related incidents. The dilemma is that most of these deaths and disabilities are curable and preventable. Therefore, there is an urgent need of creating an effective infrastructure to cut down these high number of cases. Methods: We conducted a cross-sectional study at Burns Center, Civil Hospital Karachi. Two hundred and seventy-five patients participated in the study. Data were analyzed using SPSS version 17.0. Results: Among these 275 patients interviewed 63.6% (n = 175) were males whereas 36.4% (n = 100) were females. The mean age of our participants was found to be 26.36 years. A large proportion of the population belonged to the urban areas, i.e. 76.4% (210), whereas only 23.6% (65) were from rural areas, with P = 0.001. About 63.6% of the burn injuries occurred at home (175) while 25.1% (69) got injured at the place of work. Most of the cases were found to be accidental 93.8% (258). About 53.1% (146) had <20% of the total body surface area effected, whereas 16.7% (46) had more than 40% burns. Conclusion: By introducing an effective awareness program regarding burns and teaching first aid techniques to general population, a high number of burn-related accidents could be prevented.
Keywords: Accidental injury, burn injuries, Pakistan, tertiary care hospital
|How to cite this article:|
Anwer MO, Rauf MU, Chishti N, Anwer S. Etiology and characteristics of burn injuries in patients admitted at Burns Center, Civil Hospital Karachi. Indian J Burns 2016;24:36-40
|How to cite this URL:|
Anwer MO, Rauf MU, Chishti N, Anwer S. Etiology and characteristics of burn injuries in patients admitted at Burns Center, Civil Hospital Karachi. Indian J Burns [serial online] 2016 [cited 2018 May 23];24:36-40. Available from: http://www.ijburns.com/text.asp?2016/24/1/36/195535
| Introduction|| |
Disintegration of the various layers of skin and the structures within (glands, hair follicles, etc.), from heat is termed as “burn.” According to the statistics provided by the WHO, it has been estimated that every year 265,000 people succumb to death due to burns and most of these fatalities happen in low- to middle-income group population. Millions of others are left crippled by injuries which not only leave an everlasting psychological scar on the survivors themselves but also leaves the family under immense social and economic burden.
Morbidity and mortality by burns are at an alarming level in many of the under-developed countries of the world. In Africa, which is one of the poorest regions of the world, burn injuries constitute the majority of in-hospital stays and deaths. In India alone 100,000 children are hospitalized every year due to road traffic accidents, drowning, burns, falls and poisoning, with burns being the leading cause of death in children <5 years. Pakistan a country which is marred by internal political disputes, high rates of unemployment and where 50% of the population lives under the poverty line have one of the highest incidences of burn-related injuries, about 18% of the children are left with permanent disability, and many suffer lifelong dependency.
In 2016 a research report published by the National Fire Protection Association, USA stated that about 78% of all burn-related deaths occur in homes. While in another survey conducted by the American Burn Association, 68% of the population afflicted by burns were males while only 32% were females. In Pakistan, the percentage of men injured in a burn incident are far less when compared to women, with an astonishing 92% of females injured at home, with the majority of deaths due to kitchen fires. Fire and electric burns at worksite were found to be most common among males. In a study conducted at PIMS Hospital Islamabad, the most common method of burn-related injury in Pakistan was found to be naked flame burns followed by electrical, hot liquid, and chemical burns. In pediatric population, scalds (burns injury due to hot liquids and gases) were found to be the most common method of injury.
Therefore, keeping in view, the high incidence and mortality associated with burns in Pakistan, urgent action need to be taken.
| Methods and Analysis|| |
This is a cross-sectional study conducted at Burns Center, Civil Hospital Karachi. The study involved targeting patients with any degree and type of burn admitted at the burns center. A total of 275 patients were approached all of which agreed to participate in the study through nonprobability convenient sampling with a response rate of 100%.
Ethical approval for the study was given by the Institutional Review Board of Dow University of Health Sciences. Verbal consent was taken from each respondent beforehand for participation in the study. A predesigned questionnaire was filled by the authors interviewing the patient or in cases where patients were unable to provide information or were unconscious, their attendants (only first degree relatives) were interviewed and using the data available from the patient's file.
The duration of the study was 3 months (July to September 2012). A meeting of the investigators was held prior to the administration of the questionnaire to maintain uniformity in its administration; hence, reducing chances of interviewer's bias in the study. Strict confidentiality was maintained throughout the process of data collection, entry, and analysis.
The questionnaire was designed after thorough literature search with the help of research department at burns center. Before start of data collection, twenty questionnaires were pretested to make corrections in the questionnaire. The results of pretesting were not included in the final analysis.
The questionnaire included biodata of the patient, questions pertaining to the type, cause, and manner of burn. It also inquired the place where burn occurred, surface area of the burn, and duration of hospital stay.
Data were entered and analyzed using Statistical Package for Social Sciences version 17.0 (SPSS, Inc., Chicago, IL, USA). Descriptive statistics including frequencies for categorical data means and standard deviations (SD) for continuous data were calculated. A P ≤ 0.05 was taken as significant.
All those patients who left against medical advice were not included in our sample.
| Results|| |
A total of 275 patients were interviewed, of which 63.6% (n = 175) were males, whereas 36.4% (n = 100) were females. Most of the patients, 53.8% (148) were from age group between 21 and 40 years followed by 34.5% (95) which were aged below 20 years. The average age of females and males calculated was 29.18 years (SD: ±14.18) and 24.75 (SD: ±11.13) years, respectively. The mean age of our participants was found to be 26.36 years.
When inquired about ethnicity Urdu speaking formed the largest group patients 38.2% (105) followed by Sindhi 34.2% (94). Rest of the patients about 27.7% (76) spoke other regional languages such as Balochi, Pashto, Memoni, Gujarati, etc.
Separating the results on the basis of residence, a large number 76.4% (210) of the patients belonged to urban areas, whereas only a small percentage 23.6% (65) was residing in rural areas. Nearly half, 51.3% (141) of the participants were unemployed, and similarly, 51.6% (142) were illiterate. [Table 1] summarizes the sociodemographics of the patients.
When inquired about the place of incidence, it was found that 63.6% (175) of the burns occurred at homes/residence while 25.1% (69) of the cases got burned at their place of work. The majority 58.9% (162) burn cases were reported to be from open/direct flame while 19.3% (53) were from electrical outlets. Most of the cases, 93.8% (258) were found to be accidental while only 1.5% (4) were reported cases of suicide. Many 74.8% (206) of the cases got thermal burns; about 19.3% (53) were electric burns while a minor 0.4% (1) got struck by lightning. A large proportion of the patients 85.5% (235) were conscious when they got burned whereas 14.5% (40) of them lost their consciousness when the incident took place. About 7.3% (20) of patients had the past history of burns leading to the previous hospitalization. [Table 2] summarizes the patterns of burn incidence.
When the patients were assessed for the percentage of total body surface area 53.1% (146) had ≤20% burns while 16.7% (46) had more than 40% burns. [Figure 1] shows the percentage of total body surface area affected by burns.
[Table 3] shows the P value obtained with association of gender with other factors. The relationship of gender with residence, employment, and place of occurrence of burn is found to be significant with a P = 0.003, 0.00, and 0.00, respectively. The relation of residence (rural/urban) with final outcome of the patient gave a significant P = 0.001.
| Discussion|| |
Awareness programs which target to educate masses are essential to incorporate preventive methods among local population. In a study conducted in Canada, it was found that measures taken to bring change in the lifestyle of the Canadian community about cardiovascular risk factors through preventive programs showed encouraging results. Many studies have shown that the burden of burn injuries and deaths on developing countries of the world are preventable. In Pakistan, burn-related injuries have been adding a great deal of burden to overall premature deaths and morbidity. Our study highlights that most of the injuries were accidental and were caused due to sheer negligence and lack of awareness which is consistent with studies conducted by Toon et al., Türegün et al., and Maghsoudi et al.,, Therefore, surveillance data are extremely crucial in formulating a preventive strategy for the Pakistani community so that we can work together for a better life of the victim and decrease the mortality rate. Our data are consistent with the fact that most common age group affected by burns is 21–40 years of age which is similar to a study conducted by Khan et al. which stated 21–50 years as the most common age group.,, An unexpected finding was that the pediatric age group (1–14 years) comprised a small proportion of the burns victims (8.7%). One reason for this finding might be that many of the cases remain unreported with treatment given at home most of the time and because many families are still living in the joint family system where the elderly and children are safeguarded.
Unlike the findings in other studies where the majority of males got burned at their place of work;, we found that a considerable percentage (45.7%) got injured at home, the most important reason being unemployment. Almost 37% of our male respondents were unemployed. The other contributing factor that was evident in our study was that most of the men restored to self-repair of electrical and heating appliances without taking adequate precautionary measures. From our study, it is evident that due to poverty people could not hire trained professionals to repair their appliances and indulge in such dangerous acts and place their life in jeopardy.
Females who constituted 36.4% of our study population, in most cases, became victim at home (95%). This high incidence of burn-related injuries among women taking place at home has several reasons. Cultural and social stigmas of the society in Pakistan have left women deprived of the basic necessities of life leaving them more vulnerable to not only to abuse and violence but also to such health hazards. Faulty designs of the cooking instruments, use of extremely dangerous combustible fuels without adequate safety measures, wearing loose clothes in the cooking area, and unavailability of first aid has contributed to a large number deaths due to third-degree burns among women. As stated by Marsh et al., the typical picture of a burn's victim admitted at Burns Center in Karachi is that of a young woman who was in the kitchen cooking at a floor stove, had prolonged contact with fire got nothing in the name of first aid, and then was shifted to the hospital in a normal transport carrier without lifesaving drugs or instruments. Only 1% of the women were injured while they were at their workplace contrary to the facts published in the article “epidemiological data and costs of burn injuries in Switzerland.” Where majority of the incidents took place at work.
The most susceptible group was the lower socioeconomic strata of the society constituting (70.9%) of our study which is consistent with other studies also.,, Illiteracy was common among this group where 51.6% of the affected individuals did not have any formal education signifying an important fact that illiteracy was a major contributing factor in burn-related injuries. In developing world poverty, illiteracy, underdeveloped health resources are the main reasons for high mortality rates associated with burns.,,
The most common type of burn injury was found to be thermal in both genders. About 90% of females and 66.28% of males presented with thermal burns. Whereas the second most common type of burn showed a clear gender variation with chemical burns being more common among females and electrical burns among the males. With almost nonexistent labor laws in Pakistan, this fact is further reinforced through our study that most of the males were factory employees who got injured while disposing or handling chemicals.
For pediatric population, the most common cause was direct flame, whereas most of the studies state hot fluids as the leading cause in that age group.,,, The reason for direct flame injuries in our setting can be due to overcrowding, lack of awareness, and poor safety measures.
| Conclusion|| |
Hence, our study highlights many important aspects of which, first and foremost is that an effective awareness program should be formulated with special consideration to the population that is most vulnerable to such hazards. Awareness can be created through intensive campaigns such as media advertisements and public outreach programs. Special attention should be given to training of general population in giving proper first aid to a burn's victim. Effort is needed both at the level of the government and nongovernment organizations to bring about this change. An effective and an efficient burn care should be formulated. Second, stress should be given to tertiary prevention as well, with good rehabilitation program which not only focuses on the physical rehabilitation of the patient but also on psychological aspect, which a burn's victim has to go through.
Our study also has some limitations. Homicidal burns in Pakistan are often reported as accidental due to social taboos and corrupt official departments which not only defer to register these cases but also create havoc for patients and their loved ones. These homicidal victims might have been counted as accidental burn victims. The other limitation which may be taken into account is limited data availability due to limited financial and human resources. Studies with larger sample size may further strengthen our findings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Peck M, Molnar J, Swart D. A global plan for burn prevention and care. Bull World Health Organ 2009;87:802-3.
Outwater AH, Ismail H, Mgalilwa L, Justin Temu M, Mbembati NA. Burns in Tanzania: Morbidity and mortality, causes and risk factors: A review. Int J Burns Trauma 2013;3:18-29.
Gururaj G. Injury prevention and care: An important public health agenda for health, survival and safety of children. Indian J Pediatr 2013;80 Suppl 1:S100-8.
Hylton JG, Haynes. Fire Loss in United States. National Fire Protection Association; 2016.
Marsh D, Sheikh A, Khalil A, Kamil S, Jaffer-uz-Zaman, Qureshi I, et al.
Epidemiology of adults hospitalized with burns in Karachi, Pakistan. Burns 1996;22:225-9.
Khan N, Malik MA. Presentation of burn injuries and their management outcome. J Pak Med Assoc 2006;56:394-7.
Iqbal T, Rashid R, Ibrahim M. Incidence of burn injury admission at PIMS, Islamabad. Ann Pak Inst Med Sci 2005;1:194-5.
Sharma PN, Bang RL, Al-Fadhli AN, Sharma P, Bang S, Ghoneim IE. Paediatric burns in Kuwait: Incidence, causes and mortality. Burns 2006;32:104-11.
Kaczorowski J, Del Grande C, Nadeau-Grenier V. Community-based programs to improve prevention and management of hypertension: Recent Canadian experiences, challenges, and opportunities. Can J Cardiol 2013;29:571-8.
Bongard FS, Ostrow LB, Sacks ST, McGuire A, Trunkey DD. Report from the California Burn Registry – The causes of major burns. West J Med 1985;142:653-6.
Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, et al.
Children with burn injuries – Assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011;3:98-110.
Türegün M, Sengezer M, Selmanpakoglu N, Celiköz B, Nisanci M. The last 10 years in a burn centre in Ankara, Turkey: An analysis of 5264 cases. Burns 1997;23:584-90.
Maghsoudi H, Pourzand A, Azarmir G. Etiology and outcome of burns in Tabriz, Iran. An analysis of 2963 cases. Scand J Surg 2005;94:77-81.
Rossignol AM, Locke JA, Boyle CM, Burke JF. Epidemiology of work-related burn injuries in Massachusetts requiring hospitalization. J Trauma 1986;26:1097-101.
Muqim R, Zareen M, Dilbag, Hayat M, Khan I. Epidemiology and outcome of burns at Khyber Teaching Hospital Peshawar. Pak J Med Sci 2007;23:420.
Khan AA, Rawlins J, Shenton AF, Sharpe DT. The Bradford Burn Study: The epidemiology of burns presenting to an inner city emergency department. Emerg Med J 2007;24:564-6.
Clouatre E, Gomez M, Banfield JM, Jeschke MG. Work-related burn injuries in Ontario, Canada: A follow-up 10-year retrospective study. Burns 2013;39:1091-5.
Kica J, Rosenman KD. Multisource surveillance system for work-related burns. J Occup Environ Med 2012;54:642-7.
Peck MD, Kruger GE, Merwe A, Godakumbura W, Ahuja RB. Burns and Fires from Flammable Non-electric Domestic Appliances. Available from: http://www.worldburn.org
. [Last accessed on 2016 Oct 23].
Dempsey MP, Orr DJ. Are paediatric burns more common in asylum seekers? An analysis of paediatric burn admissions. Burns 2006;32:242-5.
Rawlins JM, Khan AA, Shenton AF, Sharpe DT. Epidemiology and outcome analysis of 208 children with burns attending an emergency department. Pediatr Emerg Care 2007;23:289-93.
Dedovic Z, Brychta P, Koupilová I, Suchánek I. Epidemiology of childhood burns at the Burn Centre in Brno, Czech Republic. Burns 1996;22:125-9.
Locke JA, Rossignol AM, Burke JF. Socioeconomic factors and the incidence of hospitalized burn injuries in New England counties, USA. Burns 1990;16:273-7.
Fadeyibi IO, Mustapha IA, Ibrahim NA, Faduyile FI, Faboya MO, Jewo PI, et al.
Characteristics of paediatric burns seen at a tertiary centre in a low income country: A five year (2004-2008) study. Burns 2011;37:528-34.
Forjuoh SN. Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment, and prevention. Burns 2006;32:529-37.
Elísdóttir R, Lúdvígsson P, Einarsson O, Thorgrímsson S, Haraldsson A. Paediatric burns in Iceland. Hospital admissions 1982-1995, a populations based study. Burns 1999;25:149-51.
Mercier C, Blond MH. Epidemiological survey of childhood burn injuries in France. Burns 1996;22:29-34.
Eadie PA, Williams R, Dickson WA. Thirty-five years of paediatric scalds: Are lessons being learned? Br J Plast Surg 1995;48:103-5.
Klasen HJ, ten Duis HJ. Changing patterns in the causes of scalds in young Dutch children. Burns Incl Therm Inj 1986;12:563-6.
[Table 1], [Table 2], [Table 3]