|Year : 2018 | Volume
| Issue : 1 | Page : 24-28
Correlation of burn injury and family history of burns among patients hospitalized at a public hospital in Nairobi, Kenya: A case–control study
Joseph Kimani Wanjeri1, Mary Kinoti2, Tom H. A. M. Olewe2
1 Department of Surgery, University of Nairobi, Nairobi, Kenya
2 Thematic Unit of Disease Prevention, Control and Health Promotion, School of Public Health, University of Nairobi, Nairobi, Kenya
|Date of Web Publication||11-Mar-2019|
Dr. Joseph Kimani Wanjeri
Department of Surgery, University of Nairobi, P.O. Box 19676 KNH, Nairobi 00202
Source of Support: None, Conflict of Interest: None
Introduction: Burn injuries are physically and psychologically devastating types of trauma and are common among children especially in the home environment. They are more prevalent and are a public health problem in developing countries principally because of poor socioeconomic conditions. Effective prevention programs should be tailored for specific geographic locations and guided by the results of well-designed studies aimed at investigating local risk factors for burns. Studies targeting households can result in the identification of risk factors operating within family setups.
Study Objective: To determine the association between occurrence of burn injury and family history of burns among patients hospitalized at a large hospital in a developing country in Africa.
Methodology: This was age- and gender-matched case–control study comprising 202 patients admitted with burns (cases) and 202 nonsurgical patients (controls) admitted into the pediatric and medical wards. The study site was Kenyatta National Hospital, an 1800-bed national referral and teaching hospital in Kenya. The dependent variable was burn injury whereas the independent variables were family history of burn injury, history of hospitalization, and presence of a burn injury scar in the burnt family member. History of hospitalization following burn injury was termed as an indicator of severe burn injury having been sustained.
Data Analytical Methods: The Chi-square test was used to identify the differences between the cases and control group variables, and logistic regression analysis and odds ratio were done to determine the relationship between the dependent and independent variables.
Results: The male:female ratio was found to be 1:1, and burn injuries were found to be most common in the 0–4 years age bracket (n = 86, 42.6%), with the second most common age bracket being 20–40 years (n = 78, 38.6%). The injuries were mainly sustained in homes (n = 161, 80.9%) and the remainder at work (n = 15, 7.5%) and other places (n = 23, 11.6%). There was no significant difference between the two groups with regard to family history of burns (odds ratio [OR] = 0.689, 95% confidence interval [CI]: 0.443–1.073, P = 0.062) and presence of a burn scar in previously burnt family members (OR = 1.083, 95% CI: 0.308–3.805, P = 1.0). There was, however, a statistically significant higher incidence of postburn injury hospitalizations among the cases than the controls (OR = 2.354, 95% CI: 1.064–5.208, P = 0.033).
Conclusion: Family history of burn injury with hospitalization of those affected is an indicator of households at a higher risk for burn injuries. More of the cases had history of hospitalization for burn injury among their family members, indicating that they had more risk factors operating within their environment, or their practices made them more prone to burn injuries. Identification of the specific risk factors involved is key in the prevention of burn injuries in homes.
Keywords: Burn injury, burns, family history, hospitalization, scar
|How to cite this article:|
Wanjeri JK, Kinoti M, Olewe TH. Correlation of burn injury and family history of burns among patients hospitalized at a public hospital in Nairobi, Kenya: A case–control study. Indian J Burns 2018;26:24-8
|How to cite this URL:|
Wanjeri JK, Kinoti M, Olewe TH. Correlation of burn injury and family history of burns among patients hospitalized at a public hospital in Nairobi, Kenya: A case–control study. Indian J Burns [serial online] 2018 [cited 2019 Nov 21];26:24-8. Available from: http://www.ijburns.com/text.asp?2018/26/1/24/253860
| Introduction|| |
Burns are tissue injuries resulting from direct contact with flames, hot fluids, gases, or surfaces; caustic chemicals; electricity; or radiation. Internal burn injuries can also result from smoke inhalation; however, the skin is the tissue most commonly injured.,, Most burns are caused by wet (hot fluids and steam) or dry heat (e.g., hot surfaces/objects, ashes) and flames. Burns caused by hot fluids (scalds) are most frequent in children whereas flame burns occur more frequently in adults.,, Poverty and poor housing are known to be risk factors worldwide; however, every country has unique risk factors due to varied cultures and circumstances.,,,
In the United States, burn injuries are the fourth leading cause of unintentional injury death, accounting for 3% of all injury deaths, and in developing countries, burns are a public health issue and a major cause of injury morbidities, disabilities, and deaths., With more than 300,000 people dying from flame burns every year and many more dying as a result of scalds, electrical and chemical burns, the World Health Organization (WHO) has recognized these injuries as a serious public health problem worldwide. Over 90% of burns are avoidable and 95% of burn deaths are preventable and occur in low- and middle-income countries. Many survivors of burns are permanently disabled or disfigured, suffer from adverse psychological effects, and are oftentimes stigmatized or discriminated against.,,,,, Studies have recommended that prevention programs, such as public education on injury prevention including improved fire safety practices in homes, offices, institutions, and industries, can result in the prevention of many injuries including burns. Fewer burn cases translate into less morbidity and mortality, as well as huge savings in health expenditure by government hospitals. In the developed world, the incidence of burn injuries has been reduced through prevention strategies including the development of surveillance systems, legislation, social marketing, and advocacy.
The aim of this study was to determine if the families of burn injury patients hospitalized at a public hospital in Kenya were more susceptible to sustaining burn injuries compared to those of an age and gender-matched control group. In this journal article, the term 'burn injury' has been used synonymously with the word 'burn'.
| Methodology|| |
This was a case–control study whereby the cases were burn injury patients, and the controls were age- and gender-matched patients without any injury (including burn injury) admitted into pediatric and medical wards of the Kenyatta National Hospital (KNH), a 1800-bed public hospital in Nairobi, Kenya.
The dependent (outcome) variable was the presence of burns, and the independent (predictor variables) were history of a family member having sustained a burn and whether or not they healed with a scar and whether or not they were hospitalized.
A consecutive nonrandom sampling method was used to select 202 cases for the study from among patients admitted with burn injuries in the KNH burn wards. Consecutive nonrandom sampling was also used to select 202 age- and gender individually matched controls from among patients admitted to any of the eight medical and four pediatric wards of the hospital. The age matching was within ± 2 years and all study participants were recruited after informed consent was given either directly or through proxy.
All study participants had to be able to talk or there had to be a person (respondent) present to answer questions on their behalf. Informed consent was given by the patient or a guardian/caregiver/accompanying person in the case of minors (children aged <18 years) or difficulties in communication. The data collection instrument for both the cases and controls was a pretested questionnaire, and SPSS version 17.0 (Chicago: SPSS Inc.) was used for analysis, with tables, and charts being used to present the data. The exposure distribution among the cases was compared with the exposure distribution in the control subjects.
Pearson Chi-square analysis was used in the comparison of the two groups, and logistic regression and odds ratios were used to determine the relationship between the predictor (family history of burns, scarring, and hospitalization) and outcome variables (burn injuries). The confidence limit was 95% and level of significance 0.05 in all the analyses.
| Results|| |
A total of 404 study participants, half of whom (n = 202) were burn cases, the other half (n = 202) being controls, were interviewed.
The number of males and females were 106 and 96, respectively, for both cases and controls, giving a male-to-female ratio of 1.1:1. The age distribution for cases and controls was similar, due to age matching. The age range was 0.1–58 years, the mean was 15 years, the median age was 11 (10–14 years age group) and the modal category was the 0–4 years age group. The age group most affected by burn injuries, therefore, was 0–4 years (n = 86, 42.6%) followed by 25–29 years (n = 23, 11.4%), 20–24 years (n = 22, 10.9%), and 30–34 (n = 21, 10.4%) [Figure 1]. More males than females sustained burn injuries up to the age of 4 years, most probably because boys tend to be more active, but thereafter up to the age of 24 years, there were more females than males, as a result of their spending more time cooking in homes where most burn injuries occurred.
|Figure 1: Frequencies for the different age categories for both cases and controls|
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Site/place and causes of burn injuries for cases
The home environment was where the majority (n = 161, 80.9%) sustained burn injuries, followed by the work place (n = 15, 7.5%), and only one person (n = 1, 0.5%) sustained a burn in a motor vehicle, and the remainder (n = 22, 11.1%) sustained burn injuries in other places, for example, neighbor's/friend's house or the roadside [Table 1].
|Table 1: Site where the affected individual sustained the burn injury (n=199)|
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The major causes of burns were hot fluids (n = 93, 46.3%), followed by flame/fire (n = 81, 40.3%). whereas electricity, chemicals, and other substances contributed 6.5% (n = 13, 6.5%), 1.5% (n = 3, 1.5%), and 5.5% (n = 11, 5.5%), respectively.
Twenty-five (n = 25, 12.4%) of all burns were associated with exploding cooking stoves, and eight (n = 8, 3%) were caused by exploding wick lamps. In the hot fluids category, tea and water were the most common causes of burn injuries (n = 74, 79.6%) while in the electrical burns category, exposed electrical wires were responsible for 46.2% of the electrical injuries (n = 6, 46.2%).
History of burn injuries within families
More of the cases (n = 62, 30.7%) had either sustained a previous burn themselves or recalled a relative having sustained a burn previously, as compared to the controls (n = 47, 23.4%). This was an indication that there could be more risk factors for burn injury in the environment in which the cases resided [Table 2]. The difference was, however, found not to be statistically significant after Chi-square (P = 0.099) and logistic regression analysis (OR = 0.689, 95% CI: 0.443-1.073, P = 0.062).
Postburn injury scarring within families
The presence of a scar in previously burnt family members was the other independent variable investigated to determine whether or not there was a difference between the two groups [Table 2]. The assumption (null hypothesis) was that there was no difference between the two groups in this regard, and this was statistically proven (odds ratio [OR] = 1.083, 95% confidence interval [CI]: 0.308–3.805, P = 0.901). The null hypothesis was therefore not rejected, which means that the presence of burn scars within the family is not a predictor for burn injury.
Hospitalization for burn injuries within families
Forty-one of the cases (n = 41, 68.3%) had a family history of burn injury hospitalization, whereas only 19 (n = 19, 31.7%) said there was no history of hospitalization of family members as a result of burns. The numbers for family history of hospitalization and nonhospitalization for the controls were 22 (n = 22, 47.8%) and 24 (n = 24, 52.2%), respectively [Figure 2]. Assuming that hospitalization is an indication of the burn injury having been severe, the cases, therefore, were at a higher risk of sustaining severe burn injuries (OR = 2.354, 95% CI: 1.064–5.208, P = 0.033).
With regard to the history of hospitalization, the odds ratio of 2.354 means that the likelihood of having a family history of hospitalization from a burn injury was about 2.4 times more among cases, as compared to the controls. The other inference from this result is that there is a greater risk of sustaining a burn injury if someone in the family had previously been hospitalized with a burn [Table 3]. History of hospitalization for burns within the family is therefore a predictor for occurrence of burn injury.
|Table 3: History of hospitalization of burn injury patients among both the cases and controls|
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| Discussion|| |
Burn injury prevention campaigns should be guided by results of studies aimed at identifying risk factors or indicators for susceptibility to burn injuries. This case-control study sought to identify family medical history indicators for likelihood of sustaining burn injury. Several studies on risk factors for burn injuries have been undertaken but there is paucity of studies on indicators for likelihood of sustaining burns. In a community based study done in Ghana, Forjuoh, S.N. (1996) looked at previous patient history of burns as an indicator for likelihood of burn injury but we could not find any studies specifically targeting family history of burns as an indicator for burns.,,
The cases had 62 (n = 62, 30.7%) family members with a history of burn injuries compared to 47 (n = 47, 23.4%) in the control group. The difference was not found to be statistically significant after Chi-square and logistic regression analysis (OR = 0.689, 9 5% CI: 0.443–1.073, P = 0.062). Previous family history of burn injury per se was therefore not found to be an indicator of a high likelihood of a burn injury occurring within a family.
Admission to hospital of the family member involved and postburn scarring was used as parameters for judging the severity of burn injury. More of the cases had relatives who had been hospitalized after sustaining burn injuries (odds ratio 2.354), and the association was confirmed after logistic regression was done (P = 0.033). History of hospitalization of a previously burnt family member was therefore an indicator of a higher probability of another household member sustaining burns. This can be explained by the fact that all household members are subject to the same injury risk factors, and particularly, the children, whose cognitive ability is low. There was, however, no association between the presence of postburn scarring within families and occurrence of burn injuries (OR = 1.083, 95% CI; 0.308–3.805, P = 0.901). In his Ghanaian community-based study involving 630 children, Forjuoh found only 20 (3.2%) had sustained burns twice, in contrast to this hospital-based study, whereby we found that 110 (27.2%) out of 404 had either sustained burns before or had relatives who had experienced a burn injury.
In high-income countries, burn injuries have been reduced by, among other measures, legislation which regulated the temperature of water from bathroom taps and use of fire retardant material for night attire. In Australia and New Zealand, burn injuries have been reduced through a program whereby firemen give fire injury prevention lectures in schools. In Sri Lanka, a surgeon helped reduce incidence of burn injuries through a collaboration which resulted in the design of a safer kerosene wick lamp with a base designed to make it topple over less easily.
The WHO has recognized the magnitude of the problem and have produced a “Burn Injury Prevention Program” which should help most affected countries among the low- and middle-income countries to develop models most suitable for their environments. Countries should adopt or implement burn injury prevention strategies based on local research findings and with consideration of socioeconomic factors.,,, The results of this research should hopefully help poor socioeconomic countries develop strategies aimed at reducing the incidence of not only burns but all types of injuries, including road traffic accidents, which are a national healthcare priority.
| Conclusion|| |
Many burn injuries are preventable. History of hospitalization of a family member with burn injuries is an indicator of high risk for burn injury within a household.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Asuquo ME, Ekpo R, Ngim O. A prospective study of burns trauma in children in the University of Calabar Teaching Hospital, Calabar, South Nigeria. Burns 2009;35:433-6.
Klingensmith ME, Chen LE, Glasgow SC, Goers TA, Melby SJ. The Washington manual of surgery. Fifth edition. Philadelphia, PA: Lippincott Williams and Wilkins; 2008.
Kalayi GD. Burn injuries in Zaria: A one year prospective study. EAMJ 1994;71:317-22.
Liao C, Rossignol AM. Landmarks in burn prevention. Burns 2000;26:422-34.
Justin-Temu M, Rimoy G, Premji Z, Matemu G. Causes, magnitude and management of burns in under-fives in district hospitals in Dar es salaam, Tanzania. East African J Public Health 2008;5:38-42.
Bhansali CA, Gandhi G, Sahastrabudhe P, Panse N. Epidemiological study of burn injuries and its mortality risk factors in a tertiary care hospital. Indian J Burns [serial online] 2017;25:62-6. Available from: http://www.ijburns.com/text.asp?2017/25
. [Last cited 2018 Apr 26].
Goswami P, Singodia P, Sinha AK, Tudu T. Five-year epidemiological study of burn patients admitted in burns care unit, Tata Main Hospital, Jamshedpur, India. Indian J Burns 2016;24:41-6. [Full text]
Mashreky SR, Rahman A, Chowdhury SM, Svanstrom L, Linnan M, Shfinaz S, Uhaa IJ, Rahman F. Consequences of childhood burn: Findings from the largest community-based injury survey in Bangladesh. Burns 2008;34:912-8.
Torabian S, Saba MS. Epidemiology of paediatric burn injuries in Hamadan, Iran. Burns 2009;35:1147-51.
Lau YS. An insight into burns in a developing country: A Sri Lankan experience. Public Health 2006;120:958-65.
Mock C. WHO joins forces withn International Society for Burn Injuries to confront burden of burns. Inj Prev 2007;13:303.
Warda L, Tenenbien M, Moffat MEK. House fire prevention update. Part II. A review of the effectiveness of preventive interventions. Inj Prev 1999;5:217-25.
Forjuoh SN. Burn repetitions in Ghanaian children: prevalance, epidemiological characteristics and socio-environmental factors. Burns 1996;22:539-42.
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[Table 1], [Table 2], [Table 3]