|Year : 2012 | Volume
| Issue : 1 | Page : 66-67
An epidemiological survey of burn injuries in rural area, Bhopal: A cross sectional study
Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital and VMMC, New Delhi, India
|Date of Web Publication||13-May-2013|
Department of Burns, Plastic and Maxillofacial Surgery, Safdarjang Hospital and VMMC, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Agrawal K. An epidemiological survey of burn injuries in rural area, Bhopal: A cross sectional study. Indian J Burns 2012;20:66-7
The study from Chirayu Medical College, Bhopal is one of the few community based epidemiological studies on burns.  To the best of my knowledge this is the first of its kind from India and hence it is commendable. This type of study is difficult to conduct and interpret. However, the authors have made a good attempt to study the epidemiology of burns in rural population in a block. The methodology is based on an interview recalling the incidence of all types of burns amongst the family members over past six months. The authors have analyzed the data and concluded that the incidence of burn injury is 8.4% in the sample rural population. If we extrapolate these numbers to the entire 1.22 billion Indian population, the number of burn patients in six months period will be 100.8 million and it will be more than 200 million in a one year period.
Gupta JL (2010) extrapolated the hospital based burn patients' statistics and presumed that approximately seven million people sustain burn in India every year. As per a rough estimate, 700,000 patients require admission (10%). Half of the hospital burn patients succumb to the injury.  This was based on hospital admissions in some of the large hospitals across India. In fact, majority of burns in India do not report to hospitals. Seventy percent of Indian population lives in villages and rural areas. They do not have access to hospitals. Almost all minor burns do not report to the hospitals. Many major burns are treated in places other than recognized burn hospitals and quite a few by unqualified persons and hence, remain unreported. Only a section of the patients with major and moderate burns report to hospitals for treatment and are reflected in the hospital statistics. The patients who report to the hospitals form only the tip of the iceberg. Hence, it is imperative that true epidemiology is assessed only by community based study. The authors have made a small beginning by surveying a population of 3,677 persons. However, this may not be true representation of Indian population. The sample size is too small for an epidemiological study. Hence, our extrapolation to 200 million burn cases per year may be too high. I do believe that the number of burns in India is multifold higher than that in the USA. However, we need to conduct more such studies in different regions of the country incorporating both rural and urban areas before drawing such conclusions.
The epidemiology of burns in most countries is not reliable as many of the minor burns are not recorded as discussed earlier. The statistics presented by the American Burn Association in 2007 suggests that annually 500,000 people receive burn injuries in the USA, out of which 40,000 people require hospitalization and 4,000 persons (0.8% of total burn injury cases) die annually due to burns. 
The mortality rate in the present study is 0.64% out of burn injury patients in the population studied over six months period. If we extrapolate this to 200 million burn victims, the annual deaths due to burn will be 1.28 million which again is a falsely high number. 
In contrast to the developed world, the burn load in developing countries is many folds higher. As per the report of the Indian National Crime Records Bureau of 2007, out of 340,794 total accidental deaths, 20,772 (6.2%) were due to fire accidents. Fire (6.1%), electrocution (2.4%) and explosion (0.2%) were the main causative factors. Apart from these accidental fire victims there were 10,391 (8.5%) deaths classified as suicidal burn deaths out of a total of 122,637 suicidal deaths. The mortality due to burn injuries was reported as 3.5/100,000 population. 
For Indian population of 1.22 billion, the sample size will be too big to carry out such a study. Most of the published epidemiological studies on the incidence of burn are either hospital based or extrapolated from the available data from other countries which fail to give us the true incidence. Burn is a special type of trauma which is dependent on many factors like the habits of the community, the culture of the society, the socioeconomic status of the people, religious beliefs, environmental conditions and the psychological behavior of the population. All these factors feature in causation of burns in India. Fire is an integral part of Indian lifestyle. Fire is used in different forms during daily chores. Be it morning worship, cooking, lighting and festivities, everything revolves around fire. Hence, it is likely that the Indian community is more prone to the occurrence of burns. Understandably, the burn is more prevalent in people of lower socioeconomic status. Electricity is unsafe in many of our houses and establishments, cooking gas is prone to accidents, chemicals that can cause accidental burns are easily available, fire crackers being a part of all our festivities and many more issues favor the occurrence of burns in India. On the other hand, in the developed countries, individuals do not come in contact with fire very often. The closest they come to fire is while lighting candles for worshiping in the church. The presence of smoke detectors prevents use of fire at home, as well as at the work place.
The very high incidence of burn injuries in the population studied might be because of the selection bias or recall bias or cultural and religious beliefs of the population. Hence, the result of this study needs to be corroborated by a well designed epidemiological study with proper sampling from all over the country, representative of rural and urban population, mixture of all religions and from different terrains. Such a sample will be representative of the Indian population. Study of this sample population though a herculean task, is the only way ahead. We should plan a multi-investigator epidemiological survey of burns in India in the near future to address this very important issue.
| References|| |
|1.||Bhardwaj SD, Sinha U. An epidemiological survey of burn injuries in rural area, Bhopal: A cross sectional study. Indian J Burns 2013;[In Press]. |
|2.||Gupta JL, Makhija LK, Bajaj SP. National programme for prevention of burn injuries. Indian J Plast Surg 2010;43:S6-S10. |
|3.||A WHO plan for burn prevention and care. Geneva, Switzerland: 2008. p. 3-6. Available from: http://whqlibdoc.who.int/publications/2008/9789241596299_eng.pdf. Accessed on 11.02.2013 |
|4.||National Crime Records Bureau. Accidental deaths and suicides in India. Ministry of Home Affairs. New Delhi: Government of India; 2007. |