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ORIGINAL ARTICLE
Year : 2020  |  Volume : 28  |  Issue : 1  |  Page : 29-35

Prevalence and profile of persons with burn injuries in rural field practice area of Rajarajeswari Medical College and Hospital, Bengaluru


1 Assistant Professor, Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bengaluru, India
2 Department of Community Medicine, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

Date of Submission04-Feb-2020
Date of Decision29-Jul-2020
Date of Acceptance22-Aug-2020
Date of Web Publication21-May-2021

Correspondence Address:
Dr. Aishwarya Subramanian
#8, 2nd Main, 2nd Cross, 2nd Stage, MSH Layout, Anand Nagar, Bengaluru - 560 024, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_6_20

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  Abstract 


Background: Burn injury is one of the common medical emergencies admitted to any hospital and is an important public health problem globally. Although most burn injuries are preventable, the general lack of safety consciousness, lack of knowledge on first aid measures, compounded by the absence of organized burn care at primary and secondary health-care level, hinder the curbing of this preventable problem.
Objectives: (a) To estimate the prevalence of burn injuries in the rural field practice area of RajaRajeswari Medical College and (b) To determine the sociodemographic profile of burn injury victims and describe the burn injuries in the rural field practice area of RajaRajeswari Medical College.
Subjects and Methods: A community-based cross-sectional study was carried out among 1220 randomly selected participants in the rural area using a semi-structured, pretested questionnaire. Data were analyzed adopting descriptive statistics, univariate and multivariate statistical techniques using the Statistical Package for the Social Sciences version 22.
Results: The prevalence of burn injuries was found to be 9.5% in the present study. Logistic regression analysis showed that various sociodemographic characteristics of participants such as age, type of family, educational status, and socioeconomic status had a statistically significant association with burn injuries.
Conclusion: The prevalence of burn injuries was 9.5% among the study participants. There existed a statistically significant association between burn injuries and various sociodemographic determinants.

Keywords: Bengaluru, burn injuries, prevalence, rural field practice area


How to cite this article:
Subramanian A, Manjunatha S. Prevalence and profile of persons with burn injuries in rural field practice area of Rajarajeswari Medical College and Hospital, Bengaluru. Indian J Burns 2020;28:29-35

How to cite this URL:
Subramanian A, Manjunatha S. Prevalence and profile of persons with burn injuries in rural field practice area of Rajarajeswari Medical College and Hospital, Bengaluru. Indian J Burns [serial online] 2020 [cited 2021 Dec 5];28:29-35. Available from: https://www.ijburns.com/text.asp?2020/28/1/29/316581




  Introduction Top


Burn injuries are a global public health problem, accounting for an estimated 265,000 deaths annually majority of which occur in low- and middle-income countries as preventive measures and care of victims are yet to improve.[1]

In India, burn injuries continue to remain a challenging problem due to lack of infrastructure and trained professionals, increased cost of treatment, psychosocial trauma to patients as well as the stigma attached to the deformities, all of which have an impact on the outcome. Every year around 7 million people sustain burn injuries and 2 million among them succumb to it.[2]

The Government of India approved the “National Programme for Prevention, Management, and Rehabilitation of Burn Injuries (NPPMRBI)” is an initiative to strengthen the preventive, curative, and rehabilitative services for burn victims.[3]


  Aims And Objectives Top


As most of the research till date on epidemiological profile of burn injuries are hospital based, the present community-based study was taken up (a) to estimate the prevalence of burn injuries and (b) to determine the sociodemographic profile of burn injury victims and describe the burn injuries in the rural field practice area of RajaRajeswari Medical College and Hospital.


  Subjects and Methods Top


A community-based, cross-sectional study was conducted in the rural field practice area of RajaRajeswari Medical College and Hospital, Bangalore, from January 2016 to January 2017.

The sample size was calculated based on a study conducted by Bhardwaj and Sinha using the prevalence of burn injuries in the community as 8.4%, considering an allowable error of 19% and confidence interval of 95%.[4] The total sample of 1220 population was studied using Simple Random Sampling technique with the help of Microsoft Excel to generate random numbers.

After procuring Ethical clearance from institutional ethical committee, the data were obtained by the interview method using a semi-structured and pretested questionnaire. For children <7 years, parents or caregivers were interviewed. Persons residing in the rural field practice area for the past 6 months and who consented to participate were included in the study. Those who were not present during the study period despite three repeated visits to their households were excluded from the study.

The term burn injury was defined as a body lesion due to an external cause, either intentional (alleged homicidal or suicidal) or unintentional (accidental) resulting from sudden exposure to energy (mechanical, chemical, electrical, thermal, or radiant) generated by agent host interaction.[5]

The questionnaire included sociodemographic details of the study participants and details of burn injuries. Participants found to have moderate-to-severe burn injuries were referred to RajaRajeswari Medical College and Hospital for professional care.

The data were entered into a Microsoft Excel and analyzed using the Statistical Package for the Social Sciences software version 22.0 (SPSS- Manufacturer - IBM (International Business Machines Cooperation), Armonk, New York, United States). Descriptive statistics and suitable tests of significance like Chi-square test were used as required. Univariate analysis and multivariate analysis was carried out for variables associated with burn injuries.


  Results Top


Among the 1220 participants, 116 (9.5%) were victims of burn injury in the past 6 months. Therefore, the prevalence of burn injuries was 9.5%. There were equal numbers of male and female victims. As depicted in [Figure ]1, majority of the burn injuries 96 (83%) occurred at home, mostly in the kitchen while cooking. More number of females 53 (55.2%) sustained injuries at home than males 43 (44.8%), but for burn injuries occurring in workplace, there were more males 12 (66.6%) than females 6 (33.4%). Only 2% of injuries occurred in a public place, i.e., school and both victims were male children.
Figure 1: Distribution of burn injury victims according to place where injury occurred

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The cause of burn injury was accidental for all victims, i.e., there were no cases of homicidal or suicidal burns.

The mode of injury was flame burns for most of the victims 100 (86%) [Figure 2].
Figure 2: Distribution of burn injury victims according to mode of injury

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[Table 1] shows that out of 116 burn injury victims, 63 (54.3%) belonged to the most productive age group (20–59 years). Thirty-one (26.7%) victims were elderly, 11 (9.5%) were under 5 years and 4 (3.4%) were adolescents. This was found to be statistically significant (P < 0.001).
Table 1: Association between age and burn injuries

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The association between gender and burn injuries was not statistically significant [Table 2].
Table 2: Association between gender and burn injuries

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Majority of the burn injury victims were Hindus 110 (94.8%), and this was statistically significant (P = 0.002) [Table 3].
Table 3: Association between religion and burn injuries

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Burn injuries were more among persons living in nuclear families 55 (47.4%) than those living in joint families 46 (39.7%) or three-generation families 15 (12.9%), and this was statistically significant (P < 0.001) [Table 4].
Table 4: Association between type of family and burn injuries

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Majority of victims 42 (36.2%) were illiterate and only 4 (3.4%) were graduates. This was statistically significant (P < 0.001) [Table 5].
Table 5: Association between educational status and burn injuries

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Homemakers sustained maximum burn injuries 33 (28.4%), followed by those with agriculture as their occupation 24 (24.1%). This was statistically significant (P < 0.001) [Table 6].
Table 6: Association between occupation and burn injuries

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[Table 7] shows that the majority of the burn injury victims belonged to lower middle class 84 (72.4%) and the association was statistically significant (P < 0.001).
Table 7: Association between socioeconomic status and burn injuries

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A one-way MANOVA revealed a significant multivariate main effect for Burn Injury, Wilks” λ λ = 0.924, F (6, 1213) = 16.57, P < 0.0005. The power to detect the effect was 1.0.

Given the significance of the overall test, the univariate main effects were examined. Significant univariate main effects for Burn Injury were obtained for Religion F = 9.988, P < 0.05, power = 0.885; and type of family F = 41.279, P < 0.05, power = 1.0; and Education F = 17.847, P < 0.05, power = 0.987; and socioeconomic status F = 21.461, P < 0.05, power = 0.996.

Multivariate analysis revealed that religion, type of family, education, socio economic status were statistically significant with P < 0.005 [Table 8].
Table 8: Multivariate analysis for associated variables with burn injuries

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Most of the victims used some form of home remedy as first aid 59 (50.8%). This was followed by the application of ointment 21 (18.1%) and pouring running water 20 (17.2%), which is the recommended first aid [Figure 3].
Figure 3: First Aid followed by burn injury victims

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Ointment application was the most common treatment taken for burns 60 (52%) followed by home remedies 42 (36%) and hospital care with medications and dressing 14 (12%) [Figure 4].
Figure 4: Distribution of burn victims according to the treatment taken

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All those resorting to home remedies had <2% body surface area (BSA) burnt. For the victims resorting to hospital care, the BSA burnt ranged from 2.5% to 19%.

[Figure 5] shows that 96 (83%) of the injuries resulted in burns covering 1% BSA. Five (4%) had injuries covering 18% BSA.
Figure 5: Distribution of victims with burn injuries based on body surface area burnt

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Most of the burns, 94 (81%) were superficial thickness injuries. Twenty (17%) were partial-thickness injuries and 2 (2%) were full-thickness burns. One of the full-thickness burns involved 18% BSA and resulted in residual functional disability. The other full-thickness burns, however, resulted in the death of the victim [Figure 6]. Most 114 (98%) of the victims got completely cured. One victim had a residual functional disability due to strictures and one victim died due to electrocution.
Figure 6: Distribution of burn injury victims based on depth of burns

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The majority of burn injury victims 96 (83%) did not incur any expenditure due to their injuries as they followed home remedies. Eighteen (15%) incurred some expenditure for their treatment for the dressings and medications. Two victims had to take loans for treatment as they suffered burns with >10% BSA involvement, which required prolonged therapy.


  Discussion Top


The prevalence of burn injuries in this study was 9.5%. This was similar to a community-based study by Bhardwaj and Sinha in Bhopal, which showed a prevalence of 8.4% burn injuries and differed from a study conducted in a slum community of Delhi, which had a higher prevalence of 14.25%.[4]

Most of the burn victims 63 (54.3%) belonged to the productive age group (20–59 years) as per this study, and there was a statistically significant association between age and burn injury. This was in accordance with a study by Bhardwaj and Sinha in Bhopal, where the majority (22.7%) of the burn cases were between 31 and 40 years of age.[4] The study by Arun showed the highest incidence of burns in young adults 21–30 years of age.[6]

A study conducted by Lal et al. in the Delhi slum community showed that the majority (43.8%) of the victims were <15 years.[7]

There were equal number 58(50%) of male and female victims in this study, whereas in studies conducted by Lal et al. and Sudhir et al., burn injuries were found to be more common in females 54.4% and 68.2% respectively.[7],[8] A study conducted in Ghana revealed more number of male burn victims 54%.[9]

This study revealed that 55 (47.4%) burn injuries occurred among persons living in nuclear families. This was similar to studies conducted by Gowri et al. 47.37% and Hema and Dilli Babu 55% respectively, where many of the burn victims were from nuclear families.[10],[11]

The present study showed that 42 (36.2%) of the burn victims were illiterate. The findings of this study were similar to those of Dahal and Paudel and Haralkar SJ et al., where it was observed that more number of victims were illiterate.[12],[13] This, however, was in contrast to the study by Pravin et al., where it was seen that the maximum number of victims were educated though only up to primary school level.[14]

As per the current study, homemakers sustained maximum burn injuries 33 (28.4%), followed by 24 (24.1%) among agriculturers. This finding was in accordance with the observations of Pravin et al. and Arun but differed from a study conducted by Bhardwaj et al. in which most of the burn victims were unskilled workers (37.3%).[4],[6],[14]

Majority of the burn injury victims belonged to lower middle class 84 (72.4%) followed by lower class 19 (16.4%), in the current study, which was similar to the finding of Sumit et al. Studies conducted by Hemalatha et al. and Hema and Dilli Babu showed more number of victims belonging to the middle class.[4],[10],[15]

In the current study majority of the burn injuries, 96 (83%) occurred at home among females while cooking. This was in accordance with studies conducted by Pravin et al. and Gowri et al.[10],[14] Study of burn injuries in a slum community revealed that most of the victims, 89.5% had sustained burns at home, and 61% were female.

In the current study, the mode of injury was flame burns for most of the victims 100 (86%). This was followed by scalding 11 (9%), electrical burns 3 (3%), and chemical burns 2 (2%).

In a study done by Ashok K et al., 72% sustained flame burns, 7% sustained scald burns, 17% sustained electrical burns, and 4% sustained chemical burns. The study by Gowri et al., flame injuries contributed to 92.5% of burns in females. Another study conducted in Ghana revealed 46.2% of burn injuries were due to scalding followed by open fire 45.4%, chemical 3.5%, and electricity 2.7%.[8]

In this study, the cause of burns was accidental for all victims, whereas in the study by Gowri et al., the majority (81.59%) were accidental injuries followed by 15.79% suicidal and 2.63% homicidal. The studies by Pravin et al. and Arun also showed similar findings.[6],[10],[14]

In this study, most of the victims used some form of home remedy as first aid measure 59 (50.8%), followed by application of ointment 21 (18.1%) and pouring running water 20 (17.2%). In a study conducted by Sonavane, it was observed that for first aid of burns, the majority of the subjects used to cut potato (57.1%), castor oil, or egg white.[16] Lal P et al. observed in their study that home remedies were used in isolation or along with medical care in 73.7% of cases.[7]

It was seen that 96 (83%) of the injuries resulted in burns covering 1% BSA. The current finding differed from studies where more victims had higher BSA burnt. In a study conducted in Ghana, it was found that the highest mean % TBSA was 35.07%.[8] In a study conducted by Gowri et al., the majority of the females had more than 50% total burn surface area, whereas the maximum number of males had less than 20% total burn surface area.[10] In a study conducted in Nagpur, burns with more than 40% TBSA were more common in females (65%).

Most of the burns, 94 (81%) were superficial thickness injuries, 20 (17%) were partial-thickness injuries, and 2 (2%) were full-thickness burns in the current study. This differed from the study by Pravin et al., where it was observed that maximum cases sustained dermo-epidermal burns, and most of them were Dupuytre's fifth degree with TBSA of 48%.[14]

In this study, most of the victims 114 (98%), got completely cured as the severity of injury (depth and BSA burnt) was minimal. This differed from studies conducted by Pravin et al. and Sheena Weaver et al., who observed higher morbidity and mortality in their respective studies.[14],[17]


  Conclusion Top


The prevalence of burn injuries was found to be 9.5%. Most of the burn injuries 83% occurred at home. Burn injuries were associated with age, type of family, educational status, occupation, and socioeconomic status. Home remedies were used as first aid by 52% of the victims.

Therefore, the strategies in the NPPMRBI can help in empowering primary health-care centers and communities to bring down the morbidity and mortality due to burns.

Acknowledgment

The author would like to thank the Institution, Rajarajeswari Medical College and Hospital, for giving me the opportunity and logistic support for conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Lal P, Rahi M, Ingle GK. Epidemiological study of burn injuries in a slum community of Delhi. Indian J Community Med 2006;31:96-7. Available from: http://medind.nic.in/iaj/t06/i2/iajt06i2p96.pdf. [Last accessed on 2017 Feb 07].  Back to cited text no. 7
    
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Agbenorku P, Aboah K, Akpaloo J, Amankwa R, Farhat B, Turkson E, et al. Epidemiological studies of burn patients in a burn center in Ghana: any clues for prevention? (2016). Burns & trauma, 4, 21. https://doi.org/10.1186/s41038-016-0041-0.  Back to cited text no. 8
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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