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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 28  |  Issue : 1  |  Page : 51-56

Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia


Department of Emeregency and Critical Care, School of Nursing, Faculty of Health Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia

Date of Submission19-Oct-2019
Date of Decision22-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication21-May-2021

Correspondence Address:
Mr. Wegene Jemebere Biru
Woldeamanuel Dubale Street, Hawassa
Ethiopia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_28_19

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  Abstract 


Background: Burn-related harms are a substantial problem in children, predominantly in low- and middle-income countries, where over 90% of burn-related childhood deaths occur. The aim of this study was to determine the causes, magnitude, management, and outcome of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia.
Materials and Methods: A hospital-based retrospective cross-sectional study was conducted from 15 November to 20 December 2018 on a sample of 395 patient medical records who have been treated burn injury for 5 consecutive years from September 2013 to September 2018. Systematic random sampling was used to select the patient records, and a pretested structured checklist was organized to collect the data. Epi Info 3.5.4 was used for data entry and the Statistical Package for the Social Sciences version 20.0 for analysis.
Results: The majority (62.5%) of the burn injuries affected <5 children. The major cause of burn injury was scald (59.7%). Statistically, a significant association was found between the cause of burn and age of the patient (P = 0.000). The 5 years' prevalence of burn injury was 9.79%. Almost all burn injuries occur at home (97%) and accidental (94.2%), and more than half (56.7%) of the children suffered from the second-degree burn. Almost half (47.1%) burnt 10%–20% total body surface area, and 47.6% have got prehospital first aid interventions and 36.2% received surgical interventions. Almost two-thirds (74.4%) of the children recovered without complication. Six died and four of them were third-degree burn victims and <5 years old. There was a significant statistical association between treatment outcome and age of the patient (P = 0.004).
Conclusion: The epidemiology and outcome of burn injury among children were comparable to other developing countries, but the high magnitude was noticed. Public health education and prevention programs may help to reduce the prevalence of childhood burn injury.

Keywords: Burn injury, children, Ethiopia, prevalence


How to cite this article:
Biru WJ, Mekonnen FT. Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Indian J Burns 2020;28:51-6

How to cite this URL:
Biru WJ, Mekonnen FT. Epidemiology and outcome of childhood burn injury in Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Indian J Burns [serial online] 2020 [cited 2021 Dec 5];28:51-6. Available from: https://www.ijburns.com/text.asp?2020/28/1/51/316576




  Introduction Top


Burn injury is one of the usual and disturbing forms of trauma and a chief health problem of pediatric morbidity and mortality worldwide, resulting in substantial physical, psychological, and economic loss. Burn-related harms are a substantial problem in children, predominantly in low- and middle-income countries (LMICs), where over 90% of burn-related childhood deaths occur.[1]

In developing countries, burns may be predominantly severe because patient care requires skillful staff and medical expertise that are expensive and not accessible abundantly.[2]

In Africa, children under the age of 5 have almost 3 times the incidence of burn deaths than children worldwide. The burden of burn injury is highest among those children who live in poverty. In sub-Saharan Africa, it estimated that between 18,000 and 30,000 children under the age of 18 die annually because of burn-related injuries.[3]

Recently, burns have risen to be the main source of morbidity and mortality in LMICs ranking 4th among all injuries. It accounts for 1.1 per 100,000 of the worldwide problem of diseases and causes >265,000 deaths in developing countries annually.[3],[4]

Thermal burns are the usual type of burn injury in children under 4 years of age and are often associated with destructive consequences. The application of protective and safety practices averts such harm because the occurrence of burn events is largely preventable.[5]

Burn treatment is influenced by the severity of the burn, and superficial burns may be treated with pain medications, while deep burns may need extended treatment in specialized burn centers.

There are so many factors related to the outcome of burn injuries, such as preexisting medical conditions, the extent of burn injury, the cause of burn injury, management of burn injury, and depth of burn injury.

The most common complications of burns involve infection, tetanus, contractures, scar, and death. Since several burns that occur in children are accidental and preventable, there are still insufficient published data concerning the causes, magnitude, management, and outcome burn injury among children generally in Ethiopia and particularly in Hawassa. Therefore, a basic explanation of the epidemiology and outcome of children's burn injury would be of excellent advantage for the region.


  Materials and Methods Top


Study design, study periods, and study area

A hospital-based retrospective cross-sectional study was conducted from May 1 to June 30, 2018. Hawassa is situated at the eastern shore of Lake Hawassa and is located 275 km to the south of Addis Ababa, the capital city of the country. Hawassa University Comprehensive Specialized Hospital is located in the south part of Hawassa town in the SNNPR regional state. The university hospital is the only biggest comprehensive specialized referral and teaching hospital in the region. It is giving inpatient and outpatient services for >25 million people from the surrounding zones and nearby regions. This teaching hospital consists of an operating room, intensive care unit, 16 wards with 400 beds, and 11 outpatient departments. The study was carried out at the Pediatric Emergency Outpatient Department.

Sample size and sampling procedure

The sample size was determined using a single population proportion formula with a 95% confidence interval (CI), a 5% margin of error, and adding 5% contingency for illegible handwriting and incomplete medical records.

Using the proportion of prevalence of burning injury 50% as no published data were obtained from the previous study, the sample size was calculated as follows.

Therefore, by adding 5% for possible eligible handwriting and incomplete medical records, the final sample size was = 403.

A total of 14,596 pediatric emergencies were treated at Hawassa University Comprehensive Specialized Hospital for 5 years from September 2013 to September 2018, and 1430 cases were burned injury. From 1430 pediatric burn cases, 395 patient medical records were selected using systematic random sampling and 8 were rejected because of illegible handwriting and incomplete medical records.

Data collection tools and procedures

A pretested structured checklist which included sociodemographic characteristics and clinical information was used to collect data.

Data collection tool to review each child's medical record was developed by investigators after a literature review.

Data were collected from the medical record by four experienced BSc nurses who were working at a pediatric emergency outpatient department with data collection experience. The data collectors were trained for 1 day on data collection methodology and related issues before the start of data collection and were closely supervised during the data collection. Filled checklists were checked on a daily basis for completeness, clarity, and accuracy. Data cleaning was undertaken before entry and analysis.

Data management and analysis

Data entry was done using Epi Info 3.5.1 and exported to the SPSS (IBM Corp. Released 2011. IBM SPSSStatistics for Windows, Version 20.0. Armonk, NY: IBMCorp.) for analysis. We did a descriptive analysis to compute proportions for describing the basic characteristics of the study participants and the prevalence of burn injury. Chi-square tests with 95% CIs were used to judge the presence of an association between different factors.

Ethical consideration

A written ethical clearance was obtained from the Institutional Review Board at the College of Medicine and Health Sciences of Hawassa University, Hawassa, Ethiopia. A formal letter of cooperation was written to the Hawassa University Comprehensive Specialized Hospital, and permission was obtained before the beginning of data collection.


  Results Top


Sociodemographic characteristics of the study participants

A total of 395 patient medical records were selected, and the mean age of respondents was 6.3 years. The most burn affected age group was 0–5 years (62.5%), and the prevalence of burn injury decreases as the pediatric age increases in this finding. Female victims were 56.2%, and the majority of them were from rural areas in residency (72.2%) [Table 1].
Table 1: Sociodemographic characteristics of children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Nations, Nationalities, and People's Region, Ethiopia, from September 2013-September 2018 (n=395)

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Prevalence of burn injury

The magnitude of burn injury in the hospital was found by calculating, Prevalence = (Number of children admitted with burn in the hospital × 100)/(Total number of children admitted in pediatrics emergency within 5 years).

A total of 14,596 pediatric emergencies were treated at Hawassa University Comprehensive Specialized Hospital for 5 years from September 2013 to September 2018, and 1430 cases were admitted with burn injury; therefore, the 5 years' prevalence of burn injury among pediatric patients was 9.79%.

Characteristic of burn injury

The overall incidence of accidental burn injury was 94.2%, and it varies by the age of children as 0–-5 years (62.6%), 6–10 years (24.7%), and 11–14 years (12.6%), respectively, while 5.8% were established as intentional.

Almost all (97.7%) burn injuries occurred in the home. Upper extremities were the more affected body part (22.5%), 56.7% of the children suffered from partial thickness (second-degree burn), and 47.1% of them burnt 11%–20% total body surface area [Table 2].
Table 2: Characteristics of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Nations, Nationalities, and People's Region, Ethiopia, from September 2013-September 2018 (n=395)

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The most common cause of burn injury for the overall age group was scald (59.7%). Furthermore, the result of this study showed that the magnitude of cause burn injury is different in different age groups. Scald was common for those age groups: 0–5 years old (73.7%), chemical for those 6–10 (40.0%), and electricity for those 11–14 (66.7%). Statistically, a significant association was found between the cause of burn and age of the patient (P = 0.000) [Figure 1].
Figure 1: Cause of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Nations, Nationalities, and People's Region, Ethiopia, from September 2013 to September 2018 (n = 395)

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Clinical presentation and hospital management of burn injury

Children presented with shock to the emergency were (8.9%) and with loss of consciousness (10.6%). The majority of the children (83%) stayed home 30 min to 6 h before getting medical advice and 47.6% have received prehospital first aid intervention, and cold water and egg were applied to 34.9% of them.

Hospital stay ranged from 1 day to 2 months and only 3.5% stayed for >2 months. Most of the victims (63.8%) received antipain, fluid, Tetanus Anti Toxoid (TAT), antibiotics, and wound care without surgery and the rest (36.2%) received additional surgical intervention. From surgical interventions, debridement alone (38.3%), contracture release (15.8%), skin graft (13.1%), and fasciotomy (4.6%) were intervened.

Treatment outcome of burn injury

The majority of the children (74.4%) recovered without complication, 22.8% developed scar, and 6 of them died because of burn and its sequel giving the mortality rate (1.5%) [Figure 2].
Figure 2: Treatment outcome of burn injury among children who attended the Pediatric Emergency Outpatient Department of Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Nations, Nationalities, and People's Region, Ethiopia, from September 2013 to September 2018 (n = 395)

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Recovery without complication related to cause of burn as recovery among scald, flame, electrical, and chemical agents was 62.9%, 31.6%, 3.7%, and 1.7%, respectively, and there was no significant statistical association between treatment outcome and cause of burn (P = 0.038).

Mortality was related to the age of the patient, and death among 0–5, 6–10, and 11–14 years old was 66.6%, 16.6%, and 16.6%, respectively; there was a significant statistical association between treatment outcome and age of the patient (P = 0.004).

Mortality also related to the depth of burn as death among superficial, partial thickness, and full thickness was 0%, 33.3%, and 66.7%, respectively, and there was a significant statistical association between treatment outcome and depth of burn injury (P = 0.000).


  Discussion Top


This study gives information about the causes, magnitude, management, and outcome of burn injury among children admitted to the stated hospital. Burn is the main reason for unintentional injuries to children, particularly in developing countries. Burn injuries as a cause of childhood mortality as well as the impact on the quality of life in terms of negative cosmetic and psychosocial effects make them a major public health concern.

The result of this study discovered that the prevalence of burn injury among children was 9.79% which was relatively higher than a study done in Kenya (4.4%)[5] and Tanzania (5.18%),[6] and the difference might be due to setting, time and sample size.

The results of this study showed that the most affected children by burn injuries were under 5 years, thus making them the primary targets for prevention. These findings could be explained by the fact that children of this age do not notice what is harmful to them. This is in line with studies done in Kenya,[7] Nigeria,[8] Tanzania,[6] and India.[9] A lack of awareness of potentially dangerous situations and substances among young children is a likely contributing cause. Inadequate parental/caretaker supervision in most circumstances where children are left unattended near fireplaces and hot fluids could explain the high incidence of burns in this group.

The results also showed similar sex distribution, indicating that burns in children are not predisposed by sex, but the male was the usually affected gender in Kenya,[7] Nigeria,[8] and the UK[10] studies.

This study showed that almost all burn injuries are accidental (94.2%). This is in line with studies done in Kenya (98.5%),[7] Tanzania (97.5%),[6] and the UK (97%).[10] The finding indicated that inadequate supervision of young children as reflected by our results is probably also has a negative effect.

A minor percentage of children (5.8%) suffered from intentional burn injury similar with the study done in South Africa as 5.7% of the burns were inflicted as a way of punishment, revenge, child abuse, or false beliefs as reported to be by parents, guardians, or relatives.[11]

Almost all (97%) burn injuries occurred at home, in accordance with studies done in other centers of developing countries.[8],[12],[13] This may indicate that a lower socioeconomic status reflects a lower standard of home safety in developing countries including Ethiopia.

Most patients had burn injuries involving multiple sites, mainly the upper (22.5%) and lower (17.0%) extremities. This was in line with the study done in Mekele, Ethiopia;[14] Kenya;[7] Istanbul, Turkey;[15] and the UK.[10] The way of injury is likely to be due to younger children, or toddlers have a tendency to reach for objects on their hands, resulting in spillage of hot liquids onto upper limbs.

Full-thickness/third-degree burns were identified only 9.4% of the victims similar to the study done in North India (8.6%)[16] but 4% in the UK.[10] Third-degree burns result when the child cannot be saved in time, resulting in an extended period of contact with the cause of the burn.

Almost half (47.1%) of the children suffered from 11%–20% burnt total body surface area, and the finding is in line with different studies as the majority of the children sustained burns including <30% total burn surface area.[17],[18]

Similar to several studies,[6],[9],[13],[14],[15],[19] scalds were the most common cause of burns which ranged from 56.1% to 70%. The majorities were due to hot liquids indicating a health and safety issue in cooking areas such as kitchens; therefore, improved supervision must be emphasized in these areas.

In this study, only 47.6% of the burn victims have got prehospital/first aid intervention which was lower than Tanzania (87.3%)[6] and Indian finding (54.9%)[16] and the difference may be due to setting, knowledge, and skill of the parents. The finding points to a need for reinforcement of basic first aid intervention among household and prehospital members to reduce morbidity and complication caused by burn injuries.

According to this study, 36.2% received additional surgical intervention in line with the study done at the tertiary center in a low-income country (35.23%),[20] but only 3% of the patients required burn excision and skin grafting in the UK study.[10] This difference could be due to burn care is more advanced in the UK than Ethiopian hospitals.

This study identified that 74.4% of the children recovered without complication which is lower than the study done in southeastern Nigeria (86%).[8] The difference might be due to set as there is no special pediatric burn unit with modern management and specialized physician at Hawassa University Comprehensive Specialized Hospital, indicating that health-care facilities should be improved.

In this study, the total mortality rate was 1.5% which was lower than studies of southeastern Nigeria (3.8%),[8] rural part of India (9.52%),[9] and Turkey (4.3%),[21] but no single death was reported among 208 children with burns in the UK.[10] The difference might be due to the small sample size, study setting, and time difference among the studies.


  Conclusion Top


The study identified that the epidemiology and outcome of burn injury among children were comparable to other developing countries, but the high magnitude was noticed.

This study shows that childhood burn injuries are a challenging problem in our setting and a major cause of pediatric trauma. Children aged below 5 years are commonly affected with no sex difference. Most of these injuries were accidental, which occur in the home setting with scald injuries comprising the majority. Although most of these injuries are relatively minor, they largely result in hospitalization which impacts the economy at the individual, institutional, and national levels. Morbidity of burn injuries further ranges into physical, social, and psychological parts of life due to their harmful effects on function and cosmetics.

Therefore, prevention should be a crucial area of focus. Based on the patterns of burn injuries shown by the results of this study, public health and safety education to parents and other caregivers is needed with the goal of refining safety in the home environment.

First aid administration is a necessary skill for all individuals to have and may reduce morbidity as well as enable appropriate and timely treatment of these patients.

Acknowledgment

We are very grateful to the College of Medicine and Health Sciences of Hawassa University for technical and financial support. The authors are also grateful to data collectors who showed the greatest effort in acquiring appropriate information. The hospital medical director also deserves thanks for the assistance and permission to undertake the research.

Limitation of the study

This study was subjected to the usual limitations of a retrospective study. In addition, children not admitted to the pediatric emergency were not included in the study.

Financial support and sponsorship

This research was funded by Hawassa University for the academic staff's fund. The role of the funding body was to expense the cost for data collection, analysis, and interpretation. The study design and manuscript was designed and written by authors.

Conflicts of interest

There are no conflicts of interest.



 
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