S. Gupta1,2, U. Mahmood3, S. Gurung8, S. Shrestha7, A. G. Charles6, A. L. Kushner2,4, B. C. Nwomeh2,5 1University Of California, San Francisco – East Bay,Surgery,Oakland, CA, USA 2Surgeons OverSeas,New York, NY, USA 3University Of South Florida,Department Of Plastic Surgery,Tampa, FL, USA 4Johns Hopkins Bloomberg School Of Public Health,International Health,Baltimore, MD, USA 5Nationwide Children’s Hospital,Ohio State University, Pediatric Surgery,Columbus, OH, USA 6University Of North Carolina, Chapel Hill,Surgery, Trauma And Critical Care,Chapel Hill, NC, USA 7Nepal Medical College,Surgery,Kathmandu, , Nepal 8Kathmandu Medical College,Kathmandu, , Nepal
Introduction: The incidence of burns in low and middle income countries (LMICs) is 1.3 per 100,000 population compared with an incidence of 0.14 per 100,000 population in high-income countries, ranking in the top 15 leading causes of burden of disease globally. However, much of the data from LMIC is based on estimates of those presenting to a health facility and may underestimate the true prevalence of burn injury. The purpose of this study was to assess the prevalence of burn injuries at a population level in Nepal, a low income South Asian country.
Methods: A cluster randomized, cross sectional country wide survey was administered in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) from May 25th to June 12th, 2014. Fifteen of the 75 districts of Nepal were randomly chosen proportional to population. In each district, three clusters, two rural and one urban, were randomly selected. The SOSAS survey has two portions: the first collects demographic data about the household’s access to healthcare and recent deaths in the household; the second is structured anatomically and designed around a representative spectrum of surgical conditions, including burns.
Results: In total, 1350 households were surveyed with 2,695 individuals with a response rate of 97%. Fifty-five burn injuries were present in 54 individuals (2.0%, 95% CI 1.5% to 2.6%), mean age 30.6 (SD 2.3, 95% CI 26.0 – 35.2) and 52% in males. The largest proportion of burns was in the age group 25-54 (2.22%, 95% CI 1.47 to 3.22%), with those aged 0-14 having the second largest proportion (2.08%, 95% CI 1.08% to 3.60%). The upper extremity was the most common anatomic location affected with 36.36% of burn injuries. Causes of burns included 60.38% due to hot liquid and/or hot objects, and 39.62% due to an open fire or explosion. Eleven individuals with a burn had an unmet surgical need (20%, 95% CI 10.43% to 32.97%). Barriers to care included facility/personnel not available (8), fear/no trust (1) and no money for healthcare (2). Extrapolations suggest that nearly 608,605 people in Nepal have suffered an injury due to a burn, with potentially 124,200 unable to receive appropriate care.
Conclusion: Burn injuries in Nepal appear to be primarily a disease of adults due to scalds, rather than the previously held belief that burn injuries occur mainly in children (0-14) and women and are due to open flames. This data suggest that the demographics and etiology of burn injuries at a population level vary significantly from hospital level data. To tackle the burden of burn injuries, interventions from all the public health domains including education, prevention, healthcare capacity and access to care, need to be addressed, particularly at a community level. Increased efforts in all spheres would likely lead to significant reduction of burn-related death and disability.