A global plan for burn prevention and care

Abstract

Introduction Each year more than 300 000 people die from fire-related burn injuries. Millions more suffer from burn-related disabilities and disfigurements which have psychological, social and economic effects on both the survivors and their families. The burden of burn injury is one that falls predominantly on the world's poor: 95% of fire-related burn deaths occur in low- and middle-income countries (LMICs). Not only are burn deaths and injuries more common in people of lower socioeconomic status, but the survivors find their pre-injury poverty levels worsen after recovery. Differences in burn mortality rates vary across different age groups. For example, fire-related burns are the sixth leading cause of death among 5-14 year olds in LMICs. Survivors develop burn wound contractures and other physical impairments that limit function, lead to handicaps and reduce their chance of leading economically productive lives. Additionally these disfigurements often result in social stigma and restriction in their participation in society. Inequity of injury As noted by Mock et al. in an editorial in the Bulletin (1), injuries and violence cause disability and death to tens of millions of children across the globe each year. The burden is unfairly borne primarily by those in low- and middle-income countries where prevention programmes are uncommon and the quality of acute care is inconsistent. Burn injuries are dramatic examples of inequity. Even in a high-income country such as the United States of America (USA), burn injuries occur out of proportion among racial and ethnic minorities, as socioeconomic status--more than cultural or educational factors--accounts for most of the increased susceptibility of these children to burns. For example, the proportion of African-American infants requiring hospitalization at burn centres is double their proportion in the general population. (2,3) Most burn injuries lead to prolonged and expensive hospital stays. In addition to pain management and wound care, burn patients require attention to nutritional deficiencies, to the consequences of suppression of the immune system and to rehabilitation therapy. In the USA, the average hospital fees for care of a child (aged 5-16 years) with extensive third-degree burns requiring skin grafting was more than US$ 140 000. (2) Yet in spite of this lavish medical care, many burned children leave hospitals in the USA with permanent physical and psychological scars. Recovery not just skin-deep When confronted with the story of a burned child, the first picture that comes to mind is that of the agonizing open wounds, that eventually turn into undeniably obvious burn scars. But the thickened, non-compliant skin tells only part of the story. Much of the impact of burns is psychological. Studies of recovery from burn injury in the USA show clearly that the ability to adjust following injury is less dependent on the physical characteristics of the burn (such as burn size, burn depth or location) and more on the patient's pre-injury situation. Coping ski]Is, family and community support, and general psychological health have more impact on recovery from burns than the burn itself. (5) In the USA, this means that children from struggling family backgrounds are likely to have problems reassimilating into school and community. In low-income countries, the consequences are more serious, including isolation from or even abandonment by the family, social segregation, unemployment and extreme poverty. Although children from affluent families in low-income countries have a chance of recuperation, most children's situations deny them the opportunity to recover from even a small burn. At the time of burn injury, all patients--young and old--experience shock, horror, pain and anxiety. For children, the events that follow their injury may confuse them and lead them to believe (sometimes correctly) that their death is imminent. …