Severe burn trauma from deliberate self-harm: the Sokoto experience

Abstract

Burn injury is one of the most severe forms of trauma that can afflict mankind. Although several forms of suicide and para suicide have been reported worldwide, severe burn injuries from deliberate self-harm have been poorly documented in Africa. To evaluate the pattern of deliberate self-harm by burning in our environment. This is a 5-year retrospective analysis of all patients who sustained burns from deliberate self-harm (DSH) seen at the Usmanu Danfodiyo University Teaching Hospital, Sokoto from June 1998 to May 2003. The patients' data and other necessary information were extracted from the case notes. Seven patients were seen over the study period. There were six females and one male, giving a female to male ratio of 6:1. All the injuries occurred at home from kerosene flame burns. In all cases, the intent was to take the patient's own life. The triggering factors were mainly psychosocio-economic. Six patients had up to secondary education while one patient had a degree certificate. None of the patients was gainfully employed at the time of incidence. Two patients had previously attempted suicide. Only one patient had a history of psychiatric illness. All sustained severe flame burns ranging from 45% - 98% body surface area (BSA). Compliance to treatment was generally poor. All patients were managed at the intensive care unit (ICU) of the hospital.. Five patients died, while the remaining two signed against medical advice (SAMA) during the course of management. The duration of hospital stay ranged from 2 - 10 days. Severe burn injury from DSH, although previously poorly documented in Africa, is not uncommon in our environment. The morbidity and mortality are high, not only because of the nature of injury, but probably because of poor compliance to treatment. We advocate community based studies and routine screening of adolescents to identify those at risk. The need for the establishment suicide information, intervention and prevention centre in Nigeria cannot be overemphasised.