Clinical Review ABC of burns

Burns in the developing world and burn disasters

BMJ 2004; 329 doi: http://dx.doi.org/10.1136/bmj.329.7463.447 (Published 19 August 2004) Cite this as: BMJ 2004;329:447
  1. Rajeev B Ahuja,
  2. Sameek Bhattacharya
  1. Rajeev B Ahuja is head of department and Sameek Bhattacharya is specialist in the Department of Burns, Plastic, Maxillofacial, and Microvascular Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi, India

    Burns in the developing world

    Developing countries have a high incidence of burn injuries, creating a formidable public health problem. High population density, illiteracy, and poverty are the main demographic factors associated with a high risk of burn injury. The exact number of burns is difficult to determine: judicious extrapolation suggests that India, with a population of over 1 billion, has 700 000 to 800 000 burn admissions annually. The high incidence makes burns an endemic health hazard. Social, economic, and cultural factors interact to complicate the management, reporting, and prevention of burns.


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    Cooking at floor level in loose fitting clothes such as “dupatta” places women at increased risk of burn injury

    Epidemiology

    The epidemiology of burn injuries is different from that in the developed world. Most burn injuries are sustained by women aged 16-35 years. Women of this age group tend to be engaged in cooking, and most work at floor level in relatively unsafe kitchens and wear loose fitting clothes such as saris, dupatta, etc. Children and elderly people are at relatively less risk because many households still exist as joint families, and the system safeguards these age groups to some extent.

    The commonest mode of burn injury is a flame burn. Most such incidents are related to malfunctioning kerosene pressure stoves. These are cheap contraptions without safety features, and burns occur when carbon deposits block the kerosene vapour outlets. Unsupervised and careless handling of firecrackers during the festival of Diwali lead to an increased incidence of injuries during the festival period. Fire is also used in homicide and suicide.


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    Cheap kerosene cooking stoves, which are prone to malfunction, are a common cause of burns

    Problems in management

    Burn management in developing countries is riddled with difficulties. Lack of government initiative and low literacy rates preclude effective prevention programmes. Many uneducated households are fraught with superstition, taboos, …

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