585386 research-article2015
APHXXX10.1177/1010539515585386Asia-Pacific Journal of Public HealthSharma et al
Original Article
Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal: Gender-Specific Patterns
Asia-Pacific Journal of Public Health 1–10 © 2015 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539515585386 aph.sagepub.com
Narayan Prasad Sharma, MA1, Janine M. Duke, PhD2, Bir Bahadur Lama, MA1, Buland Thapa, MD, MS3, Peeyush Dahal, MBBS, MS3, Nara Devi Bariya, RN3, Wendy Marston1, and Hilary J. Wallace, PhD2
Abstract This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males (P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety. Keywords burns, Nepal, risk factors, epidemiology, gender
Introduction Burn injury is one of the major causes of unintentional injuries worldwide and a priority area for prevention by the World Health Organization (WHO).1,2 More than 90% of the estimated 267 885 annual global unintentional deaths (2012) due to fire, heat, and hot substances occur in low- and middle-income countries.3 In 2012, 30% of all female deaths from unintentional burn injury occurred in the WHO South-East Asian region.3 Compared to high-income countries, the death 1Burns
Violence Survivors—Nepal, Kathmandu, Nepal University of Western Australia, Crawley, Western Australia, Australia 3Bir Hospital, Kathmandu, Nepal 2The
Corresponding Author: Hilary J. Wallace, Burn Injury Research Unit, School of Surgery, The University of Western Australia, M318, 35 Stirling Highway, Crawley, Western Australia 6009, Australia. Email: [email protected]
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on July 16, 2015
2
Asia-Pacific Journal of Public Health
rate for unintentional injuries due to fire, heat, and hot substances for countries in the WHO South-East Asian region is more than double (3.9 vs 1.8 per 100 000), and the rate for disabilityadjusted life-years lost is triple (250.5 vs 84.7 per 100 000).3 Nepal (population approximately 27 million) is one of the world's least developed countries.4,5 Access to reliable electricity is limited, as is participation in secondary education.5 The overall literacy rate (5 years and older) in 2011 was reported to be 66%.4 Gender inequality in Nepal remains an important issue in relation to health and education outcomes.6 Seventeen percent of the population live in urban areas, with the Kathmandu Valley (population 2.5 million) experiencing rapid urbanization.4 Nepal has limited burns specialist facilities and a lack of staff trained in burn care throughout urban and rural areas.7 Recent reviews identify an absence of published literature on the epidemiology of burns in Nepal,8,9 but one population-based study has recently been published.10 An injury survey by the Nepal Health Research Council (2008-2009) estimated that 2.3% of all injuries were unintentional injuries due to fire.11 The lack of reliable and good-quality national or regional data has hindered recognition of injuries as a growing problem in Nepal.12 Reporting of burn injury data from Nepal will help define the public health problem, inform health care providers, and direct preventive burn strategies. This article presents analysis of adult unintentional burn admissions to the Bir Hospital, Kathmandu. Bir Hospital is the oldest government hospital in Nepal and has 400 adult beds, including a 9-bed Burns Unit. It is the only tertiary referral center for burns in Nepal providing free service, and many patients are from very low sociodemographic backgrounds. This hospital catchment is not representative of the population of Nepal. The data are biased toward more serious injuries, the catchment population of the hospital (catchment area, demographic characteristics, and referral patterns), and omits deaths prior to admission. The objective of this article was to provide a detailed epidemiological assessment of unintentional adult burn injury hospitalizations at Bir Hospital, Kathmandu, from 2002 to 2013, with a focus on gender-specific patterns of injury.
Methods A secondary data analysis was performed of de-identified data of all patients hospitalized with a burn injury at Bir Hospital, Kathmandu, during the period January 1, 2002, to August 31, 2013. Permission to analyze data was granted by the Nepal Health Research Council. Patient information used for this study included age, gender, caste (classified according to Bennett et al13), marital status, education level, economic status (capacity to pay for additional costs of treatment: none, some, sufficient), employment status, residence at time of injury (urban-rural, geographic location [hills/mountains, Terai/plains], administrative district, and region), place of burn injury occurrence, percent total body surface area burned (%TBSA), mortality, anatomical region of injury, multiple anatomical sites burned (yes/no), cause of burn, fuel/agent associated with flame/ fire burn, and days from burn injury to hospitalization at Bir Hospital. Other factors explored included activity or circumstance at time of burn injury. Descriptive analyses were conducted including percentages for categorical variables and median, interquartile range (IQR), minimum (min), and maximum (max) values for continuous (nonparametric) variables. Chi-square tests for categorical variables and Wilcoxon Rank Sum tests for continuous variables were performed to assess associations with the level of significance set at .05. All statistical analyses were performed using Stata statistical software V12 (StataCorp LP, College Station, TX).
Results During the period January 1, 2002, to August 31, 2013, there were a total of 819 unintentional burn injury admissions, of which 428 (52%) were male. Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on July 16, 2015
3
Sharma et al Table 1. Unintentional Burn Injury Hospitalizations by Gender and Sociodemographic Variables. Characteristics
Females (n = 391), n (%)a
Males (n = 428), n (%)a
Total (N = 819), n (%)a
112 (29) 82 (21) 54 (14) 38 (10) 39 (10) 33 (8) 33 (8)
155 (36) 133 (31) 61 (14) 41 (10) 16 (4) 15 (4) 7 (2)
267 (33) 215 (26) 115 (14) 79 (10) 55 (7) 48 (6) 40 (5)
176 (48) 122 (33) 58 (16) 9 (3)
70 (17) 201 (48) 124 (30) 21 (5)
246 (32) 323 (41) 182 (23) 30 (4)
192 (49) 97 (25) 4 (1) 97 (25)
12 (3) 345 (81) 10 (2) 60 (14)
204 (25) 442 (54) 14 (2) 157 (19)
152 (40) 29 (8) 37 (10) 55 (15) 101 (27) 4 (1) 0
133 (32) 42 (10) 36 (9) 70 (17) 116 (28) 16 (4) 2 (1)
285 (36) 70 (9) 73 (9) 125 (16) 217 (27) 20 (3) 2 (0.3)
Age group (years)
APHXXX10.1177/1010539515585386Asia-Pacific Journal of Public HealthSharma et al
Original Article
Descriptive Epidemiology of Unintentional Burn Injuries Admitted to a Tertiary-Level Government Hospital in Nepal: Gender-Specific Patterns
Asia-Pacific Journal of Public Health 1–10 © 2015 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539515585386 aph.sagepub.com
Narayan Prasad Sharma, MA1, Janine M. Duke, PhD2, Bir Bahadur Lama, MA1, Buland Thapa, MD, MS3, Peeyush Dahal, MBBS, MS3, Nara Devi Bariya, RN3, Wendy Marston1, and Hilary J. Wallace, PhD2
Abstract This study describes the epidemiology of unintentional adult burn injury admissions in a tertiary hospital in Nepal, from 2002 to 2013, focusing on gender-specific patterns. Chi-square tests and Wilcoxon Rank Sum tests were performed. There were 819 unintentional burn admissions: 52% were male and 58% younger than 35 years. The median percentage total body surface area burned (interquartile range) was greater in females than in males (P < .001): 28% (17-40) versus 20% (12-35), and female mortality was higher (32% vs 11%). A higher proportion females were illiterate than males (48% vs 17%). Burns occurred at home (67%), work (28%), and public places (5%); gender-specific patterns were observed. Flame burns accounted for 77%, electricity 13%, and scalds 8%. Kerosene (31%) and biomass (27%) were the major fuels. Cooking, heating, and lighting were the main activities associated with burn injury. Results support interventions to reduce the use of open fires and kerosene and to promote electrical safety. Keywords burns, Nepal, risk factors, epidemiology, gender
Introduction Burn injury is one of the major causes of unintentional injuries worldwide and a priority area for prevention by the World Health Organization (WHO).1,2 More than 90% of the estimated 267 885 annual global unintentional deaths (2012) due to fire, heat, and hot substances occur in low- and middle-income countries.3 In 2012, 30% of all female deaths from unintentional burn injury occurred in the WHO South-East Asian region.3 Compared to high-income countries, the death 1Burns
Violence Survivors—Nepal, Kathmandu, Nepal University of Western Australia, Crawley, Western Australia, Australia 3Bir Hospital, Kathmandu, Nepal 2The
Corresponding Author: Hilary J. Wallace, Burn Injury Research Unit, School of Surgery, The University of Western Australia, M318, 35 Stirling Highway, Crawley, Western Australia 6009, Australia. Email: [email protected]
Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on July 16, 2015
2
Asia-Pacific Journal of Public Health
rate for unintentional injuries due to fire, heat, and hot substances for countries in the WHO South-East Asian region is more than double (3.9 vs 1.8 per 100 000), and the rate for disabilityadjusted life-years lost is triple (250.5 vs 84.7 per 100 000).3 Nepal (population approximately 27 million) is one of the world's least developed countries.4,5 Access to reliable electricity is limited, as is participation in secondary education.5 The overall literacy rate (5 years and older) in 2011 was reported to be 66%.4 Gender inequality in Nepal remains an important issue in relation to health and education outcomes.6 Seventeen percent of the population live in urban areas, with the Kathmandu Valley (population 2.5 million) experiencing rapid urbanization.4 Nepal has limited burns specialist facilities and a lack of staff trained in burn care throughout urban and rural areas.7 Recent reviews identify an absence of published literature on the epidemiology of burns in Nepal,8,9 but one population-based study has recently been published.10 An injury survey by the Nepal Health Research Council (2008-2009) estimated that 2.3% of all injuries were unintentional injuries due to fire.11 The lack of reliable and good-quality national or regional data has hindered recognition of injuries as a growing problem in Nepal.12 Reporting of burn injury data from Nepal will help define the public health problem, inform health care providers, and direct preventive burn strategies. This article presents analysis of adult unintentional burn admissions to the Bir Hospital, Kathmandu. Bir Hospital is the oldest government hospital in Nepal and has 400 adult beds, including a 9-bed Burns Unit. It is the only tertiary referral center for burns in Nepal providing free service, and many patients are from very low sociodemographic backgrounds. This hospital catchment is not representative of the population of Nepal. The data are biased toward more serious injuries, the catchment population of the hospital (catchment area, demographic characteristics, and referral patterns), and omits deaths prior to admission. The objective of this article was to provide a detailed epidemiological assessment of unintentional adult burn injury hospitalizations at Bir Hospital, Kathmandu, from 2002 to 2013, with a focus on gender-specific patterns of injury.
Methods A secondary data analysis was performed of de-identified data of all patients hospitalized with a burn injury at Bir Hospital, Kathmandu, during the period January 1, 2002, to August 31, 2013. Permission to analyze data was granted by the Nepal Health Research Council. Patient information used for this study included age, gender, caste (classified according to Bennett et al13), marital status, education level, economic status (capacity to pay for additional costs of treatment: none, some, sufficient), employment status, residence at time of injury (urban-rural, geographic location [hills/mountains, Terai/plains], administrative district, and region), place of burn injury occurrence, percent total body surface area burned (%TBSA), mortality, anatomical region of injury, multiple anatomical sites burned (yes/no), cause of burn, fuel/agent associated with flame/ fire burn, and days from burn injury to hospitalization at Bir Hospital. Other factors explored included activity or circumstance at time of burn injury. Descriptive analyses were conducted including percentages for categorical variables and median, interquartile range (IQR), minimum (min), and maximum (max) values for continuous (nonparametric) variables. Chi-square tests for categorical variables and Wilcoxon Rank Sum tests for continuous variables were performed to assess associations with the level of significance set at .05. All statistical analyses were performed using Stata statistical software V12 (StataCorp LP, College Station, TX).
Results During the period January 1, 2002, to August 31, 2013, there were a total of 819 unintentional burn injury admissions, of which 428 (52%) were male. Downloaded from aph.sagepub.com at UNIVERSITE DE MONTREAL on July 16, 2015
3
Sharma et al Table 1. Unintentional Burn Injury Hospitalizations by Gender and Sociodemographic Variables. Characteristics
Females (n = 391), n (%)a
Males (n = 428), n (%)a
Total (N = 819), n (%)a
112 (29) 82 (21) 54 (14) 38 (10) 39 (10) 33 (8) 33 (8)
155 (36) 133 (31) 61 (14) 41 (10) 16 (4) 15 (4) 7 (2)
267 (33) 215 (26) 115 (14) 79 (10) 55 (7) 48 (6) 40 (5)
176 (48) 122 (33) 58 (16) 9 (3)
70 (17) 201 (48) 124 (30) 21 (5)
246 (32) 323 (41) 182 (23) 30 (4)
192 (49) 97 (25) 4 (1) 97 (25)
12 (3) 345 (81) 10 (2) 60 (14)
204 (25) 442 (54) 14 (2) 157 (19)
152 (40) 29 (8) 37 (10) 55 (15) 101 (27) 4 (1) 0
133 (32) 42 (10) 36 (9) 70 (17) 116 (28) 16 (4) 2 (1)
285 (36) 70 (9) 73 (9) 125 (16) 217 (27) 20 (3) 2 (0.3)
Age group (years)
