Burn injuries are a public health issue of high economic importance and continue to be a major problem both in developed and developing countries, where it is reported to be the fourth most common type of trauma following road traffic accidents, falls and interpersonal violence(1, 2). Burns can occur by any of the following causes like flames, electricity, chemicals, hot liquids or contact with any hot object leading to severe body deformities including scarring, contracture and furthermore death as major complication. It accounts for 265,000 deaths annually, with approximately 95% occurring in low- and middle-income countries (LMICs) where fire related injuries are estimated to be 1.1 per 100,000 population (3)in addition to those non-fatal burns leading cause of morbidity.
Burn injuries are very devastating conditions to the patients where the immediate and late effects of which are shown include chronic pain, physical disfigurements, scarring, deeper burns can lead to contracture or completely loss of function of the affected body parts and at most death. On the other hand, burn injuries are very stressful incidents to both the patient and the care takers as it causes emotional and psychological problem leading to post-traumatic stress disorder(4).
Major burn injuries of more than 15% to both adult and pediatric population pose a huge challenge to management especially in LMICs because of limited resources and also delayed presentation. In most developing countries late presentation, which means hospitalization after a 24 hours period at the health center since burn injury, has shown to have many impacts with severe clinical presentation as compared to the patients that fell under early presentation at the hospital(5). The outcome of burn patients is greatly influenced by quality of care that the patients receive, which is affected by the time of hospitalization(6).
Among the factors associated with delayed presentation for burn care in most of LMICs has reported by several studies that include self-medications, use of traditional and local healers, religious beliefs ,lack of well-established burn unit and burn Centre, few skilled medical personnel in burn care as well as weak referral system(7). Similar to other burn facilities in LMICs, majority of burn patients presenting at Bugando Medical Centre have large percentage TBSA of more than 15% and present late with post burn sequelae such as malnutrition, electrolyte imbalance, septicemia and acute kidney injury leading not only to severe morbidity and high mortality rate but also burden to the entire hospital system due to overuse of hospital resources with constrained facilities and infrastructures.
This study, aims at determining the pattern, presentation and outcome of patients with cute burn of more than 15 % TBSA treated at Bugando Medical Centre
1.2 Problem Statement
Burn injuries are serious problem in developing countries(1). In Tanzania, burn injuries are mentioned to be among the leading accident (8, 9) and similarly reported in the Department of Plastic, Burn, and Reconstructive Surgery at Bugando Medical Centre. Although the incidence is highly seen in children, people of elder age and ones with comorbid conditions like epilepsy are reported to the affected group as well and is reported to be in first causes of children mortality (7).
Since 2015 to date, more than 450 Patients with various cause of burn injuries have been attended in department of plastic, burn and reconstructive surgery. Based on unpublished observation by staff team in the department shows that majority of patients present late with more than 15% TBSA of burn injuries accompanied with severe morbidities leading to difficult treatment and survival hence increasing prolonged hospital stay, infection and sepsis, overuse of hospital resources, socioeconomic burden to patients and high mortality rate.
The factors associated with delayed presentation, their clinical presentation and pattern of burn injury have not yet been studied and moreover the magnitude of morbidity and mortality rate of patients treated at Bugando Medical Centre with delayed presentation and major burn of more than 15% is not known.
1.3 Study Rationale
The results of study will analyze the magnitude of patients with delayed presentation, their clinical patterns and presentations and aid in providing solutions on care and early intervention of burn injuries with more than 15% TBSA.
This study will provide evidence-based information to our institute, healthcare providers, ministry of health and patients under risk group and that will be useful for improvement of burn injury protocols and guidelines on management and outcome of burn care in addition to reducing the increasing incidence of mortality due to burn injuries respectively.
The findings of this study will establish new areas of research, and set the stepping stone for reference on outcome studies of morbidities and mortalities among burn patients
1.4 Research Questions
What are the clinical pattern and management outcome among patients with TBSA15% presented at Bugando medical centre?
1.5 Study Objectives
1.5.1 Broad Objective
To determine the pattern of burn injury and outcome following treatment given among patients with more than 15% TBSA at Bugando medical Centre
1.5.2 Specific Objective
1. To determine the clinical pattern of burn injury among patients with more than 15% TBSA treated at Bugando Medical Centre 2. To determine outcome of patients with burn injury and more than 15% TBSA treated at Bugando Medical Centre