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Burn injuries in eastern Zambia: impact of multidisciplinary teaching teams
Dianna Edwards1, Jason Heard, Barbara A Latenser
1Carver School of Medicine, University of Iowa, Iowa City, USA.
Insights
The American Burn Association/Children's Burn Foundation (ABA/CBF) burn teams improved documentation and pain management for burn patients in Zambia. This outreach program shows efficacy in enhancing critical aspects of burn care in sub-Saharan Africa.
Area of Science:
- Medical Research
- Global Health
- Burn Care
Background:
- Burn injuries pose a significant health challenge in sub-Saharan Africa.
- Limited data exists on burn patient demographics and treatment outcomes in regions like Zambia.
- The American Burn Association/Children's Burn Foundation (ABA/CBF) initiated outreach programs to improve burn care.
Purpose of the Study:
- To collect burn patient demographic data from the Eastern Province of Zambia.
- To evaluate the initial impact of ABA/CBF-sponsored burn care teams on patient management.
- To compare burn care practices and outcomes before and after the intervention.
Main Methods:
- Retrospective chart review of 510 burn patients admitted to a mission hospital in Katete, Zambia (July 2002 - June 2009).
- Data collected before (July 2002 - Dec 2006) and during/after (Jan 2007 - June 2009) ABA/CBF team interventions.
- Analysis included patient demographics, injury mechanisms, treatments, and outcomes.
Main Results:
- The study identified key demographics: average age 15.6 years, 44% under 5, average Total Surface Area (TBSA) burned 11%.
- Flame (52%) and scald (41%) were the most common burn mechanisms.
- Post-intervention (2007-2009), statistically significant improvements were observed in burn diagram documentation (48.6% vs. 27.6%) and analgesic administration (91% vs. 84%).
Conclusions:
- The ABA/CBF-sponsored burn teams have demonstrated efficacy in improving burn patient care documentation and pain management in Zambia.
- This study provides the most comprehensive burn dataset for a sub-Saharan African region to date.
- Continued support for these outreach programs may further enhance resuscitation, antimicrobial use, and surgical interventions, leading to better patient outcomes.
Abstract:
The American Burn Association/Children's Burn Foundation (ABA/CBF) sponsors teams who offer burn education to healthcare providers in Zambia, a sub-Saharan country. The goals of this study are 1) to acquire burn-patient demographics for the Eastern Province, Zambia and 2) to assess the early impact of the ABA/CBF-sponsored burn teams. This is a retrospective chart review of burn patients admitted in one mission hospital in Katete, Zambia, July 2002 to June 2009. July 2002 to December 2006 = data before ABA/CBF burn teams and January 2007 to June 2009 = burn care data during/after burn outreach. There were 510 burn patients hospitalized, male:female ratio 1.2:1. Average age = 15.6 years, with 44% younger than 5 years. Average TBSA burned = 11% and mean fatal TBSA = 25%. Average hospital length of stay = 16.9 days survivors and 11.6 days nonsurvivors. Most common mechanisms of burn injuries: flame (52%) and scald (41%). Ninety-two patients (18%) died and 23 (4.5%) left against medical advice. There were 191 (37.4%) patients who underwent 410 surgical procedures (range 1-13/patient). There were 138 (33.7%) sloughectomies, 118 (28.7%) skin grafts, 39 (9.5%) amputations, and 115 (28.1%) other procedures. Changes noted in the 2007 to 2009 time period: more patients had burn diagrams (48.6 vs 27.6%, P < .001), received analgesics (91 vs 84%, P = .05), resuscitation fluid (56 vs 49%, P = not significant [NS]), topical antimicrobials (40 vs 37%, P = NS), underwent skin grafting (35.5 vs 25.1%, P = NS), and underwent any operative intervention (40.6 vs 35.2%, P = NS), compared with patients treated between 2002 and 2006. This study represents the largest, most comprehensive burn data set for a sub-Saharan region in Africa. There has been a statistically significant improvement in documentation of burn size as well as administration of analgesics, validating the efficacy of the ABA/CBF-sponsored burn teams. Continued contact with burn teams may lead to increased use of resuscitation fluids, topical antimicrobials, and more patients undergoing operative intervention, translating into improved burn patient outcomes.
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