Food Security as a Predictor of Global Pediatric Postburn Mortality
Rafael Felix P Tiongco1, Ayman Ali2, Joseph S Puthumana1
1Departmentof Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD, USA.
Insights
Improving food security (FS) in low- and middle-income countries (LMICs) is linked to better outcomes for pediatric burn patients. Higher FS scores predict decreased pediatric postburn mortality, offering a potential avenue for intervention.
Area of Science:
- Global Health
- Pediatric Burn Care
- Nutrition and Food Security
Background:
- Children in low- and middle-income countries (LMICs) face significant risks from poor food security (FS).
- Pediatric burn injuries are a major cause of mortality, particularly in LMICs.
- The relationship between FS and pediatric postburn mortality requires further investigation.
Purpose of the Study:
- To investigate the hypothesis that higher food security (FS) predicts decreased pediatric postburn mortality in LMICs.
- To quantify the association between FS scores and mortality rates in pediatric burn patients.
- To inform international efforts aimed at improving outcomes for burn-injured children.
Main Methods:
- Utilized deidentified data from the World Health Organization's Global Burn Registry (GBR) and the Economist Intelligence Unit's Global FS Index (GFSI).
- Included pediatric patients (0-19 years) from 2016-2020, excluding countries with fewer than 100 burn cases.
- Employed descriptive statistics, bivariate analyses, and multivariable logistic regression to assess the association between FS score and mortality, controlling for confounders.
Main Results:
- Analyzed 2,246 pediatric burn cases across nine countries, with a 11.5% mortality rate.
- Patients who died were older and had significantly lower median FS scores (55.7) compared to survivors (59.8).
- Each unit increase in FS score was associated with a significant decrease in the odds of postburn mortality (OR 0.78, 95% CI 0.73-0.83).
Conclusions:
- Higher food security (FS) is a significant protective factor against pediatric postburn mortality in LMICs.
- International initiatives to enhance FS may substantially improve survival rates for children with burn injuries.
- Addressing FS is a critical component of comprehensive pediatric burn care strategies in resource-limited settings.
Abstract:
Food security (FS) is defined as access to sufficient and nutritious food. Children, especially those in low- and middle- income countries (LMICs), are disproportionately affected by low FS. We hypothesized high FS would be predictive of decreased pediatric postburn mortality in LMICs. Publicly-available, deidentified datasets were obtained from the World Health Organization's Global Burn Registry (GBR) and Economist Intelligence Unit's Global FS Index (GFSI). The GFSI calculates FS scores annually from intergovernmental organization data reviewed by a panel of experts. FS scores are reported on a 0 to 100 scale with 100 indicating the highest FS. Patients aged 0 to 19 yr were included; after linking GBR and GFSI datasets, countries with <100 burn patients were excluded. Data were analyzed with descriptive statistics and bivariate analyses. Multiple logistic regression controlling for confounders was used to quantify associations between mortality and FS score. Significance was set at P < 0.05. From 2016 to 2020, there were 2,246 cases including 259 deaths (11.5%) over nine countries. Those who died had a higher median age (7 [IQR 2, 15] vs 3 [2, 6] years, P < 0.001), higher proportion of females (48.6% vs 42.0%, P =0.048), and lower median FS score (55.7 [IQR 45.3, 58.2] vs 59.8 [IQR 46.7, 65.7], P < 0.001). Increasing FS score was associated with decreased odds of postburn mortality [multivariable odds ratio 0.78 (95% confidence interval 0.73 to 0.83), P < 0.001]. With the association between FS and mortality, international efforts to increase FS in LMICs may help improve pediatric burn patient survival.
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