Epidemiological Study of Burn Injuries in a Slum Community of Delhi
Author(s): P. Lal, M. Rahi, T.Jain, G.K. Ingle
Vol. 31, No. 2 (2006-04 - 2006-06)
Introduction
Burns are one of the top five causes of fatal injuries to people
under the age of 19 years1. Burns are also a significant cause
of mortality and morbidity among infants and children being
dependent on their mother/caretaker and they are unable to
recognize hazardous situations leading to burn injury2
whereas the aged population remains at higher risk for burn
injury due to several pre-disposing factors associated with
increased age such as reduced reaction time, poorer
dexterity, decreased mobility, inaccurate assessment of risks,
impaired senses and higher incidence of pre-morbid
conditions such as chronic debilitating diseases, alcoholism,
effect of medication, senility, and neurological and
psychological disorders3.
In developing countries, the problem of burn injuries is more
severe due to the reason that the care of burn patients
requires specialized staff and medical technologies that are
expensive and not always readily available4. More over, in
the big cities of these countries like Delhi there are numerous
slums where majority of the housing units are made up of
thatch and plastic material posing people at special risk of
burn injury due to frequent exposure to fire especially duringhousehold
activities. During the year 2001-2002, the Delhi
Fire Services attended 13685 calls out of which 126 were
from such colonies.
The consequences of burn injuries can be prevented through
early therapeutic interventions whereas occurrence of burn
injuries may be prevented by the measures focused on
prevention of exposure to fire. To develop an effective
preventive programme, the epidemiology of burn injuries is
to be clearly understood. Therefore, the present study was
carried out to find out epidemiological details of patients
exposed to burn injury and prevailing treatment practices
regarding burn care in the community.
Community based cross-sectional survey was carried out in
a slum named Balmiki Basti from September 2003 to
December 2003. This slum, situated near the Maulana Azad
Medical College, New Delhi, accommodated 1597 people
belonging to 400 families. All the families were covered in
this study. One adult person from each family was interviewed
after taking informed consent, The informant was asked about
burn injuries among all family members in the past one year.
A semi-structured pre-tested schedule containing openended
as well as close-ended questions was administered.
Information was collected regarding socio-demographic
characteristics, place of burn, cause of burn, number of times
the patient had been burnt, his/her body part(s) affected and
the treatment sought by the injured person. Data was
analyzed using Epi-info version 6.04. Chi-square test and
Fischer's exact tests were used wherever applicable for
finding out significant differences between comparable
groups. A 'p' value less than 0.05 was considered significant.
Results
Among 400 study subjects interviewed, there were
263(65.7%) females and 137(34.3%) males and their age
ranged from 16-75 years. A total of 57 persons (14.25%)
had received burns in the past one year. Out of them
26(45.6%) were males and 31(54.4%) were females with a
significant difference (p<0.05). Majority (43.8%) of them were
below 15 years of age followed by 30% people falling in the
age group of 26-35 years and 7% each, in age group of 36-
50 years and infants. Half of the victims (50.8%) were either
illiterate or children below 7 years (Table I).
Table I: Characteristics of patients who received burn injury
Characteristics
Male
n = 26
Female
n=31
Total
N=57(%)
Place of burn
Home
20
31
51
(89.5)
Working place
6
0
6
(10.5)
No.of times burnt
Once
19
22
41
(71.9)
More than once
7
9
16
(28.1)
Body part affected
Upper limb
18
21
39
(68.4)
Lower limb
5
7
12
(21)
Face
1
1
2
(3.5)
Other
2
2
4
(7)
Most of the victims (89.5%) had received burns at home,
and were females (61%). Six people had received burns at
the work place and all of them were males. Sixteen persons
(28%) had received burn injury more than once. The upper
limb was most frequently affected (68.4%), in both sexes
(Table II). Scalds with hot liquids/steam were the leading
cause of burn injury (43.8%). Flame related burn injuries
(eg. gas stove, kerosene stove) were observed in 33% of
cases followed by those due to crackers (14%), electric shock
(5.3%) and iron (3.5%).
In case of more than half of the victims (56.2%), some action
was taken on exposure to burn. Majority of these (84.4%)
received allopathic care. Some of the victims sought services
of quacks (12.5%). Three persons were admitted in the hospital. Scar was the commonest sequel of burn injury,
which was observed in 40.4% of victims. Home remedies
were used in isolation or along with medical care in 73.7%
of cases. Among these, 30% used possibly useful
medications or measures like antiseptic cream (borolin),
turmeric, crushed cotrimaxazole and water. Medically
unacceptable home remedies were used by 48.4% in the
form of coconut oil, ghee, raw potato etc.
Table II: Action taken on exposure to burn
Intervention
Number
%
Action taken (n=57)
Yes
32
56.2
No
25
43.8
Source of medical care (n=32)
Allopathy
27
84.4
Homeopathy
1
3.1
Quack
4
12.5
Hospitalization (n=57)
Yes
3
5.3
No
54
94.7
No. of days of hospitalization (n=3)
1
2
66.7
> 1
l
33 .3
Resultant disability (n=57)
None
32
56.2
Scar
23
40.4
Sight
1
1.7
Walk
1
1.7
Home remedies used (n=57)
Yes
42
73.7
No
15
26.3
Remedies**
Coconut oil
14
24.6
*Borolin/burnol
13
22.8
Any oil/ghee
9
15.8
Raw potato
5
8.8
Peepal root crushed
3
5.7
Colgate
2
3.5
*Water
2
3.5
*Turmeric
1
1.8
*Crushed Septran
1
1.8
** multiple answers *possibly useful remedies.
Discussion
The overall prevalence of burn injury in the present study
was found to be 14.2%. Females were pre-dominantly
affected in all age groups except 0-5 years. These
observations were similar to those reported from Zimbabwe5 but in contrast to many of the other studies published earlier2-4. The bimodal distribution of burn injuries with the peak
incidence being in children < 5 years and people aged 26-
35 years was observed in the present in study which was in
conformity with study carried out by Lari et al4 but there was
no significant increase in burn injuries with increasing age.
Literacy did not seem to have any influence on occurrence
of burn injuries in the present study subjects. Most of the
burn injuries in the present study occurred at home. Similar
observations have also been made by other researchers3,4.
The frequent exposure of females to burn injuries at home
could be due to their involvement in cooking and other
activities related to care of family members involving heat
such as boiling of water, ironing of clothes etc. Burn injuries
were received more than once in 28% of the victims in the
present study could be due to failure to change their
behaviour even after the first exposure. Such observation
had been reported also by Redlick in his study at Toronto,
Canada3. Like other studies, most commonly affected body
part in the present study was upper limb. Among the
causative agents responsible for burns in the present study,
the hot objects/liquids were the commonest ones. These
observations were in agreement with studies carried out
elsewhere4.
Although majority of victims received treatment from qualified
doctors, some of them sought services of quacks too and
used undesirable remedies in the form of coconut oil, ghee,
toothpaste etc. This is a matter of serious concern and
requires intensive health education to avoid such kind of
practices. Because these practices not only are undesirable
but also may worsen the condition of patient leading to
dreadful complications.
References
- Piazza-Waggoner C, Adams CD, Goldfarb IW, Slater H. An
assessment of burn prevention knowledge in a high burnrisk
environment: restaurants. Journal of Burn Care & Rehabilitation
2002; 23:342-350.
- Daisy S, Mostaque AK, Bari S, Khan AR, Karim S,
Quamruzzaman Q. Socioeconomic and cultural influence in
the causation of burn in the urban children in Bangladesh.
Journal of Burn Care & Rehabilitation 2001; 22:269-273.
- Redlick F, Cooke A, Gomez M, Banfield J, Cartotto RC, Fish
JS. A survey of risk factors for burns in the elderly and prevention
strategies: Journal of Burn Care & Rehabilitation
2002; 23:351-356.
- Lari AR, Panjeshahin M-R, Tatei A-R, Rossignot AM,
Alaghehbandan R. Epidemiology of childhood burn injuries
in Fars Province, Iran. Journal of Burn Care & Rehabilitation
2002; 23:39-45.
- Mzezewa S, Jonsson K, Aberg M, Salemark L. A prosiective
study on the epidemiology of burns in patients admitted to
the Harare burn units. Burns 1999; 25:499-504.
Deptt. of Community Medicine, Maulana Azad Medical College, New Delhi.
e-mail: [email protected]
Received: 17.11.2004
Introduction
Burns are one of the top five causes of fatal injuries to people under the age of 19 years1. Burns are also a significant cause of mortality and morbidity among infants and children being dependent on their mother/caretaker and they are unable to recognize hazardous situations leading to burn injury2 whereas the aged population remains at higher risk for burn injury due to several pre-disposing factors associated with increased age such as reduced reaction time, poorer dexterity, decreased mobility, inaccurate assessment of risks, impaired senses and higher incidence of pre-morbid conditions such as chronic debilitating diseases, alcoholism, effect of medication, senility, and neurological and psychological disorders3.
In developing countries, the problem of burn injuries is more severe due to the reason that the care of burn patients requires specialized staff and medical technologies that are expensive and not always readily available4. More over, in the big cities of these countries like Delhi there are numerous slums where majority of the housing units are made up of thatch and plastic material posing people at special risk of burn injury due to frequent exposure to fire especially duringhousehold activities. During the year 2001-2002, the Delhi Fire Services attended 13685 calls out of which 126 were from such colonies.
The consequences of burn injuries can be prevented through early therapeutic interventions whereas occurrence of burn injuries may be prevented by the measures focused on prevention of exposure to fire. To develop an effective preventive programme, the epidemiology of burn injuries is to be clearly understood. Therefore, the present study was carried out to find out epidemiological details of patients exposed to burn injury and prevailing treatment practices regarding burn care in the community.
Community based cross-sectional survey was carried out in a slum named Balmiki Basti from September 2003 to December 2003. This slum, situated near the Maulana Azad Medical College, New Delhi, accommodated 1597 people belonging to 400 families. All the families were covered in this study. One adult person from each family was interviewed after taking informed consent, The informant was asked about burn injuries among all family members in the past one year.
A semi-structured pre-tested schedule containing openended as well as close-ended questions was administered. Information was collected regarding socio-demographic characteristics, place of burn, cause of burn, number of times the patient had been burnt, his/her body part(s) affected and the treatment sought by the injured person. Data was analyzed using Epi-info version 6.04. Chi-square test and Fischer's exact tests were used wherever applicable for finding out significant differences between comparable groups. A 'p' value less than 0.05 was considered significant.
Results
Among 400 study subjects interviewed, there were 263(65.7%) females and 137(34.3%) males and their age ranged from 16-75 years. A total of 57 persons (14.25%) had received burns in the past one year. Out of them 26(45.6%) were males and 31(54.4%) were females with a significant difference (p<0.05). Majority (43.8%) of them were below 15 years of age followed by 30% people falling in the age group of 26-35 years and 7% each, in age group of 36- 50 years and infants. Half of the victims (50.8%) were either illiterate or children below 7 years (Table I).
Table I: Characteristics of patients who received burn injury
| Characteristics | Male n = 26 |
Female n=31 |
Total N=57(%) |
|
|---|---|---|---|---|
| Place of burn | ||||
| Home | 20 | 31 | 51 | (89.5) |
| Working place | 6 | 0 | 6 | (10.5) |
| No.of times burnt | ||||
| Once | 19 | 22 | 41 | (71.9) |
| More than once | 7 | 9 | 16 | (28.1) |
| Body part affected | ||||
| Upper limb | 18 | 21 | 39 | (68.4) |
| Lower limb | 5 | 7 | 12 | (21) |
| Face | 1 | 1 | 2 | (3.5) |
| Other | 2 | 2 | 4 | (7) |
Most of the victims (89.5%) had received burns at home, and were females (61%). Six people had received burns at the work place and all of them were males. Sixteen persons (28%) had received burn injury more than once. The upper limb was most frequently affected (68.4%), in both sexes (Table II). Scalds with hot liquids/steam were the leading cause of burn injury (43.8%). Flame related burn injuries (eg. gas stove, kerosene stove) were observed in 33% of cases followed by those due to crackers (14%), electric shock (5.3%) and iron (3.5%).
In case of more than half of the victims (56.2%), some action was taken on exposure to burn. Majority of these (84.4%) received allopathic care. Some of the victims sought services of quacks (12.5%). Three persons were admitted in the hospital. Scar was the commonest sequel of burn injury, which was observed in 40.4% of victims. Home remedies were used in isolation or along with medical care in 73.7% of cases. Among these, 30% used possibly useful medications or measures like antiseptic cream (borolin), turmeric, crushed cotrimaxazole and water. Medically unacceptable home remedies were used by 48.4% in the form of coconut oil, ghee, raw potato etc.
Table II: Action taken on exposure to burn
| Intervention | Number | % |
|---|---|---|
| Action taken (n=57) | ||
| Yes | 32 | 56.2 |
| No | 25 | 43.8 |
| Source of medical care (n=32) | ||
| Allopathy | 27 | 84.4 |
| Homeopathy | 1 | 3.1 |
| Quack | 4 | 12.5 |
| Hospitalization (n=57) | ||
| Yes | 3 | 5.3 |
| No | 54 | 94.7 |
| No. of days of hospitalization (n=3) | ||
| 1 | 2 | 66.7 |
| > 1 | l | 33 .3 |
| Resultant disability (n=57) | ||
| None | 32 | 56.2 |
| Scar | 23 | 40.4 |
| Sight | 1 | 1.7 |
| Walk | 1 | 1.7 |
| Home remedies used (n=57) | ||
| Yes | 42 | 73.7 |
| No | 15 | 26.3 |
| Remedies** | ||
| Coconut oil | 14 | 24.6 |
| *Borolin/burnol | 13 | 22.8 |
| Any oil/ghee | 9 | 15.8 |
| Raw potato | 5 | 8.8 |
| Peepal root crushed | 3 | 5.7 |
| Colgate | 2 | 3.5 |
| *Water | 2 | 3.5 |
| *Turmeric | 1 | 1.8 |
| *Crushed Septran | 1 | 1.8 |
| ** multiple answers *possibly useful remedies. | ||
Discussion
The overall prevalence of burn injury in the present study was found to be 14.2%. Females were pre-dominantly affected in all age groups except 0-5 years. These observations were similar to those reported from Zimbabwe5 but in contrast to many of the other studies published earlier2-4. The bimodal distribution of burn injuries with the peak incidence being in children < 5 years and people aged 26- 35 years was observed in the present in study which was in conformity with study carried out by Lari et al4 but there was no significant increase in burn injuries with increasing age. Literacy did not seem to have any influence on occurrence of burn injuries in the present study subjects. Most of the burn injuries in the present study occurred at home. Similar observations have also been made by other researchers3,4. The frequent exposure of females to burn injuries at home could be due to their involvement in cooking and other activities related to care of family members involving heat such as boiling of water, ironing of clothes etc. Burn injuries were received more than once in 28% of the victims in the present study could be due to failure to change their behaviour even after the first exposure. Such observation had been reported also by Redlick in his study at Toronto, Canada3. Like other studies, most commonly affected body part in the present study was upper limb. Among the causative agents responsible for burns in the present study, the hot objects/liquids were the commonest ones. These observations were in agreement with studies carried out elsewhere4.
Although majority of victims received treatment from qualified doctors, some of them sought services of quacks too and used undesirable remedies in the form of coconut oil, ghee, toothpaste etc. This is a matter of serious concern and requires intensive health education to avoid such kind of practices. Because these practices not only are undesirable but also may worsen the condition of patient leading to dreadful complications.
References
- Piazza-Waggoner C, Adams CD, Goldfarb IW, Slater H. An assessment of burn prevention knowledge in a high burnrisk environment: restaurants. Journal of Burn Care & Rehabilitation 2002; 23:342-350.
- Daisy S, Mostaque AK, Bari S, Khan AR, Karim S, Quamruzzaman Q. Socioeconomic and cultural influence in the causation of burn in the urban children in Bangladesh. Journal of Burn Care & Rehabilitation 2001; 22:269-273.
- Redlick F, Cooke A, Gomez M, Banfield J, Cartotto RC, Fish JS. A survey of risk factors for burns in the elderly and prevention strategies: Journal of Burn Care & Rehabilitation 2002; 23:351-356.
- Lari AR, Panjeshahin M-R, Tatei A-R, Rossignot AM, Alaghehbandan R. Epidemiology of childhood burn injuries in Fars Province, Iran. Journal of Burn Care & Rehabilitation 2002; 23:39-45.
- Mzezewa S, Jonsson K, Aberg M, Salemark L. A prosiective study on the epidemiology of burns in patients admitted to the Harare burn units. Burns 1999; 25:499-504.
Deptt. of Community Medicine, Maulana Azad Medical College, New Delhi.
e-mail: [email protected]
Received: 17.11.2004
