Pediatric Burns at The Rift Valley Provincial General Hospital, Nakuru, Kenya

Aim 
To determine the etiology and outcome of pediatric burns (0-12 years). 
 
Design 
A retrospective study of burn victims hospitalized at the Rift Valley Provincial General Hospital, Nakuru, Kenya from April 2004 to March 2007 
 
Method 
Charts of all children hospitalized for burn injury were reviewed for patient demographics, burn etiology, anatomical sites involved, extent of burn and outcome of treatment. 
 
Results 
The mean age was 2.6 years, with a male to female ratio of 1.4:1. 90.2% of the burns were due to scalds. The upper limbs and trunk were the most commonly affected. The mortality was 11.9% with flame burns resulting in a higher mortality than scalds. 
 
Conclusion 
The management of burns in the Nakuru region is challenging. The morbidity and associated mortality is high. Prevention of burn injuries should be advocated. 
 
The Annals of African Surgery, Volume 6, 2010


Introduction
Burns are a leading cause of unintentional injury in the developing world. In Africa, poverty, mass illiteracy, migration to urban areas with development of slum areas and shanty towns contribute to increasing incidence (1).
Most hospitalized burn patients worldwide are children under 5 years of age.
The injury, treatment, and rehabilitation process affect children not only physiologically, but psychologically as well (2). Admissions of pediatric burn injuries in the Rift Valley Provincial General Hospital have been on the increase. This review was undertaken to address the scarcity of valid data on the epidemiology of pediatric burns at The Rift Valley Provincial General Hospital and the greater Nakuru region. It analyses the etiology, severity and the relationship between these and patient demographics.

Methodology
The study was carried out at the Rift Valley Provincial

Results
A total of 530 patients between the ages of 0-12 years were reviewed.

Patient demographics
The age groups most affected were 0.5 to 1.5 years (n = 167, 32% of the cases) and 1.5 to 2.5 years (n =143, 30% of cases) (Fig. 1). The mean age for the patients was 2.6 years. Boys copmrised 59.1 percent of the cases (ratio, 1.4:1).

Aim
To determine the etiology and outcome of pediatric burns (0-12 years).

Method
Charts of all children hospitalized for burn injury were reviewed for patient demographics, burn etiology, anatomical sites involved, extent of burn and outcome of treatment.

Results
The mean age was 2.6 years, with a male to female ratio of 1.4:1. 90.2% of the burns were due to scalds. The upper limbs and trunk were the most commonly affected. The mortality was 11.9% with flame burns resulting in a higher mortality than scalds.

Conclusion
The management of burns in the Nakuru region is challenging. The morbidity and associated mortality is high. Prevention of burn injuries should be advocated.

Abstract
The AnnAls of AfricAn surgery • Volume 5 • January 2010 33
With regard to the hot liquids, 86% were caused by hot liquids in pots/sufurias, while hot liquids in the cup/ mug, kettle and basin caused 7.2%, 3.4 and 3.4% of the burns respectively. Of the flame burns, 68% were caused by charcoal or firewood while 32% were as a result of kerosene initiated burns.

Area of Burn and Burn Severity
Most of the victims sustained burn injuries in multiple areas. Majority of the burns involved the upper limbs (58%) and the trunk (42%) (Fig.2).
Majority of the victims sustained burn injuries ranging from 2.2% to 7.5% (228 cases or 43% of cases), followed by burn injuries of 7.5% to 12.5% (140 cases or 26% of the cases) (Fig. 3)

Outcomes
Eighty four percent (n = 445) of the burn patients were discharged after hospitalization, 12% (n 63) of the children died while 4% of the admitted cases either absconded or were transferred to other medical facilities.
There was a relationship between cause of burn and fatality resulting from the burn injuries. Approximately Food related burns were not fatal (Table 1).
For the relationship between burn extent and fatality, 72.7% of the patients who sustained more than 19% burn injuries died compared to 19.9% and 0.9% of those with 10 -19% burns and less than 10% burns respectively ( Table 2) Approximately 1 in every 18 victims (5.6% of cases) above 4 years of age succumbed to their injuries compared to one in every 7 of patients (13.5% of cases) be- The AnnAls of AfricAn surgery | www.sskenya.org The fatality rate of 12% is higher as compared to studies in other parts of the world where reported rates ranged from 1.3% to 6.4 % (9, 17). In low and middle income countries, however, mortality of 9.9% for burns reaching 21.3% have been reported (18).
Flame burns had a higher mortality, 34%, compared to scalds, 10.6%. This could be because the fires caused more extensive and deeper burns. Open fires are also more likely to be associated with inhalation injuries. In-low five years of age.

Discussion
The present study shows that pediatric burns predominantly affect boys aged 0.5 to 2.5 years of age and within their home environments. These findings corroborate recent epidemiological studies from several African Epidemiology of pediatric burns at The Rift Valley Provincial General Hospital, Nakuru, Kenya Oduor P.R.  Burns in children have a profound effect both on the family and the child. To the family, the mother has to abandon her responsibilities to care for the child in hospital. She may be forced to leave the other children in the care of the husband who is normally the bread winner and has to go to work. For the child the impact is not only physical but psychological as well. The management of pediatric burns is therefore a big challenge in

ORIgInAL ARTIcLE
Africa. This means that our aim should be burn prevention.
We recommend further studies to determine the knowledge, attitude, practice of parents and caretakers with regards to burn injury as a possible entry point for preventive measures. Studies on safer communities for children including the cooking environment may start to address the problem.
The challenge is not in the successful treatment of a severe burn wound, but rather in the successful prevention of thermal injuries (23). Pediatric burns must therefore be considered a public health problem in Kenya and other African countries as has happened in Asia.