Morbidity
Magnitude of the Problem
Mortality i
Fire-related burnsii were responsible for 282 000 deaths in the world in 1998, the
majority of which (96%) occurred in developing countries. Table 1 below
shows the distribution of these deaths in the WHO Regions - Africa (AFR), the
Americas (AMR), Eastern Mediterranean (EMR), Europe (EUR), South-East Asia
(SEAR), and Western Pacific (WPR).iii More than half of all fatal fire-related
burns occurred in South-East Asia, but Africa had the highest rate per 100 000
population.
Furthermore:
Burns represent the fourth leading cause of unintentional injury death in
the United States,2
Risk factors
Each year 1.4 million burn injuries occur in the United States, resulting in
54 000 hospitalizations.2
Some of the major risk factors for fire-related burn injuries include the following:
More than one million people suffer every year from moderate to severe
burns in India (estimates for 1982).6
Alcohol and smoking
In France, childhood burns have been reported to account for between 3%
and 8% of all injuries in children.7
Global burden of disease
Local cultural practices
In 1998, fire-related burns ranked ninth among the leading causes of global burden of disease (based on deaths and disability) among children aged 5-14 years.8
Use of floor-level stoves, bedside fires, and loose flammable attire, as well as
flammable materials in building construction, and fire-walking are some examples of culturally related risk factors for burn injuries. The tandir, a typical
underground oven in Turkey, is a significant cause of burns, particularly in
children.18 Bath-related burns are more frequent in Japan than in any other
country. This has been attributed to their lifestyle and bathing systems, as well
as an increasing elderly population.19
Who is affected?
Burns account for 1300 paediatric deaths per year in Ireland,3
Burns are the leading cause of adult deaths in the slums of Karachi (Pakistan).4
Burns cause an estimated 1700 deaths annually in Nepal (seven deaths per
100 000 population).5
Table 1. Estimated number of deaths and mortality rates due to fires, by WHO Region and
income group (high and low/middle), 1998
REGION:
AFR
INCOME GROUP:
AMR
EMR
High
Low/
middle
EUR
SEAR
High
Low/
middle
WPR
WORLD
High
Low/
middle
Burns affect mainly children and the elderly. A very high percentage of patients admitted to burns units world wide are children under 12 years of age,
e.g. 70.6% in a study conducted in Saudi Arabia.9 Besides children, the elderly
represent a significant percentage of burn victims: they are often injured at
home as a result of faulty or misused electrical goods,10 and frequently their
burns may be associated with alcoholism or chronic diseases.11
In some countries, especially in Asia, females are at higher risk for burns
because of the use of open fires for cooking, heating and lighting, which can
easily set alight the loose clothing they wear.12 Violence against women, which
is related to gender inequality, is another factor. In India, for example, about
70% of burn victims are women.
Total deaths
(000)
170
49
126
72
66
107
336
25
220
1171
Where do burns occur?
Death rate per
100 000
11.3
1.3
1.4
3.4
1.3
2.3
9.6
1
1.9
4.8
Burns occur mainly in the home and in the workplace.13 Most burn injuries,
particularly among children and women, occur in a domestic environment.
The kitchen is reported to be the most common place where children upset
receptacles containing hot liquids and where women are injured by hot cooking oil or a stove exploding. Males, in both the developing and developed
world, often sustain burns in the workplace, e.g. scalds, chemical burns, and
electrical burns (especially due to high voltage currents).14,15
% of global
mortality due
to fires
24.1
1.4
2.5
5.7
1.8
3.9
50.3
0.7
9.9
100
Source: World Health Report 1999
i
Global data are only available for fire-related burns.
Injuries due to exposure to smoke, fire and flames.
iii
The WHO Regions do not correspond exactly with geographic regions. They are made up of countries and areas
under the six WHO regional administrations.
ii
2
Alcohol abuse and smoking, particularly in combination, represent the main
cause of domestic fires in developed countries. It has been reported, for example, that cigarettes account for 28% of all fatal fires in the United States.2
Most burns occur in an urban environment (e.g. 62% and 89.5%, respectively,
in two studies conducted in India14 and Spain16). However, adverse consequences are higher in the rural areas where inadequate pre-hospital care leads
to more severe sequelae and disabilities. In a rural area of South Africa, for
example, the average interval from the time of the burn to arrival in the hospital was estimated to be 42 hours.17
3
Socioeconomic status
Low socioeconomic status is a widely acknowledged risk factor for burns in
both developed and developing countries.20-25 Overcrowded living conditions,
lack of proper safety measures, and insufficient parental supervision of children are some of the factors associated with low socioeconomic status that
could contribute to the occurrence of burns.
Gender inequality
In some Asian countries such as Bangladesh, India and Pakistan, the disfiguring
of women by throwing acid or burning them to death are frequent forms of
violence against women. The reported reasons for this phenomenon, which is
rooted in gender inequality, include disputes concerning marriage and dowry.26-28
Violence
A considerable number of burn injuries in children result from abuse and
neglect, e.g. in Australia some 8% of admissions to a paediatric burns unit are
the result of such burns.29 Abuse and neglect are also reported to be a significant cause of burns in the United States.30
The use of chemicals in assaults or as defensive weapons is a leading cause of
burns in some countries, e.g. Jamaica.31
Epilepsy
Burns during an epileptic seizure may be an important risk factor especially in
developing countries. In the rural areas of Papua New Guinea, for example,
untreated epilepsy was the second most common cause of burns cases admitted to hospital.6
4
Burns care
Although survival from serious burns has been improving in several regions,32-34
primary prevention still remains the best way to cope with the problem. For
instance, in Israel, it has been found that school-based burns prevention programs significantly improve children’s risk knowledge and injury-control
beliefs.35
Remarkable differences in burn outcomes can be observed between highincome and low/middle-income countries. This is probably related to the
difficulties in providing adequate burn care in the developing world, where
even a small but deep burn can result in severe and disabling sequelae. In
Australia, for example, a patient with a burn of 80% of the total body surface
area can be expected to survive with a satisfactory functional outcome,36 while
in Nepal no patients with greater than 40% of body surface area burns survive.5
PREVENTION OF FIRE BURNS
• Promote the use of fire-retardant fabrics for children’s sleepwear and educate
regarding the wearing of loose, flowing garments.
• Avoid smoking in bed and encourage the use of child-resistant lighters.
• Enclose open fires and limit the height of open flames in homes in developing
countries.
• Promote the use of safer stoves and less hazardous fuels.
• Improve the treatment of epilepsy, particularly in developing countries.
• Promote the use of smoke detectors, fire sprinklers, and fire-escape systems in
residential dwellings.
• Apply safety regulations to housing designs and materials, and encourage home
inspections.
• Promote fire safety education.
PREVENTION OF SCALDS
• Lower the temperature in hot water taps.
• Improve the design of kitchen utensils and stove manufacture, including more
stable cooking surfaces and devices to protect and prevent access by children.
• Promote safety education.
First aid
Cost of burns
The medical cost of primary health care for one inpatient with burns ranges
from $3000 to $5000 a day in the United States,37 however, these expenses
may account for only 23% of the total costs.38 The economic impact of burns
also includes loss of wages and the costs relating to deformities resulting from
burns, in terms of emotional trauma and loss of skills.
Role of public health
To describe the magnitude of the problem by collecting data on mortality
and morbidity from burn injuries.
To study the risk factors and protective factors.
To show the economic impact of burns on the community in order to
provide a basis for cost-benefit analysis of safety improvements.
FACTS
Prevention
about injuries
Burns
To ensure appropriate pre-hospital and hospital care and rehabilitation of
patients with burns.
DON’TS
DO’S
To promote safety education.
• Do not peel off the clothing.
• Do not apply paste, oil, kumkum
(turmeric), or raw cotton on the
burnt area.
• Do not apply ice.
• Do not open the blisters with any
needle or pin.
• Do not apply any material as the
wound might become infected.
• Avoid application of topical medication until the patient has been placed
under appropriate medical care.
• Do not give oral fluids.
• Apply cold water or allow the burnt
area to remain in contact with cold
water for some time.
• In flame injuries, extinguish the
flames by allowing the patient to roll
on the ground, or by applying a
blanket, or using water or other fireextinguishing liquids. Rapidly place
the victim in a supine position.
• In chemical burns, remove or dilute
the chemical agent by using a neutralizing agent when indicated, and
by copiously irrigating the wound.
• Get a doctor to examine the patient.
To monitor and evaluate interventions.
A BURN OR THERMAL INJURY OF THE SKIN OCCURS
To promote prevention measures and policies.
when some or all the different layers of cells in
5
References available on request.
Copies of this document are available from:
Violence and Injury Prevention Department
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
Fax : 00 41 22 791 4332
Email : pvi@who.int
6
World Health
Organization
the skin are destroyed by a hot liquid (scalds), a
hot solid (contact burns), or a flame (flame
Violence & Injuries
Prevention
burns). Skin injuries due to ultraviolet radiation,
Non-Communicable
Diseases and
Mental Health
radioactivity, electricity or chemicals, as well as
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respiratory damage resulting from smoke inhalation, are also considered to be burns.1