Geospatial Mapping and Circumstances of Burn among Patients Presenting to the Emergency Department of Tertiary Hospital Dar-Es Salaam Tanzania

Abstract

Background: Burn injuries result in severe and often life-changing medical, social and psychological problems, along with a severe economic loss to individuals and their family. Ninety-percent of burns are preventable. However, even within one country, burn injuries' location and causative factors differ substantially between communities and regions. This prospective descriptive study describes the added benefit of using the geospatial techniques in mapping the burns prevalence in Dar es Salaam. The geospatial technique could be helpful in formulating the preventive measures in highly populated cities with similar context. Study objective: To determine the geographical location of burn patients and circumstances of burn among patients with burn injuries presenting to Muhimbili National Hospital in Dar Es Salaam, Tanzania Materials and methods: Patients presenting with burns were identified from patients at the emergency department and enrolled in the study after signing the informed consent. The patient’s residency Geographical Information System (GIS) coordinates were mapped over a base map of Dar es Salaam provided by ArcGisPro and entered into a kernel density analysis to identify areas of high burn prevalence including a map on statistical spatial clustering. The study used a questionnaire to interview the patients with burns on the causes, circumstances of the burn. The analysis included the magnitude of burn, etiologies and the circumstances. Results: Among 144 participants enrolled, (56.3% (81/144) were male. The median age was 3 years (interquartile range, 2 – 9 years). Using the coordinates, most burns came from the convergence of Ilala, Temeke and Kinondoni district in Dar es Salaam, with almost two-thirds of participants coming from Ilala District alone. The majority (84.7%) were referrals from other facilities. On arrival, the majority were stable. Most, 86.8%, had superficial partial burn (wet-pink), multiple (65.3%). Nearly half of the participants had a total burn surface area of 15% or more; involving mainly the upper limbs and anterior trunk. Regarding the causative agent, 86.1% were due to scald. Over 90% of burns happened at home and in the kitchen, 88.9%. Almost half of them received first aid at home, which included the application of honey/powder. Only 43% applied cold water. Following the management at the emergency department, 11.1% were discharged home and 84.7% were admitted to the burn ward Conclusion: Geospatial technique has enabled the researchers to establish not precisely where the burn took place in the city but also a clustering of burns in the city and using the coordinates, most burns came from the convergence of Ilala, Temeke and Kinondoni district in Dar es Salaam, with almost two-thirds of participants coming from Ilala District alone. The knowledge of initial burn management before the survivors are referred to the health facilities is poor. Strengthening burn management capabilities, both in knowledge, skills and equipment, of the regional hospitals, could decongest the national hospital.