Factors associated with morbidity and mortality in children with burn injury at Muhimbili national hospital.

Abstract

Introduction: Burn injury consists of destruction of the skin and the underlying tissues, due to thermal, electrical and chemical causes. The majority of burns are thermal followed by chemicals, electrical and radioactivity. Burn injuries continue to be a significant public health problem worldwide and it is associated with high morbidity and mortality in developing countries including Tanzania.. This study aimed at determining the factors associated with morbidity and mortality in children with burn injury at our institution. Methodology: A descriptive, prospective, hospital-based study was conducted to document factors associated with the morbidity and mortality in children with burn injury at MNH in 2012-2013, involving observation of patients from admission to discharge or death. TBSA was calculated by the rule of nine for children above 10 years and for those below 10 the Lund and Browder chart was applied, swab for culture and sensitivity was taken from the wounds with clinical evidence of sepsis. Results: A total of 150 children with burn injury were studied, with mean age of 3.25years. Scald were responsible for burns in 127 patients (84.7 %) while flame caused 20 burns(13.3%). Unsupervised play in cooking environment was the leading risk factor for burn. Most patients arrived to the unit late with an interval of 2 hours to 54 days, mean 33.6 hours; this had no effect on mortality, p-value 0.965. Most of the patients had complications, 77.3% (116) with anaemia being the most common isolated complication developed by 45 patients (38%). The mortality in this series was 23 children15.3% with electrolyte imbalance and septicemia being the leading killers. Other factors associated with mortality were TBSA, p-value <0.001. Seventy eight out of one hundred and six (72.6%) of the specimens had bacteria yield with S aureus being the commonest organism isolated, 32.1% (25), followed by Pseudomonus spp and Klebsiella and E coli. All the isolated S aureus were sensitive to penicillin. Conclusion: Burn is still a big health problem in our society especially in children below two years, as it is associated with high mortality, 15.33%. The factors associated with morbidity and mortality include; TBSA and source of burn. As most of the children get burn injury while playing at home especially around the cooking places, this can be preventable. Diarrhoea which lead to electrolyte imbalance causing death is due to overcrowding and lack of restriction rules into the burn unit at MNH. Recommendation: Community programmes to ensure adequate child supervision and general child wellbeing, particularly for those under five, as well as parental education about burns are recommended to reduce childhood burns in Tanzania. Rules restricting unnecessary entry to the burn unit should be advocated. More wards are needed to the unit to prevent the overcrowding.