Burns represent a major portion of the workload for the Plastic Surgery and Burns Unit, and 45% of burns patients seen are children (1). Literature suggests that up to 98% of rural Ghanaian population rely on gas cylinders for cooking.  Many store these cylinders indoors for security purposes. Roadside cooking over open flames is also commonplace.  As such accidental burn injuries and pediatric burns are all too frequent.  Poor transport systems result in increased road traffic accidents and vehicle fires, combined with difficulty in accessing medical services quickly.

Road traffic accidents and fires are recognized as two of the leading causes of the burden of disease in Africa(5).  WHO figures state that 833,773 African children, under the age of five, suffered fire related injuries or deaths in the year 2000.  Fire related mortality rates in Africa (6.1 per 100 000 population) are much more common when compared to those seen in high-income countries (just 1.0 deaths per 100 000 population)6.

The presence of a pre-existing impairment, history of a sibling burn, and maternal illiteracy or low education are all cited as significant risk factors for childhood burns(7). Due to genetic factors, accessibility and affordability of hospital treatment, reliance on traditional medicine and high burns infection rates, many of these burns result in keloid scarring or contracture formation, in turn leading to significant physical impairment (18% in a study of 650 childhood burns in the Ashanti region(8).  A 1995 community based survey of determinants of modern healthcare use by families after a childhood burn in the Ashanti region found that only 48% (of a cohort of 955) of burned children were taken to a modern health facility for treatment, of these 68% reached healthcare within 24 hours(3). This was prior to the opening of the plastic surgery units at Accra and Kumasi and there has been improvement in transport links in recent years. It would be of interest to repeat a similar study now.

The WHO worked in collaboration with the International Society for Burn Injuries to create the Plan For Burn Prevention and Care (2008). This document aimed to catalyse burn prevention and care efforts globally and focuses on how great a problem fire related injuries are in developing countries like Ghana(6).  Mr Opoku Ware Ampomah of Korle Bu has recently established Ghana Burns Society, as well as improving burns treatment units preventive measures and public education is recognized as a major objective.

Burns section References

(1) Staff and surgeons at Korle Bu Plastic Surgery Unit.
(2) Agbenorku P, Akpaloo J, Farhat BF, Hoyte-Williams PE, Yorke J, Agbenorku M, Yore M, Neumann M (2010) Burn disasters in the middle belt of Ghana from 2007 to 2008 and their consequences JBurns  Epub ahead of print
(3) Forjuoh SN, Guyer B, Strobino DM (1995) Determinants of modern health care use by families after a childhood burn in Ghana JInjPrevention 1<: 31-34>
(5) WHO Injury A Leading Cause of the Global Burden of Disease (2000) http://whqlibdoc.who.int/publications/2002/9241562323.pdf
(6)A WHO plan for burn care and prevention (2008)http://whqlibdoc.who.int/publications/2008/9789241596299_eng.pdf
(7) Forjuoh SN (2006) Burns in low- and middle-income countries: A review of available literature on descriptive epidemiology, risk factors, treatment and prevention.
(8) Forjuoh SN, Guyer B, Ireys HT (1996) Burn-related physical impairments
and disabilities in Ghanaian children: prevalence and risk factors. AmJ Public Health 86:81–3.
(9) Papini R. (2004) ABC of burns. BMJ; 329 158-161
(10) www.ameriburn.org

Main Photo: Wound Dressing for burned hand. Arthur Morris