Morbidity and mortality of paediatric burns patients at Maputo Central Hospital, Mozambique

Abstract

Background: The incidence of paediatric burn injuries is increasing in Africa. Paediatric burn injuries are among the leading causes of preventable morbidity and mortality in sub-Saharan Africa. Research on the morbidity and mortality in this setting is much needed. Methods: We conducted a prospective questionnaire-based analysis of paediatric burn patients presenting to the Maputo Central Hospital during a five-month period. Interviews were conducted with the children's caretakers by 2 paediatric surgery residents and 1 paediatrician at the Eduardo Mondlane Medical School in Maputo, with the aid of nursing staff. Results: Questionnaires were completed for 66 patients. Most burns occurred from scald injuries (n = 46), particularly from cooking (n = 27) and bathwater (n = 19), followed by fire injuries (n = 16). Burns occurred more frequently in the afternoon (n = 26) and morning (n = 23). Many patients reported no adult caretaker present at the time of the burn injury (n = 24). Most burns were grade II (n = 49). Nearly half of the patients received a blood transfusion (n = 30). One-third of the patients underwent operative surgical debridement (n = 21). Skin grafting was performed on a subset of these patients (n = 13). A large number of patients developed a wound infection (n = 39). All deaths occurred in patients who were admitted to the paediatric intensive care unit and had sepsis (n = 9). The mean total body surface area (TBSA) of burn deaths was 37% (range 20% to 50%), and many deaths were secondary to fire burns (6 of 9; 66.7%). Conclusions: Most paediatric burn injuries occur in association with domestic activities, such as cooking and bathing. Adult caretakers are frequently not present at the time of the burn injury. Mortality rates are high, especially for large body surface area burns caused by fire. Educational programmes may help reduce the incidence of burns and the associated morbidity and mortality. The improvement and expansion of emergency and intensive burn care services may help to improve survival. Keywords: burns; morbidity; mortality; paediatrics; paediatric surgery; Mozambique