Annals of the M.B.C. - vol. 1° - n° 1 - September 1987

THE PREVENTION OF BURNS IN PEDIATRICS: 10 YEARS'ACTIVITY IN THE CESENA AREA

Landi G., Arcangeli F.

Divisione Dermatologica - Centro Ustion Ospedale Sufalini - U.S.L. N. 39 - Cesena

SUMMARY. In 1987 and 1978 a domestic burns prevention campaign was organised in the area of Cesena and 10 years later the epidemiological data were compared and reported.
A substantial reduction of bum morbidity was observed in the resident population, but not in the non-resident population.
The morbidity reduction was very important in resident children, in accordance with the campaign purposes.

Much has been written about the high frequency of bum accidents in children and the seriousness of the clinical and psychological consequences which burning can cause in subjects at a critical stage of their development.
Numerous epidemiological investigations in Italy and abroad have shown that among children burn accidents occur most frequently at home, and mainly involve contact with hot liquids. This finding is confirmed by a statistical analysis of the cases observed at the Divisione Dermatologica of Cesena Hospital.
Between October 1969 and December 1986 a total of 2,417 cases were admitted here, 961 being children under age 14 years, equal to 39% of all the cases (Tables I and 11).
Bums at work constituted no more than 21% of the total, most cases (71%) occurring at home, with a particulary high rate among pre-school infants and schoolchildren (95%). In this age-range burns were caused by hot liquids in 73% of cases and by flame in 19%. In the latter category, the most frequent cause was the use of surgical spirit by the children in imitation of adults in order to light or revive e fire.
In such an important field of collective pathology, the epidemiological investigation underlines the absolute need for preventive measures, since bum accidents - as indeed all accidents in general - are strongly conditioned by human behaviour patterns. The high frequency of bums in children is also attributable to behaviour patterns typical of the age, such as the wish to explore, inexperience, overestimation of personal capabilities, thoughtlessness and the tendency to imitate adults, who themselves with regard to children are responsible for acts of carelessness and unawareness of environmental risks.
As a follow-up to our first epidemiological analyses and on the basis of the above considerations we organized in 1977 and 1978 a campaign for the prevention of burns in the home, with particular regard to pre-school and school age. This campaign was carried out -in the area covered by the U.S.L. N. 39,

Cesena, with a population of about 175,000 inhabitants.
In collaboration with assistants of the School Medical Service we gave a series of informative lessons at nursery, primary and junior secondary schools, using specially prepared audiovisual aids. In order to stimulate the interest of the parents we also used local information media (newspapers, radio and TV stations).
Our illustrative material was deliberately clear and straight forward so that it should be immediately understood by the children. There were pictures of risk situations due either to personal behaviour or to environmental factors. The accidents themselves and their dramatic consequences were however never stressed (Figs. 1 and 2).We checked the actual utility of our campaign, with a view to extending and renewing it, by comparing the epidemiological data of the years 1980, 1983 and 1986 with those of 1976, the year immediately before the campaign began.

The statistical data of the last 10 years and a comparison of the sample years show (Fig. 3) that the burn morbidity rate in our territory, on the whole, gradually dropped: there were 95 cases in 1976, 38 in 1980, 25 in 1983 and 18 in 1986 (- 81% compared to 1976). In contrast the number of bum patients not residing in our territory who came to our attention increased in the same period as follows: 93 in 1976, 109 in 1980, 110 in 1983 and 100 in 1986 (+ 8% compared to 1976). 
The number of bum patients aged 0-14 years resident in our territory (Fig. 4) dropped sharply by 77% in 1980 and 90% in 1983 and 1986. Non-resident patients in the same age range, taken as a reference control group, showed an increase of 48% in 1980 and only a small decrease in 1983 and 1986 (- 15%).
These results clearly indicate a reduction in the bum morbidity rate in residents in the Cesena area in the years subsequent to the prevention campaign. This reduction is present among adults but it is particulary clear and marked among residents of pediatric age.
This is in agreement, at least apparently, with the angle we gave to our compaign, which was particularly aimed at infants and children of compulsory school age.
Morbidity in general is affected by numerous variables that are only partially known and always difficult to quantify. Thus, with particular reference to bum pathology, it is difficult to assess to what extent the reduction in the number of cases in our territory can be attributed to the success of our prevention compaign.
However, the statistical findings that we collected, even in the limited geographical area that comes under our Centre, do seem to confirm and reinforce in their homogeneity over a 10 - year period the widespread conviction of the usefulness of basic prevention campaigns with regard to burn morbidity, as also of every appropriate initiative of public information.

RÉSUMÉ. Pendant 1977 et 1978 on a organisé dans la zone de Césène une campagne pour la prevention des brûlures domestiques, et à
distance de 10 ans les données épidémiologiques out été confrontées et décrites.
On note une importante diminution de la morbidité des brûlures chez la population résidante, mais non pas chez la population non-résidante.
La diminution de la morbidité était très importante chez les enfants résidants, d'accord avec les buts de la campagne,

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