SUMMARY. A total of 36 patients were seen and managed at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a period of five years (2000 to 2004). There were 28 males and 8 females (male to female ratio, 3.5:1). The ages ranged from 1 to 46 yr (mean, 14.5 yr). The burn surface area percentage ranged between 2.5 and 70% (mean, 22.9%). Flame constituted the commonest source of injury (66.7%). Other agents were scalding (9 patients = 25%) and electrical burns (3 patients = 8.3%). The sources of flame burns were kerosene lantern/stove explosion (7 patients = 29.2%); petrol explosion (7 patients = 29.2%); road accidents followed by an explosion (3 patients = 12.5%); one case each (4.2%%) involving ethanol explosion, gun powder explosion, firewood, a lighted candle that ignited furniture and then a whole house; and other unexplained sources (3 patients = 12.5%). Mortality in this study was 7 cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. We conclude that most of the injuries were preventable. Education regarding refuelling a lighted lantern/stove, discouraging the storing of petrol in the house, and driving with care will reduce the number of accidents and subsequent possible burn injuries. Children should be monitored carefully to prevent scalding from hot water and food.
Burn injuries are assuming ever greater importance as a cause of ill health in the developing nations.1 The majority of burns are domestic, fire being the predominant cause.
This is a review of the patients seen and managed at a young Nigerian teaching hospital, with no burns unit or burns specialist. The patients admitted to this centre were restricted to those with moderate burn injuries - others with complicated or major burns were referred to a nearby teaching hospital. The aim of this paper is to highlight the patients seen and managed at the hospital, as well as the outcome, as also to outline the various aetiologies of burn injuries in this environment and proffer possible methods of preventing burns.
A retrospective review of all burn-injured patients seen and managed at the Ladoke Akintola University of Technology, Osogbo, between 2000 and 2004 was carried out. The sources of information were the accident and emergency registers, ward admission registers, and the patients’ case notes. Age, sex, agent and nature of the injuries, treatment offered, outcome, and follow-up were extracted from the case notes. The data were collated and analysed.
A total number of 36 patients presented with burn injuries during the study period. There were 28 males and 8 females with a male to female ratio of 3.5:1. The ages ranged from 1 to 46 yr, with a mean of 14.5 yr. The burn surface area percentage ranged from 2.5 to 70%, with a mean of 22.9%. The agents of the burn injuries were flame (24 cases = 66.7%), scalding (9 cases = 25%), and electrical burns (3 cases = 8.3%).
The sources of the flame burns were kerosene lantern/stove explosion (7 cases = 29.2%), petrol explosion (7 cases = 29.2%), road accidents followed by an explosion (3 cases = 12.5%), one case each (4.2%) of ethanol explosion, gun powder explosion, fire wood, a lighted candle igniting furniture and then a whole house, and other unexplained sources (3 cases = 12.5%).
Scald injuries were caused by hot water in six cases (66.7%), hot food in two (22.2%), and hot oil in one (11.1%), while the three patients who sustained electrical burns were victims of professional accidents.
Only one of the patients was treated as an out-patient: all the rest were hospitalized for a period ranging from 4 to 98 days (mean period, 24.6 days). Comparing the percentage of burn surface area to the number of days spent in the hospital, it was found that patients stayed one day for every 19.4% of burn surface area.
Wound infection was observed in ten of the patients (27.8%), i.e. Staphylococcus in five of them (50.0%), Pseudomonas aeruginosa in four (40.0%), and Proteus in one (10.0%).
The treatment administered to the patients consisted of wound dressing until the eschar separated; six of the patients were skingrafted, and four patients needed blood transfusion.
The complications observed in these patients were mentosternal contractures in two cases (5.6%), depigmentation in six (16.7%), axillary contractures in six (16.7%), and hypertrophic scars in ten (27.8%). Mortality occurred in seven cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. Seven patients (19.4%) had to be referred to a nearby teaching hospital.
Burn injuries have long been described as amongst the severest that afflict human beings3 and they remain a huge health issue at least in terms of morbidity, especially in the developing countries.
Burn injuries due to contaminated kerosene explosion have been reported from various parts of Nigeria, especially from Lagos.5,6 In the present study flame burns were the commonest mode of burn injury, as in most reports from Nigeria. A slight predominance of scalds has however been reported in some parts of the country.
Kerosene explosions, as also those due to petrol, were a major cause of burn injuries in this study. This is consistent with findings reported from Enugu, Nigeria (to be published), as also from Lagos and Ibadan. The injuries mainly occurred in the adult age group - only twelve of our patients (33.3%) were aged 14 years and below. Some unusual causes of flame burns, such as gunpowder explosion, ethanol explosion, and burns from firewood, were also observed.
Scald injuries were seen only in children, due to hot water or food that they accidentally spilled over themselves. A similar scald predominance was also noted in Enugu.
Most of the patients were also admitted for treatment because of the extent of the burns, the areas affected, and associated problems such as multiple fractures, as in a patient involved in a road accident.
Electrical injuries were seen in three of our patients who were staff in the country’s electric power authority: the electricity was switched on accidentally by their colleagues while they were working on the lines outside their station. They were all without protective gloves when they sustained their injuries.
Wound infection was seen in a few patients. The offending organisms were most commonly Staphylococcus aureus, followed by Pseudomonas and Proteus. Pseudomonas aeruginosa and Staphylococcus aureus remain the most important pathogens and are frequently the cause of burn wound infections.7 Pseudomonas aeruginosa has been found to be one of the most important and most common causes of serious infection in burn patients, especially in developing countries.
Mortality was 19.7%, but this figure compares favourably with others recorded in our environment.12-14 The mortality was however high compared with that of burns centres in advanced countries15,16 with well-equipped burns units and burns care specialists. We hope there will be an improvement in our burns care with a burns unit in place and with a burns specialist in our centre.
Education will however go a long way to reduce burn injuries.16 Kerosene stoves or lanterns should not be refuelled when alight. Gasoline or petrol should not be kept in the house for any reason. Mothers should be taught how to handle hot liquids, especially with a little child in the house. Youngsters should not be allowed in the kitchen without supervision. The number of injuries due to road accidents would be reduced if drivers obeyed traffic rules and wore seat belts, which are now being enforced in Nigeria, with severe penalties for offenders.
Men working in electrical companies should be properly informed of the need to wear protective gloves. Such training should be regular and anyone disobeying should be penalized. This will reduce the number of cases of electrical burn injuries among workers.
Only a few patients presented to our centre during the study period. This we attribute to the fact that patients with extensive burn injuries were referred outside our centre because of our inadequate facilities and personnel involved in burns management. We believe there will be an increase in the number of patients in the next few years with improvement in burns care and the presence of a burns specialist and a burns unit. We also hope that this will eventually lead to better burns care and reduced morbidity and mortality.
RESUME. Les Auteurs de cette étude ont observé et traité un numéro total de 36 patients au Centre Hospitalo-Universitaire de l’Université de Technologie Ladoke Akintola, Osogbo, Etat d’Osun, Nigeria, pendant une période de cinq ans (2000/2004). La division par sexe était de 28 mâles contre 8 femelles (rapport mâle:femelle, 3.5:1). L’âge variait d’un à 46 ans (moyen, 14,5 ans). Le pourcentage de la surface corporelle brûlée variait de 2,5 et 70% (moyen, 22,9%). Les flammes constituaient la cause la plus commune des lésions (66,7%). Les autres causes étaient l’ébouillantement (9 patients = 25%) et les brûlures électriques (3 patients = 8,3%). Les causes des brûlures par flamme étaient l’explosion d’une lanterne/poêle à kérosène (7 patients = 29,2%); explosion d’essence (7 patients = 29,2%); accidents de la route suivis par explosion (3 patients = 12,5%); un cas chacun (4,2%%) causé par explosion d’éthanol, explosion de poudre à canon, bois de chauffage, une bougie allumée qui a incendié les meubles et ensuite toute la maison; et d’autres cause non définies (3 patients = 12,5%). La mortalité dans cette étude concernait 7 cas (19,4%). Le décès a été causé par la détresse respiratoire aiguë (1 patient), sepsis (5 patients) et infection tétanique (1 patient). Les Auteurs concluent que la plupart des lésions étaient évitables. Eduquer sur le ravitaillement des lanternes/poêles, décourager de tenir en réserve de l’essence dans la maison et conduire l’automobile avec attention: en cette manière on pourra réduire le numéro des accidents et les brûlures qu’ils peuvent provoquer. Il faut monitoriser les enfants pour prévenir les ébouillantements causés par l’eau et les aliments chauds.