<% vol = 9 number = 1 titolo = "BURNS AND SCALDS: FIRST-AID HOME TREATMENT AND IMPLICATIONS AT ENUGU, NIGERIA" volromano = "Pendig Publication" data_pubblicazione = "" header titolo %>

Olaitan P.B.1, Iyidobi E.C.1, Olaitan J.O.2, Ogbonnaya I.S.1

1 Department of Plastic and Reconstructive Surgery, National Orthopaedic Hospital, Enugu, Nigeria
2 Department of Microbiology, College of Natural Sciences, University of Agriculture, Abeokuta, Nigeria


SUMMARY. Burn management has yet to be fully understood by everyone in our environment in Nigeria. That is why many of our patients who sustain burns still apply to their wounds any substance available. An analysis of the 147 patients studied in this work shows that 51% of the patients applied one substance or another. Various substances were used, including raw eggs, gentian violet, cassava, engine oil, kerosene, etc. The risk of infection with most of these substances is obvious. Intensive campaigns and education of the people are urgently needed. This will reduce the current spate of morbidity and mortality following burn injuries in our communities.

Introduction

Throughout the world, burns remain a huge health issue, at least in terms of morbidity, especially in the developing countries.1 It is the nature of man “to want to do something” whenever there is an injury, and this leads to the application of various agents to burns. While some of these agents used in treating such injuries may be beneficial, many of them are harmful and have no scientific basis for their use. The use of such harmful agents therefore calls for education of the people in order to prevent their damaging effects.

We have observed that various substances are applied to the burn wounds of patients presenting to our burns unit immediately after the injury and prior to presentation. We have also noticed that these substances may be harmful to the burn wounds and to the patients, thereby increasing morbidity and mortality.

For this reason we conducted a retrospective study of the substances used to treat burns in our communities in Nigeria, in order to have them documented and to use this knowledge in the education of our people.

We believe that this will help to reduce the risk of burn wound infection, with resultant better care and reduced morbidity and mortality in our patients.

Materials and methods

A retrospective study was carried out of patients who presented to our burns unit over a period of two years (January 1999 to December 2000). The sources of information were the folders of all patients presenting to our unit in that period.

The information obtained included age, sex, type of burn injury, and percentage of body surface involved, as well as the agent(s) used to treat the wound immediately after the injury. Documentation regarding whether or not the wound became infected was also effected. The data were collated and then analysed.

Results

One hundred and forty-seven patients presented with burn injury during the period under study. Eighty-one of these patients (55.1%) were males and 66 were females (44.9%). The ages ranged between 3 weeks and 70 yr, with a mean of 21.5 yr.

The percentage of burned body surface area ranged from 3.5 to 94%, with a mean of 23%. Flame was the cause in the largest group (88 patients, or 59.9%), followed by scalds (56, or 38.1%); two patients (1.4%) sustained electrical burns and one patient had chemical burns (Fig. 1).

<% immagine "Fig. 1","gr0000001.jpg","Sources of burn injury.",230 %>

Seventy-five of the patients (51.0%) had records showing that they applied one or more substances to their body immediately after their burn. Of these 75 patients who had first-aid treatment before presentation, raw eggs were the commonest agent, both alone (13 patients) or in addition to one or more other agents (27 patients) (Figs. 2,3), for a total of 40 patients (27.2%) who applied eggs.

<% createTable "Fig. 2","Various agents used to treat burn wounds.",";1.; Raw eggs alone ; 13@;2.; Raw eggs + water ; 5@;3.; Raw eggs + kerosene ; 5@;4.; Raw eggs + cassava paste ; 3@;5.; Raw eggs + engine oil ; 3@;6.; Raw eggs + gentian violet ; 6@;7.; Raw eggs + table salt ; 2@;8.; Raw eggs + “Pap” + cold water ; 1@;9.; Raw eggs + penicillin ointment ; 1@;10.; Raw eggs + salt + kerosene ; 1@;11.; Gentian violet alone ; 7@;12.; Gentian violet + penicillin ; 3@;13.; Gentian violet + water ; 2@;14.; Gentian violet + kerosene ; 1@;15.; Gentian violet + kerosene + salt ; 1@;16.; Gentian violet + engine oil ; 1@;17.; Gentian violet + cassava ; 1@;18.; Gentian violet + salt + water ; 1@;19.; Engine oil alone ; 5@;20.; Engine oil + water ; 1@;21.; Water alone ; 3@;22.; Water and sand ; 1@;23.; Water and kerosene ; 1@;24.; Table salt alone ; 2@;25.; Palm oil ; 1@;26.; Honey ; 1@;27.; Vaseline ; 1@;28.; Kerosene alone ; 1@;29.; Cassava paste alone ; 1","",4,300,true %> <% immagine "Fig. 3","gr0000002.jpg","Total number of patients, with specific substances used.",230 %>

Twenty-three of the patients (15.6%) applied gentian violet either alone (7 patients) or in addition to one or more other agents (16 patients). Cold water, either alone or in addition to one or more other substances, was used by 15 patients (10.2%). Eleven patients (7.4%) applied engine oil; one patient applied kerosene, while eight patients (5.4%) and five patients (3.4%) respectively applied table salt and cassava paste.

“Pap”, a locally made corn flour paste, was applied by one patient (0.6%) and penicillin ointment by four (2.7%). Other substances applied by one patient each were palm oil, Vaseline, honey, and sand.

Of about half (51.0%) of the patients who applied one substance or another, 25 patients (33.8%) were found to have a wound infection compared to the 73 patients who applied nothing at all. Only 13 (17.8%) of this latter group of patients had a wound infection. This shows a significant rate of wound infection in the group that applied substances (p < 0.05).

Discussion

The treatment of burns, whether serious or mild, has always constituted a problem, and progress has only recently been achieved as regards treatment and full recovery.

Decisive procedures have to be initiated directly at the scene of the accident and this first aid affects the course of further treatment.

In this study, only 15 of the patients (10.2%) used water, either alone or in addition to one or more other substances, and, of these, only three patients (2.0%) used cold water alone. It appears that the patients used any liquid or paste available at their disposal as the first-aid material to treat their burn injuries. About half of the patients (49.0%) did not use any first aid at all before presenting at the hospital.

An in-house study at the Medico-Social Welfare unit of the Tata Main Hospital, India,4 found that only 22.8% of their burn patients had used or were given water as first aid for burns. The remainder of the respondents had used either no first aid at all or inappropriate forms of first aid, such as raw eggs, ink, Murgi tel (oil extract from chicken skin), toothpaste, mashed potato, oily substances, etc., thus infecting or complicating the wound. Twenty per cent of their patients used no first aid at all, compared to 49.0% of our patients who also used no first aid.

While the patients in the above study and our own patients appeared to act alike in choosing any material available to apply to their burns, 22.8% of the Indian patients used cold water compared to only 2.0% of our patients who used only water.

Marktelow5 noted that the “country medicine” prescribed in Liberia by a local medicine man or woman in the form of various portions, salves, and heat applications was not only the first line of treatment for many patients for their burns but could also be the cause of burn infections in that country.

The use of ink as a first-aid treatment for scalds and its implications has been discussed.

Burn wounds are sterile immediately after being inflicted but are liable to be colonized very rapidly by bacteria. The large raw area, with its exudates of serum, is like a huge culture plate on which organisms can multiply, little affected by the body’s defence mechanism.

Substances like gentian violet, when applied immediately after a burn injury, can hinder the proper assessment of a burn’s depth, because unclear areas are created that could have been treated with early excision. The risk of infection from applying most of these substances to a fresh burn wound is obvious. Eggs can serve as a culture medium for micro-organisms, while infection resulting from dirty engine oil, cassava pastes, and sand can lead to increased morbidity and eventual mortality.

Lawrence8 suggests that it is necessary to remove the causative substances of the burn as quickly as possible by washing with a large volume of water. Water carries away heat by dilution, and thus prevents further damage.

The dilution caused by washing eliminates chemical reaction, suppresses any increase in tissue metabolisms, exerts an anti-inflammatory action, stops hygroscopic action, and returns skin pH levels to normal.

As first-aid treatment for burns and scalds, the British Burn Association recommends the prompt and direct application of cold water to the injured part, irrespective of the presence or absence of clothing.9 The cooling should continue for 20 minutes, ideally using water at a temperature of 15 °C, although any temperature between 8 and 25 °C is effective.10 This not only eases pain11 but also reduces tissue damage by quenching residual heat.

Conclusion

This study shows a significantly higher incidence of wound infection among burn patients who before presentation applied various substances to their wounds than among those who applied nothing. However, a prospective study is needed for an objective consideration of the effects of such substances on burn wound healing and infection in our environment. The need to educate people to apply only cold water to burn injuries must be emphasized.

Intensive education is urgently needed. This will go a long way to reduce the use of these substances and the subsequent burn morbidity and mortality in our environment.


RESUME. La gestion des brûlures doit être encore complètement comprise par notre population en Nigeria. Pour cette raison beaucoup de nos patients brûlés continuent à appliquer à leurs brûlures tous les matériaux disponibles. L’analyse des 147 patients étudiés dans cette recherche démontre que 51% des patients ont appliqué quelque substance, y compris les œufs crus, le bleu de méthylène, le manioc, l’huile pour moteurs, le kérosène, etc. Le risque d’infection à cause de ces substances est évident. Il faut absolument organiser des campagnes intensives pour instruire la population. En cette manière il sera possible de réduire la fréquence actuelle des nombreux cas de morbidité et de mortalité qui se produisent dans nos communautés.



Bibliography

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<% riquadro "This paper was received on 12 January 2004.
Address correspondence to: Dr P.B. Olaitan, Department of Plastic and Reconstructive Surgery, National Orthopaedic Hospital, Enugu, Nigeria." %>
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