The profile and psychosocial impact of burn injuries among children and their caregivers in Addis Ababa, Ethiopia

Abstract

Over one million burns occur in sub-Saharan Africa each year, leading to significant morbidity and mortality. In Africa, children under five have almost three times more burn-related deaths than children worldwide. There has been wide and diverse research carried out with regards to burn injury related topics. However, there is limited published literature within the Ethiopian context concerning burn injuries among children and the psychosocial impact on caregivers and this research project aims to close the gap. This project had five study objectives: objective 1 forming part of Stage I (Study 1); Objective 2 and 5 forming part of Stage II (Study 2 and Study 5); Objective 3 and 4 forming part of Stage III (Study 3 and Study 4). These studies were clustered into stages based on similarities in study methods. Objectives: The purpose of this research project was to assess the patterns, circumstances, and characteristics of burn injuries in children admitted to Yekatit 12 Hospital, Myungsung Christian Medical Centre and Addis Ababa Burn Emergency and Trauma Hospital in Addis Ababa; explore the psychosocial impact of burn injuries on children and their caregivers; identify the caregivers practice of first aid among children with current burn injuries; assess the post burn health related quality of life (HRQoL) of the children aged less than 18 years and the socioeconomic impact of burn injuries on current caregivers in Addis Ababa; and to assess the current children burn injury prevention practice in Addis Ababa. Methodology: This thesis was conducted in three stages. Stage I: A retrospective review of records from 1st of January 2016 to 31st of December 2020 to assess the patterns, circumstances and characteristics of burn injuries of children. Data collection sites were included based on availability of burns unit centre for children. Data was extracted from the files of children with burn injuries who were less than 18 years of age and did not have missing information. Descriptive analysis was carried out. Stage II: A qualitative study to assess the psychological impact of burn injury among the caregivers and the current burn prevention program in use in Addis Ababa. Content analysis was used to analyse the data. v Stage III: A quantitative study to assess post burn HRQoL among the children, Household and socioeconomic impact of burn injury and first aid practice knowledge among the caregivers where carried out. Paeds QoL inventory questionnaire was used for children and closed and open ended questionnaire were used for the caregivers. Descriptive analysis was carried out. Results: Stage I: The total number of children at the three hospitals from January 2016 to December 2020 was 15,600 and of these, 350 (2.24%) had major and minor burn injuries. From the 350 files of children with burn injuries only 282 (80.6%) fulfilled the criteria for inclusion in the study. The majority n=134 (48%) of children with burn injuries were less than 4 years old and 146 (51.8%) of children who sustained a burn injury were females. The major cause of the burn among the children was hot liquid and flame burns. The association between the age group 0-4 years and contracture development was shown to be statistically significant (OR 2.1.88 95% CI (0.835-5.730) P-Value was ≥ 0.05). Stage II: Most of the children and the caregivers had difficulty in sleeping, nightmares and fear of the hot liquid among the children and loneliness among the caregivers. Some of the caregivers felt that they had lost all their friends because of their children’s burn injuries and no one to speak to in the time of emergency. There is a gap on burn injury prevention school programmes in government departments and there is no evidence of current dedicated burn injury prevention programs in use at Health Ministry level. Stage III: The household and socio-economic status analysis shows that 31(33%) of the fathers were illiterate and 43(45%) of the mothers completed or enrolled in primary schools. The majority of the caregivers [n=49 (52.1%)] were getting between 3501 and 4500 Birr per month which is equivalent to USD 62-74. Most of the families [n=40 (42.6%)] had 5-6 people in a one room house followed by 7-10 people [n=13 (32%)]. The study on HRQoL revealed that there were no major differences between physical and social component. The psychosocial health score was calculated as the mean of the items from the emotions, social and school functioning scales. The result indicate that physical and social component was higher compared to the emotional and school functioning component. There was no difference in any domain between caregivers reports and self-reports. Most of the caregivers [n=30 (31.9%)] applied cool water on the burned site of the vi body, 29 (30.9%) applied Litti (a dough for bread) and honey [n=7 (7.4%)] as first aid at home whereas 22 (23.4%) of the caregivers used animal manure, salt, sugar, milk, butter and traditional herbs. The caregivers used the cool tap water application method as first aid and there were no statistically significant differences in the knowledge of the standard 20-minute application duration between different facilities (p-value = 0.974). Conclusion: Burn injuries are an important public health problem with high incidence and mortality rates. There is a need to establish a burn prevention department at the government level in Ethiopia, a support group for caregivers and burn injury survival in Addis Ababa hospitals with burn units. Collective action is required from the health authorities and their partners to address these issues through developing prevention strategies incorporating further research on burns. The results of this study should be regarded as a first attempt rather than the final outcome on the level and extent of psychosocial impact of burn injury in Addis Ababa and hopefully another study will be conducted at national level on the caregivers and children post burn experiences.