Development of a Protocol for Holistic Paediatric Burns Management, Korle Bu Teaching Hospital, Ghana

Abstract

Background: Burns remain a significant cause of morbidity and mortality globally, particularly among children in low and middle income countries (LMIC). In Ghana, data on the prevalence of paediatric burns and the lived experiences of affected children and their caregivers remain limited, highlighting a critical gap in local knowledge. Even after hospital discharge, paediatric burn survivors face multiple complications, including pain, reduced mobility, metabolic and neurological issues, skin-related concerns, as well as emotional and psychological challenges, necessitating a holistic approach to their care and rehabilitation. Despite the existence of international evidence-based guidelines for paediatric burn management, these may not always be applicable to resource-limited settings such as Ghana. Currently, no standardised protocol has been developed for the management and rehabilitation of paediatric burns in Ghana, necessitating this study to develop a set of context specific, expert validated protocol for paediatric burns management. Aim and Objectives: The overall aim of the study was to develop a protocol for holistic paediatric burns management at Korle Bu Teaching Hospital. The specific objectives were: (1) to establish the prevalence and characteristics of paediatric burn injuries at Korle Bu Teaching Hospital, (2) to explore the experiences of paediatric burn patients and their caregivers on burns management, (3) to assess the perceptions of healthcare practitioners on paediatric burns management practices, and (4) to develop a set of expert validated recommendations for paediatric burns management within this setting. Methods: A four-phase, mixed methods approach was employed. Phase 1 involved a retrospective cohort study of medical records from 335 paediatric burn patients admitted to the Burns Centre at Korle Bu Teaching Hospital between 2020 and 2022, using descriptive statistics and univariate logistic regression. Phase 2 comprised an exploratory qualitative study with semi structured interviews involving 12 paediatric burn patients and 12 caregivers, analysed using thematic content analysis. Phase 3 involved focus group discussions with 15 multidisciplinary health professionals to understand their perspectives, with thematic content analysis applied. In Phase 4, a modified Delphi study was conducted with seven rehabilitation specialists to develop and validate a set of recommendations through a three round iterative process. 5 Results: Children accounted for 50.6% of burn admissions during the study period, with the majority being male (57.6%) and aged 1 to 5 years (70.1%). Superficial partial thickness burns were most common (51.9%), and hot water was the leading cause of injury (58.4%). Most burns involved less than 20% of total body surface area (59.0%), and the mortality rate was 21.0%. Higher TBSA was significantly associated with increased mortality (p < 0.001). The qualitative studies revealed six themes including causes of burns, care pathways, challenges following discharge, and reintegration concerns. Although participants expressed some satisfaction with care, procedural pain, scarring, and limited post discharge support were noted. Healthcare providers acknowledged the strengths of existing multidisciplinary care but cited the absence of standardised protocols, infrastructural limitations, financial barriers, and socio cultural challenges. The Delphi process resulted in a 40-item set of expert validated recommendations for paediatric burns care. Conclusion: This study highlights the significant burden of paediatric burns with prevalence of 50.6% at the KBTH, Ghana. Causes of child burns were mainly from hot water and food related incidents. It identifies gaps in post burn care, systemic challenges, and the need for structured, context specific approaches to care. The final set of recommendations provides a practical framework for multidisciplinary management of paediatric burns in low-resource settings, with potential for improving consistency and quality of care at Korle Bu Teaching Hospital and similar LMIC contexts.