Assessing the Capacity of African Burn Care: The First Ever Survey of African Burn Care Centers

OBJECTIVE: Burn injury is still an important cause of morbidity and mortality in low and middle-income countries (LMICs). Despite dramatic advances in burn care over the past 50 years, the standard of burn care in LMICs has lagged significantly behind that which exists in high-income countries. This first ever survey of the capacity, services, and mortality rates and causes in African burn centers allows an initial descriptive review of African centers' progress toward international best practices in burn prevention and burn care. METHODS: A survey was conducted at the 5th Pan African Burn Society Congress in Accra, Ghana in November 2013. Experts in survey design methodology reviewed the survey tool. Survey questions were based on an expert consensus document on standards of burn care appropriate to LMIC settings and on personal experience with providing burn care in Africa. Results were analyzed with STATA statistical software. RESULTS: Seventy-nine attendees participated in the survey. Thirteen countries from four African regions were represented. Eighty-seven percent of the respondents worked in urban settings and 80% in tertiary referral centers. Among those surveyed, 52% were nurses and 34% were physicians. Burns/plastic surgery was the leading specialty represented (47%). The majority of respondents reported adequate access to blood and blood products (63%). More than half of providers had access to most specialized burn support services (pediatric providers 54%, dedicated burn nurses 66%, nutritional support 76%, physiotherapy 87%, reconstructive surgery 80%, and post-hospital follow-up 62%) but fewer had access to rehabilitation (44%). Treatment protocols were noted to be in place by the majority of respondents (fluid resuscitation 85%, pain control 68%, wound care 78%, and splinting/positioning 60%). Adequate burn operative time was not widely available, with only 30% of respondents reporting a dedicated burn operating room and 74% reporting an average of 5 or fewer burn operative cases per week. The most common procedures were skin grafts, mentioned by 61% of respondents, and debridements, mentioned by 44% of respondents. Regarding burn survival, the most commonly cited estimated mortality rate was 10-29%, mentioned by 45% of respondents, with infection and delayed presentation being reported as most common causes of death by 46% and 27% of respondents, respectively. Closed wound care predominated in this context, with open wound care being reserved for facial and perineal burns. Sixty-three percent of respondents reported initiation of antibiotics on admission, while only 34% reported the practice of early excision in their center. The majority of respondents reported that their center is involved in research (61%) and burn training for staff (66%) but less than half provided burn training for staff at district hospitals (43%) or participated in community outreach (43%). Sixty-two percent of respondents were not aware of any public health policies for burn prevention in their countries and 91% of respondents did not believe their government provides adequate funding for burn care. CONCLUSION: While much work remains to be done before a full picture of the status of burn care in Africa is obtained, this paper provides an initial view into the challenges and opportunities faced by burn care providers across the continent. Our survey shows that despite availability of facilities, specialized providers, and treatment protocols, accepted standards of antibiotic use and early burn excision have yet to be universally adopted. Furthermore, outreach, policy, and support for burn prevention are lacking. These barriers must be addressed to make evidence-based burn care in Africa a reality.Master of Public Healt