Burns in Sri Lanka: analysis of pattern of burns and initial management steps of patients admitted with burns to Teaching Hospital Kandy

Introduction –Sri Lanka has emerged as a LMIC with an urban to rural population distribution of approximately 25% to 75%. In rural areas, due to lack of electricity or its inconsistent supply and cost of gas, cooking is often on open hearths and lighting is by use of kerosene oil lamps. With its unique sociocultural, religious and economic inequalities, there is a scarcity of information on the incidence, causes and outcomes after burn injuries. There is one designated “burns” unit at the National Hospital, Colombo- capital city in the Western Province, one of the nine provinces in the country.ariables more than clinical aspects and ths the necessity to have more regional units This preliminary survey was to obtain reliable data on the epidemiology of burns victims, pattern of burn, the circumstances associated with the injury and management steps carried out during the initial period. This was to reduce the incidence or prevent burn injuries and to establish a unit for care of patients with burns in Kandy, at the second largest hospital in Sri Lanka. Methodology -A prospective observational study was carried out among all patients admitted to Teaching Hospital, Kandy with burn injuries over a period of six months. Data was collected using a pre tested questionnaire, completed by the investigators. Results –Of the 46 victims of burn injuries, majority were females (74%, p<0.05) and 50% were between the ages 18 -55years. Majority were ethnic Sinhalese (69%). Over half of the patients (52.2%) reaching Kandy Hospital were transferred from satellite hospitals. Most of the burns were accidental (n= 43,93.5%) and 82% were in households. Highest proportions were caused by thermal burns (n= 42, 91.3%), while flame burns caused 54.4 %. Electrical and chemical burns were rare. Cooking related incidents accounted for 65% of the incidents of flame burns. Fifty percent of the adults (n=23) and 83% (n=5) of children less than 12 years sustained major burn injuries. Twenty four percent sustained facial burns and 10.8%(n=5)- inhalational injuries, seven patients (25%) required endo-tracheal intubation and management in an intensive care unit. Over 64% (18) of the patients had not received any form of local first aid care for the injury. Analgesics were administered to all patients. The burnt areas were left uncovered until surgical dressings were applied at Kandy Hospital. The Parkland formula was utilized to calculate the volume of fluid in majority (> 67%) of the patients (p=0.17). Silver sulfudiazine (n=15,53.6%) was the commonest local application used. All patients received antibiotics. Hypothermia prevention strategies were not implemented on a significant majority of victims (92.8%,p<0.05). Conclusion -Predominant proportion of patients admitted Teaching Hospital Kandy were adult females who suffered house hold accidental flame burns, many of them being classed as major. Awareness programmes need to be planned and implemented to improve knowledge on prevention, first aid and initial management of burns for general public and health care workers serving in peripheral hospitals. There is a need for specialized burns unit at the Teaching Hospital Kandy.