32 Food Security as a Predictor of Global Pediatric Postburn Mortality
Authors: Tiongco Rafael Felix , Ali Ayman , Puthumana Joseph , Hultman C Scott , Caffrey Julie , Redett Richard , Cooney Carisa 
Published: May 2023

Abstract

Introduction
Food security (FS) is defined as access to sufficient and nutritious food. Children are disproportionately affected by low FS. Globally, burns contribute to over 50% of the disability-adjusted life years lost among 0-14 year-old children. Given the significance of nutrition in postburn outcomes, we hypothesized that high FS would be predictive of decreased global postburn mortality in pediatric patients.

Methods
Publicly-available, deidentified datasets were obtained from the World Health Organization’s Global Burn Registry (GBR) and Corteva Agriculture’s Global FS Index (GFSI). The GFSI calculates a FS score annually from intergovernmental organization data reviewed by a panel of experts. FS score was reported on a scale from 0-100 with 100 indicating the highest FS. The GFSI also groups countries into “Good” (FS score ≥ 60) or “Moderate” (FS Score ≥ 40) FS environments (FSEs). Patients aged 0-19 years were included; after linking GBR and GFSI datasets, countries with &lt; 100 patients were excluded. Descriptive statistics and non-parametric tests were performed on data stratified by FSE. Multiple logistic regression controlling for %TBSA was used to predict mortality with FS score. All statistical analyses were conducted in R version 4.1.2.

Results
From 2016-2020, there were 2,246 cases over nine countries: Peru (n=839, 37.4%), Tanzania (n=290, 12.9%), India (n=225, 10.0%), Nigeria (n=195, 8.7%), Pakistan (n=181, 8.1%), Kenya (n=166, 7.4%), Nepal (n=145, 6.5%), South Africa (n=105, 4.7%), and Mexico (n=100, 4.5%). Median age was 3.0 [IQR 2.0, 7.0] years with 42.7% female. Median %TBSA was 15.0 [IQR 5.0, 25.0]%. Most injuries were by hot liquid, steam, or gas (n=1,457, 64.9%) followed by flame (n=560, 24.9%). There were 259 deaths (11.5%).
Stratified by FSE, 939 cases occurred in “Good” and 1,307 in “Moderate” FSE countries. More flame injuries occurred in Moderate (n=373, 28.5%) vs. Good (187, 19.9%, p&lt; 0.001) FSEs while more hot liquid, steam, or gas injuries occurred in Good (n=688, 73.3%) vs. Moderate (n=769, 58.8%, p&lt; 0.001) FSEs. Mortality was higher in Moderate (n=245, 18.7%) vs. Good (n=14, 1.5%, p&lt; 0.001) FSEs.
Regression analysis controlling for %TBSA showed increased FS score was associated with decreased odds of pediatric postburn mortality [multivariable OR 0.77 (95%CI 0.72-0.81), p&lt; 0.001]. Additionally, urban vs. rural patient residence was associated with decreased odds of postburn mortality [multivariable OR 0.36 (95%CI 0.16-0.85), p=0.015].

Conclusions
Our study shows that increasing FS score was associated with decreased odds of pediatric postburn mortality. Additionally, mortality and flame injuries were higher in Moderate vs. Good FSE-grouped countries. International efforts to increase FS may improve survival in pediatric burn patients.

Applicability of Research to Practice
Improving food security is an actionable item that may improve pediatric postburn outcomes regardless of the country’s FSE-grouping.