burns 45 (2019) 957 –963

Available online at www.sciencedirect.com

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journal homepage: www.elsevier.com/locate/burns

Epidemiology and outcomes of burn injuries at a

tertiary burn care center in Bangladesh

M.E. Bailey a,b, * , H.K.R. Sagiraju b, S.R. Mashreky c , H. Alamgir d

a
School of Medicine, University of Texas Health Science Center San Antonio, 7733 Louis Pasture San Antonio, TX 78229,
USA
b
The University of Texas School of Public Health, 7411 John Smith Dr, #1100 San Antonio, TX 78229, USA
c
Centre for Injury Prevention and Research, Bangladesh (CIPRB), House # B-162, Road # 23, New DOHS, Mohakhali,
Dhaka, 1206, Bangladesh
d
New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA

article info abstract

Article history: Globally, burns are among some of the most devastating injuries and account for more
Accepted 13 December 2018 than 265,000 deaths worldwide. In Bangladesh alone, nearly 3000 people die annually
from burn-related injuries. This study was conducted at the National Institute of Burn
and Plastic Surgery in Dhaka, Bangladesh in June of 2016. Data included conducting
surveys of hospitalized burn patients (N = 66) and a chart review of deceased burn
Keywords: patients (N = 88). In addition to reporting on the demographic profile of patients,
Burns information was also obtained on clinical measures during hospitalization. For non-
Bangladesh fatal burns, high risk groups included young adult males (early 30s) of lower
Epidemiology socioeconomic status. Among children, the most vulnerable group was found to be
Prevention children less than eight years old. The most common non-fatal types of burn injuries
were flame (35%), electrical (31%) and scald (24%). Discharged patients had an average
hospital stay of around 30 days with half of all patients requiring surgical intervention,
thus indicating the severity of those cases and the need for resource-intensive care.
Among the discharged patient population, factors significantly associated with a longer
duration of hospital stay included severity of injury, not having received prior
treatment before admission and whether or not patients required surgery during
hospitalization.
Among the mortality cases, the high-risk groups also included young adult males and
children of around eight years of age. The average total body surface area (TBSA) sustained in
these cases was 46.4%, with 65% of deaths attributable to complications from flame burns.
These findings highlight the frequency and severity of burn injuries, identify vulnerable
population groups and list common causes of burns in this large developing country of
160 million people. Furthermore, these findings may be applicable to the epidemiology and
outcome of burns in similar low and middle income countries.
Published by Elsevier Ltd.

* Corresponding author at: Department of Internal Medicine, The University of Arizona, 1501 N. Campbell Ave Tucson, AZ, USA.
E-mail address: [email protected] (M.E. Bailey).
https://doi.org/10.1016/j.burns.2018.12.011
0305-4179/Published by Elsevier Ltd.

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958 burns 45 (2019) 957 –963

nature, etiology and risk factors for such injuries. Therefore,

1. Introduction
this study aims to identify the characteristics of populations
who have sustained severe burns and to describe the 60-day
The World Health Organization (WHO) reports that burn outcomes of such patients who received care from a tertiary
injuries account for an estimated 265,000 deaths annually [1]. care center. Length of stay was used as a primary outcome of
In addition to inflicting substantial mortality, millions of non- interest, as this is an indicator of injury severity and use of
fatal cases often leave people with lifelong disabilities and resources [14].
disfigurements. In 2013, such injuries accounted for an
average of 12.3 disability adjusted life years per person [2].
Lack of access to appropriate clinical care and the inability to 2. Methods
subsequently integrate burn victims back into their commu-
nities, creates an enormous social and economic burden for This cross-sectional study was conducted at the National
these victims and their family members. Progress has been institute of Burn and Plastic Surgery at Dhaka Medical College
made in high income countries to reduce the morbidity and Hospital (DMCH) from May 26, 2016 to June 22, 2016. Data were
mortality resulting from burn injuries, however, many of these collected from patients who had been admitted to the hospital
advances in care and rehabilitation have not been translated to for inpatient burn care during that month and who had either
low- and middle-income countries (LMICs) even though nearly been discharged home in stable condition or had succumbed to
90% of all burn injuries occur in LMICs [3]. Despite the emerging their injuries during that time period. Inclusion criteria were
and growing evidence on improved burn care management in defined as any patient who had sustained any burn injury
high-income countries, few studies in LMICs have been requiring hospital admission to DMCH, who could provide
conducted to characterize the epidemiology of burns with consent and who was either discharged or had expired during
respect to cause, type and severity, as well as on provisions of the time of data collection. IRB approval was obtained from
hospital care or assessment of outcomes. Given that burns are both the University of Texas Health Science Center San
largely classified as unintentional in many LMICs, social Antonio and the Centre for Injury Prevention and Research
awareness of burn prevention and fire safety measures is low. in Bangladesh (CIPRB). Written consent was obtained from
In addition, cost-effective and practical interventions imple- each participant; for children under the age of 18, consent was
mented in high-income countries to reduce such risks have obtained from the child’s parent or guardian. Verbal transla-
not been disseminated to the policy makers, health care tion of both the consent form and the survey were provided by
practitioners and public health advocates of LMICs. medical physicians who were fluent in both English and
Despite the fact that 40% of world’s burn injuries occur Bengali. Surveys were administered on the day of hospital
exclusively in South and Southeast Asia, few studies have been discharge and included demographic information in addition
conducted in this region regarding burn epidemiology. In to information regarding basic burn injury causes and types.
India, over a million people suffer moderate to severe burns All other information detailing hospital complications, length
each year [1]. In Nepal, burns continue to be the third most of stay, outcomes, etc. were obtained via chart review.
frequent cause of injury and are one of the leading causes of The survey tool used was originally developed by Johns
disability-adjusted life-years [1,2]. Studies conducted in Hopkins University as part of their South Asia Burn Registry
Bangladesh, Colombia, Egypt and Pakistan show that 17% of (SABR) and modified and abbreviated by our research team for
children affected by burns each year are afflicted with this specific study. Total body surface area (TBSA) was
temporary and permanent disability [1,4–6]. In Bangladesh, determined via the Lund-Browder chart for both children
more than 3000 people die annually from burn injuries alone and adults. Burns were further classified as mild (superficial),
[1]. Burns affect men, women and children; however, prior moderate (partial thickness) or severe (full thickness) accord-
research indicates that young women [17–35] tend to be the ing to the standards set forth by the American Burn
victims of unintentional burns [7,8], while men are more Association [15,16].
susceptible to unintentional burns within the workplace, and In addition to data collected from discharged patients, a
children are largely at risk for unintentional burns within the chart review was conducted on burn patients who expired
home [9,10]. Studies have indicated that at risk populations during that month using the death registry of the hospital.
within Bangladesh include women of low socioeconomic Data for this group was limited to patient age, gender, type of
status who work in the kitchen with cooking fires and kerosene burn, TBSA of burn and cause of death. For the discharged
lamps [4,11]. Previous studies [4,11–13] have identified certain group, more complete data were available to report on income,
population groups to be at high risk of burn injuries within gender, occupation, burn severity and place of injury. All data
LMICs, however research investigating short-term outcomes were recorded manually and then entered electronically into
of patients who sustained serious burn injuries and describing Excel. Stata version 14.0 for Windows (Stata Corp., College
care provisions in tertiary hospitals is limited. Station, TX) was used for analyses. Once data were de-
Bangladesh, with its population of 163 million, has only one identified, it was assessed for quality by investigating
tertiary burn care center: The National Institute of Burn and duplicates, out of range values, and missing data. An initial
Plastic Surgery at Dhaka Medical College Hospital. Therefore, it descriptive analysis of all the variables was performed.
receives a wide range of patients from across the country who Univariate and multivariate log linear regression models were
have sustained burn injuries requiring a higher level of care. used to assess the factors associated with the length of
Despite the high incidence of burns in Bangladesh, very few hospital stay. As the length of hospital stay was not normally
studies have attempted to comprehensively characterize the distributed, a log transformed variable was used for the linear

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 burns 45 (2019) 957 –963 959

regression models. Small sample size limited the number of vs 25.3 (21.8) days]. Average length of hospital stay for
variable that can be included in the multivariate regression the deceased group were similar for both children and adults
model. Hence it was only limited to clinical characteristic (6.7 days).
variables which are our major study variables of interest. Type Table 2 presents the data categorized by burn type. Patients
of burn which was not significantly associated in the with flame burns had a mean age of 25.9 years and were
univariate regression was not included in the multivariate predominantly male (61.9%). Nearly 33.0% of flame burns were
regression model. Demographic variables such as gender, sustained during domestic chores, whereas 33.0% occurred
marital status and family income which were not significant in during recreational activities and 28.6% during activities
the univariate analysis were not included in the multivariate involving work outside home. Flame burns also had the
regression analysis, except for age category. Coefficients from longest hospital stay [mean (SD): 31.7 (40.8) days]. Children
the regression analysis were given in Tables 3 and 4 and should were primarily affected by scald burns [mean age 14.0 years,
be interpreted as percent change in the duration of the hospital 57.1% male]. About 78.6% of scald burns were sustained at
stay for the given category compared to the reference category home. Electrical burns were more common among males [80%
for categorical variables and as percent change in duration of with a mean age of 20.1 years]. Approximately 36% of electrical
hospital stay for one unit increase in continuous variables. burns were sustained at a workplace and 32% occurred within
the home. With regards to burn severity, patients with minor
burns were predominantly male [61.5%; mean age 27.1 years].
3. Results Patients with minor burn injuries required a mean hospital say
of 16.1 days. Moderate burns mostly occurred among males
Data were collected from 66 discharged patients and 88 de- [68.0%; mean age of 19.95 years] with an average hospital stay
ceased cases. Table 1 summarizes the characteristics of these of 32.6 days. Patients with severe burns were also predomi-
two population groups by age. The results are stratified for nantly male (75.0%) with an average age of 17.86 years and an
children under the age of 18 and adults in order to delineate the average hospital stay of 37.1 days. The majority (>50%) of
differences in burn epidemiology. Mean age of discharged and patients in all categories of burn type and severity were of low
deceased adults patients were 32.2 (10.1) and 35.1 (13.7) socioeconomic status with a monthly income of less than
years respectively. Mean age of discharged and deceased 10,000 takas ($124 USD).
children were 8.5 (5.9) and 8.7 (5.9) years respectively. The Table 3 demonstrates the univariate linear regression
majority of patients in both groups were male. Flame burns analysis on the length of hospital stay as the outcome variable
contributed to the largest proportion of mortality among both among the discharged alive (n=66) patients. Severity of injury,
adults (67.2%) and children (55%). Among the discharged having received a surgery during hospital stay and having
group, scald burns were more common in children (37.5%) received prior treatment prior to hospitalization were signifi-
while flame (42.4%) and scald burns (39.4%) contributed to cantly associated with length of hospital stay. Patients with
more injuries sustained by adults. About half of all children severe burns had a 51% longer hospital stay compared to those
and 36.4% of adults suffered severe burns within the dis- with mild or moderate burns. Patients who received treatment
charged patient group. In the discharged group, adults had, on prior to hospitalization to this tertiary care center had a 62%
average, a longer hospital stay than children [36.9 (30.3) days shorter duration of stay in this hospital compared to those who

Table 1 – Demographic and clinical characteristics of the sample by age group.

Discharged (n=66) Deceased (n=88)

Children Adult Children Adult

<18years (N =32) 18 or above (N =33) <18years (N =20) 18 or above (N =67)
Age in years (M (SD)) 8.5 (5.9) 32.2 (10.1) 8.7 (5.9) 35.1 (13.7)
Gender
Female (% (n)) 25% (8) 36.4% (12) 35% (7) 35.8% (24)
Male (% (n)) 75% (24) 63.6% (21) 45% (9) 49.3% (33)
Unknown (% (n)) 20% (4) 14.9% (10)
Type of Burn
Flame (% (n)) 21.9% (7) 42.4% (14) 55% (11) 67.2% (45)
Electrical (% (n)) 12.5% (4) 6.1% (2) 10% (2) 3% (2)
Scald (% (n)) 37.5% (12) 39.4% (13) 5% (1) 22.4% (15)
Other (% (n)) 28.1% (9) 12.1% (4) 30% (6) 7.5% (5)
Severity of burn
Minor (% (n)) 12.5% (4) 27.3% (9)
Moderate (% (n)) 37.5% (12) 36.4% (12)
Major (% (n)) 50% (16) 36.4% (12)
TBSA (M (SD)) 14 (11.8) 14.9 (11.7) 39.5 (19.9) 48.3 (21.6)
Length of hospital stay (M(SD)) 25.3 (21.8) 36.9 (30.3) 6.7 (5.8) 6.7 (9.7)

Notes: Percentages are column percentages.

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960 burns 45 (2019) 957 –963

Table 2 – Demographic and clinical characteristics by type of burn injury.

Discharged Deceased

Flame Electrical Scald Other Flame Electrical Scald Other

Total [%(n)] 31.8% (21) 37.9% (25) 21.2% (14) 9.1% (6) 64.8% (57) 18.2% (16) 12.5% (11) 4.6% (4)
Age category
Child (% (n)) 33.3% (7) 48% (12) 64.3% (9) 66.7% (4) 19.3% (11) 6.3% (1) 54.6% (6) 50% (2)
Adult (% (n)) 66.7% (14) 52% (13) 28.6% (4) 33.3% (2) 79% (45) 93.8% (15) 45.5% (5) 50% (2)
Unknown (% (n)) n/a n/a 7.1% (1) 0% (0) 1.8% (1) 0% (0) 0% (0) 0% (0)
Gender
Female (% (n)) 38.1% (8) 20% (5) 42.9% (6) 16.7% (1) 42.1% (24) 6.3% (1) 45.5% (5) 25% (1)
Male (% (n)) 61.9% (13) 80% (20) 57.1% (8) 83.3% (5) 38.6% (22) 81.3% (13) 45.5% (5) 50% (2)
Unknown (% (n)) 0% (0) 0% (0) 0% (0) 0% (0) 19.3% (11) 12.5% (2) 9.1% (1) 25% (1)
Severity of burn
Minor (% (n)) 14.3% (3) 20% (5) 28.6% (4) 16.7% (1) n/a n/a n/a n/a
Moderate (% (n)) 38.1% (8) 32% (8) 42.9% (6) 50% (3) n/a n/a n/a n/a
Major (% (n)) 47.6% (10) 48% (12) 28.6% (4) 33.3% (2) n/a n/a n/a n/a
TBSA % (M (SD)) 8.7 (17.3) 14.6 (13.4) 7.7 (10.9) 13.1 (16) 20.6 (50) 15.2 (37.6) 22 (35) 32.3 (62.3)
Length of Hospital Stay % (M (SD)) 31.7 (40.8) 25.5 (33.4) 11.6 (13.4) 23.1 (26.7) 7 (5.9) 14.7 (8) 6.1 (8) 11.4 (9)
Education
None 9.5% (2) 12.0% (3) 21.4% (3) 0.0% (0) n/a n/a n/a n/a
Middle 57.1% (12) 40.0% (10) 21.4% (3) 50.0% (3) n/a n/a n/a n/a
High 14.3% (3) 28.0% (7) 0.0% (0) 16.7% (1) n/a n/a n/a n/a
Other 19.1% (4) 20.0% (5) 57.1% (8) 33.3% (2) n/a n/a n/a n/a
Income
<10,000 61.9% (13) 64% (16) 57.1% (8) 83.3% (5) n/a n/a n/a n/a
10,000 28.6% (6) 28% (7) 35.7% (5) 16.7% (1) n/a n/a n/a n/a
Unknown (% (n)) 9.5% (2) 8% (2) 7.1% (1) 0% (0) n/a n/a n/a n/a
Occupation
None 4.8% (1) 4% (1) 57.1% (8) 16.7% (1) n/a n/a n/a n/a
House wife 19.1% (4) 0% (0) 28.6% (4) 0% (0) n/a n/a n/a n/a
Laborer 14.3% (3) 20% (5) 0% (0) 33.3% (2) n/a n/a n/a n/a
Student 23.8% (5) 44% (11) 0% (0) 0% (0) n/a n/a n/a n/a
Other 28.6% (6) 24% (6) 14.3% (2) 33.3% (2) n/a n/a n/a n/a
Unknown (% (n)) 9.5% (2) 8% (2) 0% (0) 16.7% (1) n/a n/a n/a n/a
Place of injury
Home 52.4% (11) 36.0% (9) 78.6% (11) 33.3% (2) n/a n/a n/a n/a
Work 19.1% (4) 32.0% (8) 7.1% (1) 66.7% (4) n/a n/a n/a n/a
Other 19.1% (4) 24.0% (6) 0.0% (0) 0.0% (0) n/a n/a n/a n/a
Unknown 9.5% (2) 8.0% (2) 14.3% (2) 0.0% (0) n/a n/a n/a n/a
Surgery required 61.9% (13) 60% (15) 14.3% (2) 50% (3) n/a n/a n/a n/a

Notes: Percentages are column percentages.

For education, middle is defined by up to completion of primary school. High is defined as up to completion of secondary school. Other includes
categories such as college or graduate school.

did not receive any care at other clinics. Having required a occurred during hospitalization) can be influenced by demo-
surgery during hospitalization was associated with signifi- graphic factors, burn type and severity of burn injuries. Age
cantly longer length of stay (134% increase). These factors and gender were both found to be related to the types of burns
remained significantly associated with duration of hospital sustained. The majority of patients had low education and
stay when adjusted in multivariate models for age, place of income. Most had at or below a sixth-grade education level as
injury and time to hospital admission from initial injury well as monthly income was only about 10,000 takas
(Table 4). Adults had a significantly longer (46% increase) ($124 USD). Since this study was conducted at the only tertiary
hospital stay compared to children when adjusted by burn center in Bangladesh, which is a government-run public
other factors. facility, patients of low socioeconomic status were likely to be
over-represented in this study. However, previous studies
indicate that population with lower socioeconomic status who
4. Discussion live in rural communities are more vulnerable to burn
injuries [3,4,12,13].
This study seeks to contribute to the current understanding of Flame burns were found to correlated with higher mortali-
how certain demographic and socioeconomic groups remain ty, in addition to resulting in the longest duration of hospital
at high risk for burn injuries. In addition, it highlights how stay. Over half of all flame burns occurred at home. One third of
short-term outcomes (defined as within 60days and having injuries were sustained by women during activities involving

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 burns 45 (2019) 957 –963 961

Table 3 – Univariate analysis of log transformed length of hospital stay.

Variable Exp (coefficient) 95%CI p-Value
Type of burn (Ref: other)
Flame 1.56 0.65 3.7 0.312
Electric 1.34 0.57 3.14 0.495
Scald 0.56 0.22 1.39 0.207
Severity (Ref: mild/moderate)
Severe 1.66 1.02 2.69 0.040
Age Category (Ref: children <18yrs)
Adult 1.35 0.83 2.22 0.226
Gender (Ref: female)
Male 1.28 0.75 2.18 0.361
Marital status (Ref: other)
Married 0.67 0.38 1.18 0.163
Family income (Ref:<10K Takas)
10 K to 30K 1.11 0.61 2.03 0.731
30 K to 50K 0.75 0.22 2.57 0.647
Work related injury (Ref: No)
Yes 0.81 0.48 1.35 0.410
Surgery during hospitalization (Ref: no)
Yes 3.82 2.66 5.49 <0.001
Time since injury (days) 1.01 0.99 1.02 0.353
Received prior treatment (Ref: No)
Yes 0.54 0.33 0.87 0.012

Table 4 – Multivariate analysis of log transformed length of hospital stay.

Variable Exp (coefficient) 95%CI p-Value
Severe injury (Ref: mild/moderate) 1.58 1.10 2.28 0.015
Adults (Ref: children <18yrs) 1.58 1.09 2.29 0.017
Work related injury (Ref: other) 1.12 0.73 1.71 0.595
Surgery during hospitalization 3.01 2.07 4.39 <0.001
Time since injury (days) 1.00 0.99 1.01 0.607
Received prior treatment 0.63 0.42 0.95 0.028

cooking and meal preparation, and one third were sustained young children. Previous studies indicate that community-
by children under age five while at home. Previous studies also based interventions focused on home interventions as
indicate that among adult women, flame burns most com- detailed above, have been shown to be effective for reducing
monly occurred while cooking in the kitchen [15], and scald burns in children [24].
produced the highest mortality rates in Bangladesh [3], Kuwait Electrical burns were also found to be a large contributor to
[17], Iran [18] and India [19]. Population-based studies in patient mortality. Patients with electrical injuries resulted in
Bangladesh also indicate that flame burns account for a large the second longest hospital stay (at 25.5 days), with an average
proportion of burn injuries among children under age five of 60% of patients requiring surgical intervention. With regards
within the home [3]. Nearly three-quarters of adult patients to demographics, burn injuries occurred primarily in working
with flame burns had at or below a sixth-grade education level adult men as well as school-aged children. This study showed
and 76% were of low socioeconomic status. that two-thirds of all electrical injuries occurred outside home
Scald burns were found to contribute to morbidity among among both men and children. Therefore, interventions
young children not only in Bangladesh but in other LMICs should primarily focus on targeting city infrastructure includ-
[3,6,21,22]. Subjects were young, with a significant proportion ing powerline safety. However, it is worth noting that more
of injuries occurring in children under the age of five. Nearly severe injuries were common among adult males. The
79% of all scald burns occurred within the home, with greater increased severity of burn injuries in men is possibly due to
than half taking place during domestic activities such as the predominance of occupational-related high voltage elec-
cooking and eating. Typical Bangladeshi cooking includes trical injuries. High voltage electrical burns can have a number
boiling large quantities of rice, often resulting in standing pots of severe sequlae including amputation, multi-organ damage
of boiling rice water set on the floor which can easily spill on and death [25–27] and can pose a significant burden on young
young children who are around. [3,20,23]. Therefore, inter- men in LMICs [28].
ventions should once again focus on educating families about Variables significantly affecting length of hospital stay
elevating cooking stoves and keeping hot food out of reach of included surgery during hospitalization, severity of burns and

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962 burns 45 (2019) 957 –963

whether or not the patient received burn care prior to hospital

6. Study limitations
admission. The latter was defined as whether or not wounds
were dressed prior to hospital arrival. As expected, more severe
burns and patients who required surgical intervention had on As this was a cross-sectional pilot study, study findings may
average a longer hospital stay, as severe burns are associated not be generalizable to all burn cases within this country. In
with longer healing times and complications such as sepsis and addition, the epidemiology of burns has been shown to vary by
skin graft failure [29]. In looking at interventions prior to seasons which, due to the short duration of data collection in
hospital care, outcomes appeared to be dependent on access to this study, might have been overlooked. However, when
care. Patients who were able to receive intervention prior to care compared to burn studies conducted in other LMICs, this
at this hospital had shorter hospital stays. Barriers to receiving study’s findings were mostly comparable and consistent with
care likely include a lack of reliable transportation, under- results from other studies. Thus, clear patterns are observed by
developed roads and highway infrastructure, inadequate population demographics and type of burns sustained.
nearby healthcare resource as well as a lack of specialized Limitations with regards to data collection also included an
burn centers in rural or other urban centers outside the capital inability to conduct historical data access and analyses owing
city. A global assessment of prehospital care in several LMICs to a lack of appropriate record keeping at this hospital. Small
also cited lack of reliable transportation, funding and absence of sample size also limited the number of variables that can be
legislative standards as primary barriers for a lack of prehospital modelled into the regression analysis and hence limit the
care in developing nations [30]. interpretation of the results and their generalizability. This
Although burn injury surveillance in Bangladesh is limited highlights an important need for improved systems of data
as there is no unified database for recording demographics and gathering via creating national burn registry and implement-
outcomes, recent efforts with the Global Burn Registry are ing standardized population-based surveys. In conjunction
attempting to collect data identifying risk factors and preven- with legislative support, active burn surveillance will hopeful-
tion strategies for mitigating burn injuries [20]. Bangladesh is ly allow for the evaluation of future or ongoing interventions
one of the most densely populated countries in the world and a and strengthen the country’s capacity to meaningfully reduce
substantial proportion of the population, both adult and the burden of burn injury.
pediatric, suffers from preventable burn injuries with a high
degree of morbidity and mortality. As nation with a relatively
high proportion of burn injuries within South Asia, burns in Author contributions
Bangladesh should be studied further. With improved injury
surveillance, interventions can target specific risk factors and All authors have made substantial contributions as detailed
tailor adequate prevention strategies. Therefore, in the case of below:
electrical burns, interventions should focus on preventative Morgan Bailey: study planning and design, data collection,
measures such as public education, training of laborers and data analysis and manuscript preparation.
infrastructural support to help increase powerline safely. Hari Krishna Sagiraju: conducting statistical analyses.
Enhanced life expectancy and improved quality of life after [email protected]
burn injury have been attributed to early acute management Siadur Mashreky: providing field level logistics, organizing
and long-term rehabilitation techniques in the developed data collection and survey review. [email protected]
world [31]. Many of the non-immediate consequences suffered Hasanat Alamgir: overall direction, planning and supervi-
by the individuals from burns do not occur from the injury sion of the study, manuscript preparation and final approval of
itself, but rather due the physical, social and economic barriers submitted manuscript. [email protected]
which exist in the society and workplace.

Funding
5. Conclusions
This study was supported by funding from the UT Health
The findings of this study mostly corroborate findings of Science Center San Antonio’s Global Health Program.
previous studies with respect to identifying high risk demo-
graphic groups [3,7–10]. Flame burns had the most severe
outcomes and highest mortality rate. A large proportion of Conflict of interest
burns among children occurred either within or just outside
home [3,32]. Research continues to identify high risk pop- The authors have nothing to declare.
ulations in other LMICs such as Pakistan [32], Nepal [3] and
India. Socio-economic risk factors for burn injuries in LMICs
also include poverty, education, income and occupation. Acknowledgements
However, prevention and early intervention should be priority
[33,34]. This study highlights the importance of having ongoing The authors would like to thank Dhaka Medical College
injury surveillance programs not only to understand the Hospital for allowing them to collect data at their institution,
morbidity and mortality patterns and trends of a preventable as well as Dr. Kimberly Vogelsang for assisting in on-site data
injury like burns, but also to develop and evaluate potential collection. In addition to Johns Hopkins University to let us use
interventions. their instrument.

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 burns 45 (2019) 957 –963 963

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