Epidemiology of fatal burns in rural South Africa: A mortuary register-based study from Mpumalanga Province
Introduction
In spite of the consequences on individuals, families and societies, and although considered as highly preventable, burns are still a much neglected public health problem in low and middle income countries.
The African region is among those where the highest mortality rates due to fire-related injuries are found, along with the Eastern Mediterranean region and after the South-East Asian one (with 6.1, 6.4, and 11.6 fire-related deaths per 100,000, respectively) [1]. There are several types of explanations as to why burn mortality and morbidity is high in Africa. Among others, people's living conditions are of importance, where the design of traditional dwellings, extensive use of open fires or flames (such as provided by kerosene stoves) for heating and cooking, and the growth of impoverished, densely populated living areas, are a source of concern [2], [3], [4]. To this can be added life style factors like alcohol use [2] and underlying health problems like anemia and malaria, the former increasing the risk of burn occurrence and the latter, the individual potential for recovery [4]. In this respect, problems related to healthcare services may come into play, including access to care due to long distances, poor transportation, and lack of adequate healthcare facilities, trained personnel and resources [4]. Poverty is a common denominator to many of these factors [2], [3], [4] and the current energy crisis in Africa is expected to aggravate the use of cheaper but more flammable heat sources further [5].
A number of South African studies on burns have been published in recent years. These are predominantly from Cape Town, Johannesburg and other more urban settings [2], [3], [9], [10], [11], [12], [13], [14], [15], [16], [17]. In 2004, the national burn mortality rate was estimated to be higher than that of the region (9.8 per 100,000) [7], as was the rate for the city of Cape Town for the years 2001–2004 (7.9 per 100,000) [2]. As an upper-middle-income country with one of the world's most unequal distributions of income, poverty has become more widespread in rural rather than urban areas of South Africa [6]. Epidemiological differences, concerning both the circumstances and the outcomes of burns, can be expected between urban and rural settings [18], [19], hence the need for greater examination of burns in rural South African settings.
Mpumalanga is the South African province with the third highest percentage of rural households (about 60%) and is considered to be predominantly rural [20]. It has three districts, of which two are on the South African highveld (a high plateau), and is therefore an interesting area for burn research due to varying geographical and climatic conditions, which may impact on the epidemiology of burns in low- and middle-income countries [21].
This study was hence embarked upon so as to investigate the epidemiology of fatal burns in Mpumalanga, considering their geo-demographic distribution, manner and location of occurrence, and temporal patterns.
Section snippets
Study design
The study is cross-sectional and register-based and deals with burn and electrocution fatalities registered in the National Injury Mortality Surveillance System (NIMSS) in Mpumalanga for the years 2007 and 2008.
Setting
Mpumalanga is one of South Africa's nine provinces, situated in the northeastern part of the country and has a population of 3.6 million inhabitants, representing about 7.4% of the South African population [22]. Poverty is a major factor in the province, although the poverty rate of
Results
The total number of fatalities for the years 2007 and 2008 was 304, with 33 of those being due to electrocution. A total of 86 cases were treated at hospital prior to death and a few received emergency care at scene.
Main findings
This study shows that the burn mortality rate in Mpumalanga during the study period is 3.8 per 100,000 population (age adjusted 4.8) and that the rate is highest among adults 55 years of age and older. High rates are also found among young children (0–4 years) of both genders and among males, 25 years and older. Of the three districts of the province, the highest burn mortality rates were found in Nkangala. The majority, over two thirds of fatal burns were classified as non-intentional, but as
Conclusions
In rural South Africa, there seem to be certain groups and areas that are more affected than others by fatal burns. Burn fatalities in Mpumalanga in particular are most common among older people or small children (under 5 years), adult males and in the Nkangala district. Whereas the rates in general are lower than in urban South Africa, higher proportions of intentional burns are of note.
For future preventive work, older people are of particular concern as they are by far the group at highest
Conflict of interest statement
The authors declare that they have no conflicts of interest.
Acknowledgements
Firstly, we would like to acknowledge the extensive work done by staff at the mortuaries in Mpumalanga and at the Safety and Peace Promotion Research Unit at Medical Research Council and University of South Africa in the collection, registration and the maintenance of data, on which this study was based. We would specifically like to thank Mariëtte Smith and Hilton Donson for methodological and technical support in the management of data.
We would also like to express our gratitude to the
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