Developing a framework for prevention of childhood burn in a low-income country perspective : epidemiological appraisals

Childhood burn is a major issue in children's health in Bangladesh however it was not studies and documented systematically earlier. A comprehensive prevention programme is necessary to address this child health issue. Designing a community based prevention programme with adequate information about epidemiology, risk factors, social, cultural and economic factors and people's perception about the problem is necessary. This thesis attempted to determine the epidemiological features, the social and economic consequences and risk factors of childhood burn. It also explored the health seeking behaviour of parents and people's perception concerning burn and the issue of prevention. Six studies were carried out in this dissertation, four of which included a qualitative study using the data of the Bangladesh Health and Injury Survey (BHIS). A nested case control study was conducted by using the existing injury surveillance system of Centre for Injury Prevention and Research Bangladesh. Finally a framework for a childhood burn prevention programme for rural Bangladesh was designed based on the findings of both quantitative and qualitative studies. The first study enabled us to calculate the incidence of childhood burn and it's relation with age, sex and place of residence. The incidence of burn among children less than 18 years was 288,1 per 100,000 children with the highest rate among the 1 to 4 years age group at 782.1 per 100,000 children. This study also revealed the place of occurrence, time and cause of childhood burn in Bangladesh. The second study enabled us to learn social and economic consequences of childhood burn. It explored the hospitalization rate, hospital stay, workdays lost/scholl days lost and permanent disability due to childhood burn injury. The rate of permanent disability was found to be 5.7 per 100,000 population year. The average direct expenditure incurred by a family for treatment of severe burn was determined to be USD462 which was more than their annual income. The third study illustrated how the parents seek health care for their children after a burn injury and how health seeking behaviour varies with the economic condition of the family, parents' education, family size, birth order of children and gender of the children. About 60% of parents seek health care from unqualified service providers for their children during a childhood burn injury. The fourth study determined the relationsships of childhood burn with the type of cooking area at home, use of traditional kerosene lamp and type of family. Children were at significantly higher risk of burn in families who did not have a separate kitchen in their home. The fifth study looked into people's beliefs, emotions and judgements about childhood burn injuries, people's perception about place, time and cause and prevention of childhood burn. Finally, the sixth study provided a framework for a childhood burn prevention programme for rural Bangladesh. In conclusion the thesis illustrated the high incidence of childhood burn in Bangladesh. The thesis demonstrated consequences, risk factors and characteristics of childhood burn. It explored the health seeking behaviour of parents and people's perception about child burn and its preventive issues. Finally considering all this information a frame-work for childhood burn prevention programme was developed for rural Bangladesh, which can be replicated in countries with similar socio-cultural conditions

Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh

© 2018 The Author(s). Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred. Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes. Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above. Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful

Response to an Earthquake in Bangladesh: Experiences and lessons learnt

A powerful earthquake occurred in Nepal on 25th April 2015 where the highest measure of the tremor was 7.9 on the Richter scale with a minimum of 6.6. The death toll was around 3000 and thousands were injured in the devastation of the disaster. The earthquake and subsequent earth tremors were also felt in other South East Asian countries including Bangladesh, India and China. Bangladesh was jolted twice by tremors and, although the tremor was not as severe, it was reported to be between 4 and 5 on the Richter scale. Aftershocks over the next few days were also experienced and these ranged around 5 on the Richter scale. In Bangladesh, six lives were lost, and more than 200 people were injured and were taken to hospital. There were also many buildings that collapsed in the mega city Dhaka and its surrounding areas. This study describes the country’s response to the earthquake. This experience and the lessons learnt highlight the importance for national earthquake-proof building regulations and systems to lessen the damage and devastation of any future earthquake

Exploration of gaps and challenges in managing burn injury at district and sub-district government health care facilities in Bangladesh

Background: Burn injury is one of the leading cause of mortality and morbidity worldwide. In developing countries like Bangladesh, burn is one of the leading causes of illness, disabilities and deaths. More than 365,000 people are injured every year by electrical, thermal and other causes of burn injuries where 27,000 people needed hospital admission and over 5600 people died. Emergency management of burn at the facility level can reduce the severity of burn injuries and improve overall survival. The study has explored the health care providers’ views on gaps and challenges in management of burn injury at the facilities district and sub district health facilities in Bangladesh. Methodology: A qualitative study was conducted during the period in July 2015. In-depth interviews (n = 19) were performed with the doctors and nurses working in the three district government hospitals and seven sub-district (upazila) government health facilities. Thematic analysis was performed on different themes. Results: Health care providers mentioned that the people are coming to the facilities usually, hours after the incidence. Before visiting the facilities, the burn victims mostly seek treatment from the traditional healers or form village doctors (quack) or from the local pharmacy, over the counter. Family waited until they felt that the patient may not survive. It has identified that delaying in decision making and transferring the patient to the health facility are the key challenges identified by the doctors and nurses when they attended any burn patients in their facility. Moreover, use of different traditional infectious agent in burnt areas from their home make the burn surface more damage. While as, deficiency of adequate supplies, logistics and adequate trainings for the health workers in the facility create much more difficulties to treat a burn patient at primary or secondary health care centers. Conclusion: Burn patients are maltreated in the community before coming to the healthcare facility in most of the cases. The community has misperceptions on burn management which delay the proper management in the facility. Readiness of the facility on the other hand is a big challenge. In order to consistent in burn care in Bangladesh, its equally important to build knowledge and awareness among the community on burn prevention and their role. Like this, readiness of the facilities in time will build confidence in community, thus in turns, will save thousands of lives from burn injury in Bangladesh

Socioeconomic inequality in child injury in Bangladesh – implication for developing countries

<p>Abstract</p> <p>Background</p> <p>Child injury is an emerging public health issue in both developed and developing countries. It is the main cause of deaths and disabilities of children after infancy. The aim of this study was to investigate the socioeconomic inequality in injury related morbidity and mortality among 1–4 years children.</p> <p>Materials and methods</p> <p>Data used for this study derived from Bangladesh Health and Injury Survey. A multistage cluster sampling technique was conducted for this survey. In this study quintiles of socioeconomic status were calculated on the basis of assets and wealth score by using principle component analysis. The numerical measures of inequality in mortality and morbidity were assessed by the concentration index.</p> <p>Results</p> <p>The poorest-richest quintile ratio of mortality due to injury was 6.0 whereas this ratio was 5.6 and 5.5 for the infectious diseases and non-communicable diseases. The values of mortality concentration indices for child mortality due to infection, non-communicable diseases and injury causes were -0.40, -0.32 and -0.26 respectively. Among the morbidity concentration indices, injury showed significantly greater inequality. All the concentration indices revealed that there were significant inequalities among the groups. The logistic regression analysis indicated that poor children were 2.8 times more likelihood to suffer from injury mortality than rich children, taking into account all the other factors.</p> <p>Conclusion</p> <p>Despite concentration indices used in this study, the analysis reflected the family's socioeconomic position in a Bangladesh context, showing a very strong statistical association with child mortality. Due to the existing socioeconomic situation in Bangladesh, the poor children were more vulnerable to injury occurrence.</p

The Horizon of Unintentional Injuries among Children in Low-Income Setting: An Overview from Bangladesh Health and Injury Survey

Introduction. The paper aims to explore the magnitude and distribution of unintentional injuries among Bangladeshi children (<18 years). Methodology. A cross sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising of 351 651 children of under 18 years. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results. There were 351651 children in the study, of which 5577 had one or more injuries in the past one year. Drowning and falls was the leading cause of injury mortality and morbidity in children over 1 year of age respectively. Incidence of unintentional injuries was significantly higher among boys (95% CI = −2157.8) than girls (95% CI = 968.7 − 1085.8) while rural children were the most vulnerable group. Home and its premises was the most common place for the injury incidence. Conclusion. The result of the study could be an insight to the policy makers to develop realistic and effective strategies to address the issue

Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics

Objective: The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries. Methods: A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0–18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information. Results: About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children. Conclusion: Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parent's education a national burn prevention program needs to be developed to combat the devastating child injury, burn

Consequences of childhood burn: Findings from the largest community-based injury survey in Bangladesh

In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10– 14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be $462. In this study it was found that more than 61$50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority

Applying quality improvement methods to neglected conditions: Development of the South Asia Burn Registry (SABR)

Objective: South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.Results: The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients

Protocol to develop sustainable day care for children aged 1-4 years in disadvantaged urban communities in Dhaka, Bangladesh

INTRODUCTION: Lack of safe, stimulating and health-promoting environments for children under-5 hinders their physical, social and cognitive development, known as early childhood development (ECD). Improving ECD impacts on children, and can improve educational attainment for girls, who often care for younger siblings, and employment prospects for mothers. Developing and evaluating the impacts of ECD programmes within childcare needs to assess a range of social, health, educational and economic impacts, including women's empowerment.Children living in slums are at high risk of poor early development and holistic, sustainable interventions are needed to address ECD in these contexts. This study will be undertaken in Dhaka, Bangladesh, a city where over 8.5 million inhabitants live in slums. In collaboration with government, non-governmental organisations and communities, we are developing and testing a sustainable day-care model for low-income communities in Dhaka. METHODOLOGY AND ANALYSIS: A sequential mixed methods approach is being used in the study, with qualitative work exploring quantitative findings. Two hundred households with children under-5 will be surveyed to determine day-care needs and to assess ECD (parent-reported and direct assessment). The feasibility of four ECD measuring tools Caregiver-Reported Early Development Index, Measuring Early Learning Quality and Outcomes, The Early Human Capability Index and International Development and Early Learning Assessment will be assessed quantitatively and qualitatively. Qualitative methods will help understand demand and perceptions of day care while mothers work. Participatory action research will be used to develop a locally appropriate and potentially sustainable model of day care for under-5 children. A ward in the south of Dhaka has been selected for the study as this typifies communities with slum and non-slum households living next to each other, allowing us to explore potential for better-off household to subsidise day care for poorer households. ETHICS AND DISSEMINATION: Findings will be published and inform decision makers at the national, regional and the local actors in order to embed the study into the policy and practice on childcare and ECD. Ethical approvals for this study were obtained from the School of Medicine Research Ethics Committee at the Faculty of Medicine and Health at the University of Leeds (ref: MREC16-106) and the Bangladesh Medical Research Council (ref: BMRCAIREC/20 I 6-20 I 9 I 250)