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Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21.

Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries.

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Department of Surgery, University of California San Diego, San Diego, CA, USA. Electronic address:
Department of General Surgery, Brigham and Women's Boston Hospital and Medical Center, Boston, MA, USA.
Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Surgeons OverSeas, New York, NY, USA; Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Surgery, University of Washington, Seattle, WA, USA.



Low-and middle-income (LMIC) countries account for 90% of all reported burns, nevertheless there is a paucity of providers to treat burns. Current studies on burns in LMICs have not evaluated the gap between care seeking and receiving. This study explores this gap across socioeconomically similar populations in a multi-country population based assessment to inform burn care strategies.


The Surgeons OverSeas Assessment of Surgical Need (SOSAS) instrument is a cross sectional national, cluster random sampling survey administered in Nepal, Rwanda, Sierra Leone, and Uganda from 2011 to 2014. The survey identifies burn etiology, demographics, timing, disability, and barriers to receiving care.


Among 13,763 individuals surveyed, 896 burns were identified. Rwanda had the highest proportion of individuals seeking and receiving care (91.6% vs 88.5%) while Sierra Leone reported the fewest (79.3% vs 70.3%). Rwanda reported the largest disability while Nepal reported the highest proportion with no disability (47.5% vs 76.2%). Lack of money, healthcare providers, and rural living reduce the odds of receiving care by 68% and 85% respectively.


Despite similar country socioeconomic characteristics there was significant variability in burn demographics, timing, and disability. Nevertheless, being geographically and economically disadvantaged predict lack of access to burn care.


Barriers; Burn; Epidemiology; Global surgery; Low & middle-income countries; Population survey

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