Burn Injury prevention in Kenya and the world

Presentation at 6th Pan African Burns Congress in Abidjan – Cote D’Ivoire

Tuesday – 12th May 2015

Dr.Kimani WanjeriLecturer – Dept of Surgery, University of Nairobi

Joseph.wanjeri@uonbi.ac.keonejerry@yahoo.com

Introduction• 265,000 deaths are estimated to result from fire alone

every yr all over the world (does not include scalds, electrical and other types of burns)

• Many more are left disfigured, disabled & stigmatized• Over 90% of the world’s burn injuries occur in developing

countries • Injuries occur in homes, workplaces (Manufacturing,

Construction, Agriculture industries and Transport sector) • Public Health problem especially among the world’s poor

http://www.who.int/violence_injury_prevention/other_injury/burns/en/

Prevention is better than cure• The suffering caused by burns is tragic because

burns are so eminently preventable• The developed world has managed to reduce burn

mortality by; Proven prevention strategies Improvements in burn care

• Most of these intervention strategies have not been completely applied in Africa

• Objective of participants at the 6th Pan African Burns Congress (PABS) was principally to learn from one another and brainstorm/discuss on ways and means of rectifying this situation

Nairobi:Urbanisation/poor housing/& overcrowding results in burns

Kibera slum in Nairobi, KenyaLargest slum in Africa and 3rd largest in the world

Google map of Kibera slum in Nairobi

Causes of high burden of Burn Injuries

• Poverty• Urbanisation• Poor housing• Ignorance• Poor utilization of available resources• Emphasis on treatment and poor emphasis on

prevention

Burns vs other injuries

We can learn from studying strategies employed in the prevention of other injuries and especially; • Occupational injuries, • Road Traffic Accidents (RTAs)• Aviation industry accidents• Sports injuries

Strategies used for prevention of other injuries and diseases

• International Labour Organization (ILO) – Involved in promotion of occupational safety and health

• Has set aside the World Day on Safety and Health at work – observed annually on 28th Apr by ILO member states

• On this day; issues concerning safety and health at the workplace are discussed and awareness is created

Occupational safety strategies in Kenya(Ministry of Labour, Social Security and Services)

• National policy on Occupational Safety and Health

• Establishment of Occupational Safety and Health Institute

• Conference on Occupational Safety and Health held – During the world day on Safety and Health (28th April 2015)

• Occupational Safety and Health Awards (Awarded for first time on 28th Apr 2015)

Stages of injury prevention

• Surveillance• Analysis• Intervention & Evaluation• Education, Engineering & Enforcement

Approach to burn injury prevention

• Surveillance – Magnitude of burden determined

• Analysis – Risk factors identified• Intervention; Raise awareness,

promote/advocate for an environment that minimizes the risk of burn injury

• Evaluation

Surveillance; magnitude of burden

• Data – develop efficient burns data collecting systems

• Regular monitoring of patient numbers at institutional and national level

• Research on prevalence of burns

Analysis; Causes & Risk factors

Causes• Urbanisation• Poverty• Carelessness – homes,

industries and outside• Wrong handling of cooking

appliances• Inter-personal conflict• Crime• Terrorism• War

Risk factors• Overcrowding• Low level of education and

especially maternal education

• Race• Disease – Convulsive

disorders eg Epilepsy• Use of cheap fuels for

cooking (Kerosene)

Intervention

• Raise awareness• Promote/advocate for an environment that

minimizes the risk of burn injury eg advocate for minimum safe housing standards

Evaluation

• Clinical meetings• Health departments and ministries – Review

of statistics• Review of National statistics eg Kenya

Demographic Health Survey (KDHS)

Education, Engineering and Enforcement

• Education– Seminars– Workshops– Conferences/Congresses

• Safe homes and work places• Safe lighting & cooking appliances• Legislation eg

– Fire fighting appliances in homes, institutions & workplaces– Mandatory fire safety training for institutions and industries– Safe fire safety practices

How do we prevent burn injuries

• Raise awareness • Educate public on fire safety and burn injury

prevention• Make the home environment safe for children

especially – better housing/better planning of homes• Initiate hazard reduction programs for informal

settlements/slums • Resource centres for burn injury prevention• Create/build a culture of prevention of burn injuries

African countries with centres dedicated to injury control

• South Africa• Uganda – Injury Control Centre

http://www.cnis.ca/what-we-do/safer-communities-in-africa-program/icc-u/

Improve residential areas: eg Kibera slum upgrading project

What we are doing in Nairobi to help reduce burn injuries

• Burn Society of Kenya (BSK) Formed in 2014 and held its first scientific

meeting/symposium at the Boma Hotel in Nairobi on 25th October 2014

1st Annual General Meeting (AGM) of BSK – 25thApr 2015

• Partnership with Kenya Power Pension Fund Renovation of KNH Burns Unit & Plastic Surgery ward Burns awareness week in August 2015; Media to help raise

awareness, Speeches, Exhibitions and a Walk

• Plans for construction of a National Burns Centre

Ensuring fire safety within KNH Burns Unit

Challenges faced in burn injury prevention

• Lack of funding• Lack of manpower/Inadequate personnel• Poor governance• Political instability• Corruption• Culture/Cultural beliefs• Terrorism and warfare

Stakeholders• Health institutions• Ministries of Health• Pan African Burn Society (PABS)• Local burn societies• Interburns – Organizes Essential Burn Care Courses

& set up training centre for Africa at Korle Bu in Ghana

• International Society of Burn Injuries (ISBI)• World Health Organisation (WHO)• Non Governmental Organizations (NGOs) eg

– Injury Prevention Initiative For Africa (IPIFA)– Canadian Network for International Surgery (CNIS)

Lessons from the west• The American Burn Association – Has a prevention committee & Burn awareness

week (First full week of February)• Research - to inform burn prevention programs• Surveillance systems eg The National Electronic Injury Surveillance System (NEISS)• In Australia and New Zealand the fire department regularly educates the

community on fire safety• Support groups for burn injury prevention eg Children’s Burn Foundation• Legislation geared to safety eg Legislation controlling temperature of bath water,

construction of buildings

American Burn Association. Scalds: a burning issue. A campaign kit for burn awareness week 2000. http://www.ameriburn.org/Preven

World Burn injury prevention success stories

• The west has generally done relatively well in burn injury prevention – eg fire retardant material for children’s clothing

• Childhood Burn Foundation - Taiwan: example of model surveillance system

• The Safe Bottle Lamp Foundation (Sri Lanka 1992 – Dr Wijay Godakumbura)

Conclusion

• Burns are preventable even in resource poor setting• Burn care givers should be the champions for

prevention• Good patient records, research and frequent

Monitoring and Evaluation are important• More efforts in burn injury prevention are needed in

Africa even as we strive to improve the quality of burn care

• Set aside time in your units/cities/countries to discuss fire safety and burn injury prevention

References

• PABS history;• http://pabs2015.org/history?locale=en

• Ronald Lett (The Canadian Network of International Surgery), Olive Kobusingye (Injury prevention initiative for Africa): Achievements and Challenges of Injury Prevention

• WHO website• American Burn Association website• Asha Parbhoo, Q.A. Louw , K. Grimmer-Somers

Burn prevention programs for children in developing countries require urgent attention: A targeted literature review

• The Safe Bottle Lamp Foundation; http://www.safelamp.org/

The End

Turn up the heat in Africa and help your country prevent Burn Injuries