Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 14  |  Issue : 2  |  Page : 22-27

Epidemiology of hand burns among children in Zaria, Northwestern Nigeria


1 Division of Plastic Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria
2 Department of Pediatrics, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria

Date of Web Publication28-Nov-2018

Correspondence Address:
Dr. Muhammad L Abubakar
Division of Plastic Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njps.njps_7_18

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  Abstract 

BACKGROUND: The events leading to hand burns injuries in a child are a complex relationship between the child, heat source, mechanism, and the environment where the event occurs. Preventing hand burns in children needs an understanding of its epidemiology. OBJECTIVES: To describe the etiology, pattern, mechanism, and the environmental setting in childhood hand burn injuries. MATERIALS AND METHODS: The study was a retrospective study of all children who sustained burns injury to the hand over a 5-year period (January 2011–December 2015). The study was conducted at the Plastic Surgery Unit of the Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria. Recorded information included age, gender, agent of burns, pattern of injury, mechanism of injury, and the setting at the time of injury. A descriptive analysis of the data was performed using SPSS version 21. RESULTS: A total of 47 children sustained burn injuries to the hand. The mean age was 2.17 years, a standard deviation of ±2.15, and age range of 0 to 13 years. There were 26 children <2 years old (55.32%), whereas 18 (38.30%) were of 2 to <4 years of age. Twenty-six (55.32%) were male, and the male-to-female ratio was 1.23:1. Most of the children suffered scald injury [29 (61.7%)] followed by contact burns in 12 (25.53%). Dipping hands into hot water was the most common cause of injury. Holding hot charcoal was the most common type of contact burns. The hands only were affected in 37 (78.72%) of the children. The burns mostly [45 (97.87%)] occurred at home. Mothers were the custodians of the children in 42 (93.33%). CONCLUSION: Targeted preventive approach for mothers, especially through maternal education using ante natal, immunization, and pediatric clinics are suggested.

Keywords: Epidemiology, hand burns, children


How to cite this article:
Abubakar ML, Maina D J, Adebayo W O, Kabir M A, Ibrahim A, Abdulkadir I. Epidemiology of hand burns among children in Zaria, Northwestern Nigeria. Nigerian J Plast Surg 2018;14:22-7

How to cite this URL:
Abubakar ML, Maina D J, Adebayo W O, Kabir M A, Ibrahim A, Abdulkadir I. Epidemiology of hand burns among children in Zaria, Northwestern Nigeria. Nigerian J Plast Surg [serial online] 2018 [cited 2018 Dec 12];14:22-7. Available from: http://www.njps.org/text.asp?2018/14/2/22/246155


  Introduction Top


The hand is a very important organ in the child’s developmental mile stones. Hand function involves a complex coordinated integration of motor, sensory, visual, and cognitive components.[1] The skills that are developed during childhood lay the foundation for activities of daily living, the ability to evaluate the environment, and protection from injury. The exploratory curiosity of children makes them a vulnerable group to sustain hand burn injuries that can result in significant disabilities.[2] Despite the small area the hand represents in the body (5% of the total body surface area), even a small surface area burns may adversely affect hand function. These burn injuries have a huge impact in the overall quality of life and significantly influence successful integration into the society.[1],[2],[3],[4],[5]

The events leading to burn injuries in a child are a complex relationship between the child, heat source, mechanism, and the environment. The pattern, distribution, and severity of injury that the child sustains are a product of the interplay of these factors.[6] Reports have shown that the hand and upper extremity are involved in up to 50% of children who sustained burns.[3],[7],[8] Furthermore, the prevention of hand burns in children requires an understanding of its epidemiology to guide education and prevention strategies.[9] Although epidemiology of childhood burn has been studied in our environment, there is a lack of epidemiologic data specifically on hand burns in children.[10],[11],[12],[13],[14] This paper describes the agents, pattern, mechanism, and the setting of children with hand burn injuries in Zaria, Northwest Nigeria.


  Patients and methods Top


The study was a retrospective one of all children who sustained burn injury in the hand over a 5-year period (January 2011–December 2015). The study was conducted at the Plastic Surgery Unit of the Department of Surgery, Ahmadu Bello University Teaching Hospital, Shika, Zaria. Recorded information included age, gender, agent of burns, pattern of injury, mechanism of injury, and the setting at the time of injury. Patients who did not sustain hand burns and those with incomplete data were excluded from the study. A descriptive analysis of the data was performed using IBM SPSS Statistics for Windows, Version 21, IBM Corporation Armonk, New York USA.


  Results Top


Demographic characteristics

A total of 47 children sustained burn injuries to the hand. The mean age was 2.17 years [±2.15 standard deviation (SD)] age range of 0 to 13 years. There were 26 children less than 2 years (55.32%), whereas 18 (38.30%) were of preschool age (2 to <5 years). Twenty-six (55.32%) were male, and the male-to-female ratio was 1.23:1 [Table 1].
Table 1: Age and gender distribution

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Etiology of burns and mechanism of injury

Most of the children sustained scald injury [29 (61.7%)], whereas contact burns were the causative agent in 15 (31.91%) with flame and electrical injuries been the least (6% and 4%, respectively) [Figure 1]. Less than 2-year olds and the preschool age group sustained predominantly scald injury followed by contact burns. The school age (≥5 years) children had contact injury with one that had flame burn as part of a larger burn [Table 2]. The mechanism of injury was documented in 41 (87.23%) of the patients. Nineteen (65.51%) of the children who sustained scald injury dipped their hands into hot water. Four children pulled down hot water, whereas seven dipped hands in hot food. Holding hot charcoal was the most common type of contact burns (63.64%). Poorly insulated live electric cables were held by two children sustaining electrical injury [Figure 2]. Dipping hand into hot water was common among less than 2-year olds. Contact burn was most common among the preschool age [Table 3].
Figure 1: Etiology of burns injury to the hands

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Table 2: Distribution of age and etiology of burns

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Figure 2: Mechanism of burn injury to the hand

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Table 3: Distribution of age and mechanism of burn injury

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Pattern of injury

The hands only were affected in 37 (78.72%) of the children followed by the upper limb (including hands) in seven (14.9%) with hand, and other parts of the body [3 (6.4%)] (hand burns as a part of larger burn injury) were least affected [Table 3]. The hand-only injuries were mostly scald injuries in 21 (56.8%) and contact burns in 10 (27.0%) [Table 4]. Less than 2-year olds [20 (42.55%)] have most of the hand only burns. However, they showed a broader pattern of injuries involving other parts of the body. The injuries were restricted to upper limbs (including hands) in the preschool age [18 (38.30%)], whereas those of the school age had mostly hand only [Table 3]. The right hand was mostly involved in 23 (48.9%), whereas both hands were involved in six (12.8%) [[Figure 3] and [Figure 4]].
Table 4: Distribution of age and pattern of injury

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Figure 3: Distribution of pattern of injuries

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Figure 4: Distribution of hand(s) affected

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Burns injury setting

The burn injuries to the hand mostly [45 (97.87%)] occurred at home, whereas the rest occurred at school and workplace (of custodian of child) [Figure 5]. Forty-six (97.87%) of the burns were accidental injuries with one occurring when the mother immersed the child’s hand in hot water as “treatment for convulsions.” The custodians of the children at time of injury were recorded in 45 (97.87%) of the cases [Table 5]. Mothers were the custodians of the 42 (93.33%) children, whereas a father, sister, and a grandmother were the other three custodians. Most of the mothers [41 (97.62%)] were at home with the children, whereas the one was at her workplace. A child was under the custody of his older sister at school when the child held hot charcoal from a burnt refuse dump close to school. A child dipped his hand in hot water while with father at home and another picked hot charcoal from a clay container while warming the room during winter season under the custody of his grandmother [[Figure 5] and [Table 5]].
Figure 5: Place of injury

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Table 5: Custodian and place of injury

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  Discussion Top


Burns in children impose enormous economic burdens on families and society.[15] Burn injuries are most prevalent in children under 3 years[16] as was documented to have constituted a large proportion (>50%) in this study. This relates to the concept that the mechanism of burns injuries are related cognitive and motor functions.[2] A child exploring its environment lack the power to assess possible hazards, which coupled with negligence of parents exposes the child to risk of burn injuries.[16] Hence, the investigations of hand burn epidemiology for formulating and evaluating the effect of prevention measures are needed.[17]

The mean, SD of the ages, age range, and sex ratio in this study are comparable to other studies.[1],[2],[4],[18],[19] The peak prevalence of burn injuries in 0 to <2 years seen in this study coincides with a period that starts around 9 months of age when independent mobility begins. These infants and toddlers explore their environment without a commiserate endowment to assess and/or avoid the dangers. This has been observed among infants and toddlers in other studies on childhood burns injuries in the literature.[2],[6],[11],[12],[14],[18],[20],[21],[22] Parents, it appears however, are unprepared for this developmental stage in terms of preventive strategies to keep the child’s environment danger free. Hand burns in this study were lower at school age (≥5 years); this may be due to the child’s increased cognitive awareness of the dangers of heat and her/his environment or more time spent outside the home also reported by Kemp et al.[6]

Scald injury is the most common type of burns in children reported in literature followed by flame and electrical injury as also seen in our study.[11],[23],[24],[25],[26]

In Nigeria, fuel wood has been reported to be used by 66.3% of households and kerosene being the second household energy with 23.6% of usage on a daily basis.[10],[27],[28] This makes cooking on ground level and open flame cooking a common practice. This could explain the pull-down cause of injury and dipping of hands as the child reaches for boiled water, food, and hot cooking utensils within her/his reach when the child is exploring her/his environment unsupervised. The ash left in the cooking area might still contain some hot charcoal as the unwary child picks it up. This could explain the high incidence of burns from charcoal in our study. Electrical burns are least common in this study and in reports from Nigeria probably due to the frequent power outages experienced.[27],[28]Kemp et al.[6] noted a predictable relationship among the agent and mechanism, age of the child, and anatomical distribution of the burn injury. The agent and mechanisms of injuries seen in this study explain the predominance of upper limbs as the sites of injury. The child pulls down a container of hot liquid, resulting to burns of the upper limb, and dips his hands or holds an object that leads to burns of the hands.

In this study, most of the hand burn injuries occur at home similar to other reports of pediatric burns in our environment.[11],[12],[14],[29] Most of the children are infants and toddlers who are mostly at home with their mothers. In previous studies, the kitchen has been identified as the potential source of burn injury to the child in the home followed by the living room and the bathroom.[13],[18],[23],[29],[30]

Several studies on the epidemiology of burns in children have suggested that prevention remains very important in the management of burns in children.[6],[15],[20],[21],[23],[25],[30],[31],[32],[33] Lack of supervision was noted by Rossi et al.[34] as an important factor in childhood burns and that parents, or guardians, should be instructed about the preventive aspects of upbringing that would consciously provide a “developing—child friendly environment” keeping children away from risks. Because mothers (93%) were the parents mostly with the children, a focus on them would be of utmost importance. Effective places that could be utilized are the ante natal clinics, the immunization clinics, and the pediatric outpatient clinics. These places bring together “experienced” and new mothers. These are places where women share experiences of motherhood. Burn prevention can be incorporated in health talks given to them. Short video clips on burn safety and prevention would also be helpful.

Study limitation: The study was a hospital-based retrospective review of records which led to some missing data.


  Conclusion Top


This study showed that childhood hand burn injuries mostly affected children less than 5 years of age and is due to poor supervision and negligence. Most of these injuries occurred at home with mothers as the custodians. Scald injuries predominate with electrical injury least occurring. We suggest the use of ante natal clinics, immunization centers, and pediatric clinics as places to educate women on childhood burns prevention and safety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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