title: Burn management in sub-Saharan Africa: opportunities for implementation of dedicated training and development of specialty centers.
abstract: BACKGROUND
  In low- and middle-income countries burn injuries remain responsible for a large burden of death and disability. Given an annual worldwide incidence of almost 11 million new individuals affected per year, major burn injuries have a higher annual incidence than HIV and tuberculosis combined.
  
  
  METHODS
  A survey instrument was adapted for use as an international assessment tool and then used to measure the availability of personnel, materials, equipment, medicines, and facility resources in nine Rwandan hospitals, including three referral centers.
  
  
  RESULTS
  Forty-four percent of surveyed hospitals had a dedicated acute-care burn ward, while two-thirds had intensive care options. Relevant wound-care supplies were widely available, but gaps in the availability of critical pieces of equipment such as monitors, ventilators, infusion pumps, electrocautery, and dermatomes were discovered in many of the surveyed institutions, including referral hospitals. Early excision and grafting were not performed in any of the hospitals and there were no physicians with specialty training in burn care.
  
  
  CONCLUSIONS
  Whereas all surveyed hospitals were theoretically equipped to handle the initial resuscitation of burn patients, none of the hospitals were capable of delivering comprehensive care due to gaps in equipment, personnel, protocols, and training. Accordingly, steps to improve capacity to care for those with thermal injury should include training of physicians specialized in critical care and trauma surgery, as well as plastic and reconstructive surgery. Consideration should be given to creation of national referral centers specializing in burn care.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States. Electronic address: calland@virginia.edu.
authors.forename: James Forrest
authors.initials: JF
authors.lastname: Calland
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Holland
authors.affiliation: National University of Rwanda, Department of Surgery, United States.
authors.forename: Oscar
authors.initials: O
authors.lastname: Mwizerwa
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: Robin T
authors.initials: RT
authors.lastname: Petroze
authors.affiliation: National University of Rwanda, Department of Surgery, United States.
authors.forename: Georges
authors.initials: G
authors.lastname: Ntakiyiruta
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: Kunal
authors.initials: K
authors.lastname: Patel
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Gampper
authors.affiliation: National University of Rwanda, Department of Surgery, United States.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Byiringiro
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Campbell
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, United States.
authors.forename: James Forrest
authors.initials: JF
authors.lastname: Calland
mesh_terms: D017954:Africa South of the Sahara; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000628:therapy*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006280:Health Workforce / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D012432:Rwanda; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
keywords: Africa; Burn; Burn management; Capacity survey; Rwanda; Thermal injury; Training; Treatment capacity