title: Burn management capacity in low and middle-income countries: a systematic review of 458 hospitals across 14 countries.
abstract: OBJECTIVE
  More than 90% of thermal injury-related deaths occur in low-resource settings. While baseline assessment of burn management capabilities is necessary to guide capacity building strategies, limited data exist from low and middle-income countries (LMICs).
  
  
  OBJECTIVE
  The objective of our review is to assess burn management capacity in LMICs.
  
  
  METHODS
  A PubMed literature review was performed based on studies assessing baseline surgical capacity in individual LMICs. Seven criteria were used to assess burn management capabilities: presence of surgeon, presence of anesthesiologist, basic resuscitation capabilities, acute burn management, management of burn complications, endotracheal intubation and skin grafts.
  
  
  RESULTS
  Fourteen studies were reviewed using data from 458 hospitals in fourteen countries. Of these, 82.3% (284/345) of hospitals had the capacity to provide basic resuscitation and 84.9% (275/324) were capable of providing acute burn management. Endotracheal intubation was only available at 38.3% (51/133) of hospitals. Moreover, only 35.6% (111/312) and 37.9% (120/317) of hospitals were able to provide skin grafts and treat burn complications, respectively.
  
  
  CONCLUSIONS
  Many hospitals in LMICs are capable of initial burn management and basic resuscitation. However, deficiencies still exist in the capacity to systematically provide advanced burn care. Efforts should be made to better document resources in order to guide burn management resource allocation.
authors.affiliation: Department of Surgery, University of California, San Francisco East Bay, Oakland, CA, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA. Electronic address: shagupta@jhsph.edu.
authors.forename: Shailvi
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA; Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada. Electronic address: evwong@jhsph.edu.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Wong
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of South Florida, Tampa, FL, USA. Electronic address: umbarm@gmail.com.
authors.forename: Umbareen
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. Electronic address: anthchar@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of Pediatric Surgery, Nationwide's Children Hospital, Columbus, OH, USA. Electronic address: benedict.nwomeh@nationwidechildrens.org.
authors.forename: Benedict C
authors.initials: BC
authors.lastname: Nwomeh
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons OverSeas (SOS), New York, NY, USA; Department of Surgery, Columbia University, New York, NY, USA. Electronic address: adamkushner@yahoo.com.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000776:Anesthesiology; D002056:Burns / Q000628:therapy*; D003906:Developing Countries; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data; D016038:Skin Transplantation / Q000706:statistics & numerical data; D066231:Surgeons / Q000600:supply & distribution; D000078329:Workforce
keywords: Burns; Countries; Global surgery; Low and middle income; Surgical capacity