title: Burns in Nepal: A population based national assessment.
abstract: BACKGROUND
  Burns are ranked in the top 15 leading causes of the burden of disease globally, with an estimated 265,000 deaths annually and a significant morbidity from non-fatal burns, the majority located in low and middle-income countries. Given that previous estimates are based on hospital data, the purpose of this study was to explore the prevalence of burns at a population level in Nepal, a low income South Asian country.
  
  
  METHODS
  A cluster randomized, cross sectional countrywide survey was administered in Nepal using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) from May 25th to June 12th, 2014. Fifteen of the 75 districts of Nepal were randomly chosen proportional to population. In each district, three clusters, two rural and one urban, were randomly selected. The SOSAS survey has two portions: the first collects demographic data about the household's access to healthcare and recent deaths in the household; the second is structured anatomically and designed around a representative spectrum of surgical conditions, including burns.
  
  
  RESULTS
  In total, 1350 households were surveyed with 2695 individuals with a response rate of 97%. Fifty-five burns were present in 54 individuals (2.0%, 95% CI 1.5-2.6%), mean age 30.6. The largest proportion of burns was in the age group 25-54 (2.22%), with those aged 0-14 having the second largest proportion (2.08%). The upper extremity was the most common anatomic location affected with 36.4% of burns. Causes of burns included 60.4% due to hot liquid and/or hot objects, and 39.6% due to an open fire or explosion. Eleven individuals with a burn had an unmet surgical need (20%, 95% CI 10.43-32.97%). Barriers to care included facility/personnel not available (8), fear/no trust (1) and no money for healthcare (2).
  
  
  CONCLUSIONS
  Burns in Nepal appear to be primarily a disease of adults due to scalds, rather than the previously held belief that burns occur mainly in children (0-14) and women and are due to open flames. This data suggest that the demographics and etiology of burns at a population level vary significantly from hospital level data. To tackle the burden of burns, interventions from all the public health domains including education, prevention, healthcare capacity and access to care, need to be addressed, particularly at a community level. Increased efforts in all spheres would likely lead to a significant reduction of burn-related death and disability.
authors.affiliation: University of California San Francisco, East Bay, Department of Surgery, Surgeons OverSeas, 1411 East 31st Street, Oakland, CA 94602, USA. Electronic address: Shailvi.gupta@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.affiliation: University of South Florida, Department of Surgery, Division of Plastic Surgery, Tampa, FL, USA.
authors.forename: U
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Kathmandu Medical College, Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Gurung
authors.affiliation: Nepal Medical College, Department of Surgery, Kathmandu, Nepal.
authors.forename: S
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Surgeons OverSeas, Johns Hopkins Bloomberg School of Public Health, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Kushner
authors.affiliation: Surgeons OverSeas, Johns Hopkins Bloomberg School of Public Health, USA; Nationwide Children's Hospital, Ohio State University School of Medicine, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Nwomeh
authors.affiliation: University of North Carolina, Chapel Hill, Department of Surgery, USA.
authors.forename: A G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002056:Burns / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000067010:Literacy / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D017678:Sex Distribution; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Burns; Global surgery