title: Intentional burns in Nepal: a comparative study.
abstract: OBJECTIVE
  Intentional burns injuries are associated with high mortality rates, and for survivors, high levels of physical and psychological morbidity. This study provides a comprehensive assessment of intentional burn admissions to the adult Burns Unit at Bir Hospital, Kathmandu, Nepal, during the period 2002-2013.
  
  
  METHODS
  A secondary data analysis of de-identified data of patients hospitalized at Bir Hospital, Kathmandu, with a burn during the period of 1 January 2002 to 31 August 2013. Socio-demographic, injury and psychosocial factors of patients with intentional and unintentional burns are described and compared. Chi-square tests, Fisher's exact test and Wilcoxon rank sum tests were used to determine statistical significance.
  
  
  RESULTS
  There were a total of 1148 burn admissions of which 329 (29%) were for intentional burn, 293 (26%) were self-inflicted and 36 (3%) were due to assault. Mortality rates for intentional burns were approximately three times those for unintentional burns (60 vs. 22%). When compared to unintentional burns, patients with intentional burns were more likely to be female (79 vs. 48%), married (84 vs. 67%), younger (25 vs. 30 years), have more extensive burns (total body surface area, %: 55 vs. 25) and higher mortality (60 vs. 22%). Intentional burns were more likely to occur at home (95 vs. 67%), be caused by fire (96 vs. 77%), and kerosene was the most common accelerant (91 vs. 31%). A primary psychosocial risk factor was identified in the majority of intentional burn cases, with 60% experiencing adjustment problems/interpersonal conflict and 32% with evidence of a pre-existing psychological condition. A record of alcohol/substance abuse related to the patient or other was associated with a greater proportion of intentional burns when compared with unintentional burns (17 vs. 4%).
  
  
  CONCLUSIONS
  The majority of intentional burn patients were female. Almost all intentional burns occurred in the home and were caused by fire, with kerosene the most common accelerant used. Underlying psychosocial risk factors were identified in most cases. Intentional burns resulted in severe burns with high mortality. Intentional burns are not only a serious medical issue; they represent significant public health and gender issues in Nepal.
authors.affiliation: Burn Violence Survivors Nepal, Kathmandu, Nepal.
authors.forename: Bir Bahadur
authors.initials: BB
authors.lastname: Lama
authors.affiliation: Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia. Electronic address: janine.duke@uwa.edu.au.
authors.forename: Janine M
authors.initials: JM
authors.lastname: Duke
authors.affiliation: Burn Violence Survivors Nepal, Kathmandu, Nepal.
authors.forename: Narayan Prasad
authors.initials: NP
authors.lastname: Sharma
authors.affiliation: Bir Hospital, Kathmandu, Nepal.
authors.forename: Buland
authors.initials: B
authors.lastname: Thapa
authors.affiliation: Bir Hospital, Kathmandu, Nepal.
authors.forename: Peeyush
authors.initials: P
authors.lastname: Dahal
authors.affiliation: Bir Hospital, Kathmandu, Nepal.
authors.forename: Nara Devi
authors.initials: ND
authors.lastname: Bariya
authors.affiliation: Burn Violence Survivors Nepal, Kathmandu, Nepal.
authors.forename: Wendy
authors.initials: W
authors.lastname: Marston
authors.affiliation: Burn Injury Research Unit, School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Wallace
mesh_terms: D000275:Adjustment Disorders / Q000453:epidemiology* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D002056:Burns / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D002648:Child; D015331:Cohort Studies; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005390:Fires; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007398:Interpersonal Relations; D007648:Kerosene; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011634:Public Health; D012189:Retrospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000523:psychology; D017678:Sex Distribution; D012923:Social Class; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014505:Urban Population / Q000706:statistics & numerical data; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007648:Kerosene
keywords: Burns; Comparator study; Epidemiology; Intentional; Risk factors