title: Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey.
abstract: OBJECTIVE
  Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad.
  
  
  METHODS
  A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship.
  
  
  RESULTS
  Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn.
  
  
  CONCLUSIONS
  Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: stewarb@uw.edu.
authors.forename: Barclay T
authors.initials: BT
authors.lastname: Stewart
authors.affiliation: Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA.
authors.forename: Riyadh
authors.initials: R
authors.lastname: Lafta
authors.affiliation: Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq.
authors.forename: Sahar A
authors.initials: SA
authors.lastname: Esa Al Shatari
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Cherewick
authors.affiliation: Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
authors.affiliation: Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Hagopian
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Lindsay P
authors.initials: LP
authors.lastname: Galway
authors.affiliation: Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Kushner
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001830:Body Surface Area; D002056:Burns / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002947:Cities / Q000453:epidemiology*; D017281:Cost of Illness; D005191:Family Characteristics; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006801:Humans; D007493:Iraq / Q000453:epidemiology; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: Burn; Electrical injury; Epidemiology; Global surgery; Iraq; War