title: Assessment of Acute Burn Management in 32 Low- and Middle-Income Countries.
abstract: BACKGROUND
  The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs).
  
  
  METHODS
  The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries.
  
  
  RESULTS
  A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank.
  
  
  CONCLUSIONS
  The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.
authors.affiliation: General Surgery, Wexham Park Hospital, Berkshire, UK. krishanjoseph@googlemail.com.
authors.forename: Krishan
authors.initials: K
authors.lastname: Joseph
authors.affiliation: Chelsea and Westminster Hospital, London, UK.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Trehan
authors.affiliation: Emergency & Essential Surgical Care Program, World Health Organisation, Geneva, Switzerland.
authors.forename: Meena
authors.initials: M
authors.lastname: Cherian
authors.affiliation: Service Delivery and Safety, World Health Organisation, Geneva, Switzerland.
authors.forename: Edward
authors.initials: E
authors.lastname: Kelley
authors.affiliation: Department of Surgery, Deakin University and Barwon Health, Geelong, VIC, 3220, Australia.
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
mesh_terms: D001771:Blood Banks / Q000600:supply & distribution; D002056:Burns / Q000628:therapy*; D003151:Community Health Centers; D003286:Contracture / Q000601:surgery; D003646:Debridement; D003906:Developing Countries; D019468:Disease Management; D004864:Equipment and Supplies / Q000600:supply & distribution*; D006268:Health Facilities / Q000706:statistics & numerical data*; D006296:Health Services / Q000600:supply & distribution*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006767:Hospitals, District; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D012151:Resuscitation; D016038:Skin Transplantation