title: The effect of seasonality on burn incidence, severity and outcome in Central Malawi.
abstract: BACKGROUND
  In much of the world, burns are more common in cold months. However, few studies have described the seasonality of burns in sub-Saharan Africa. This study examines the effect of seasonality on the incidence and outcome of burns in central Malawi.
  
  
  METHODS
  A retrospective analysis was performed at Kamuzu Central Hospital and included all patients admitted from May 2011 to August 2014. Demographic data, burn mechanism, total body surface area (%TBSA), and mortality were analyzed. Seasons were categorized as Rainy (December-February), Lush (March-May), Cold (June-August) and Hot (September-November). A negative binomial regression was used to assess the effect of seasonality on burn incidence. This was performed using both the raw and deseasonalized data in order to evaluate for trends not attributable to random fluctuation.
  
  
  RESULTS
  A total of 905 patients were included. Flame (38%) and Scald (59%) burns were the most common mechanism. More burns occurred during the cold season (41% vs 19-20% in the other seasons). Overall mortality was 19%. Only the cold season had a statistically significant increase in burn . The incidence rate ratios (IRR) for the hot, lush, and cold seasons were 0.94 (CI 0.6-1.32), 1.02 (CI 0.72-1.45) and 1.6 (CI 1.17-2.19), respectively, when compared to the rainy season. Burn severity and mortality did not differ between seasons.
  
  
  CONCLUSIONS
  The results of this study demonstrate the year-round phenomenon of burns treated at our institution, and highlights the slight predominance of burns during the cold season. These data can be used to guide prevention strategies, with special attention to the implications of the increased burn incidence during the cold season. Though burn severity and mortality remain relatively unchanged between seasons, recognizing the seasonal variability in incidence of burns is critical for resource allocation in this low-income setting.
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; Carolinas Medical Center, Charlotte, NC, United States.
authors.forename: Anna F
authors.initials: AF
authors.lastname: Tyson
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Surgery, University of North Carolina at Chapel Hill, United States.
authors.forename: Jared
authors.initials: J
authors.lastname: Gallaher
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mjuweni
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, United States.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Surgery, University of North Carolina at Chapel Hill, United States. Electronic address: anthchar@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002053:Burn Units; D002056:Burns / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D002648:Child; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008295:Malawi / Q000453:epidemiology; D008297:Male; D040841:Resource Allocation; D012189:Retrospective Studies; D012621:Seasons; D055815:Young Adult
keywords: Burn; Burn seasonality; Burns; Malawi; Seasonality of injury; Sub Saharan Africa