title: Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?
abstract: BACKGROUND
  Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this.
  
  
  METHODS
  The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times.
  
  
  RESULTS
  A total of 624 acute burn cases were treated during the period; among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were  recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons.
  
  
  CONCLUSIONS
  There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.
authors.affiliation: Burns and Plastic Department, National Orthopaedic Hospital, PMB 01294 Enugu, Nigeria.
authors.forename: R E E
authors.initials: RE
authors.lastname: Nnabuko
authors.affiliation: Burns and Plastic Department, National Orthopaedic Hospital, PMB 01294 Enugu, Nigeria.
authors.forename: C P
authors.initials: CP
authors.lastname: Okoye
authors.affiliation: Burns and Plastic Department, National Orthopaedic Hospital, PMB 01294 Enugu, Nigeria.
authors.forename: I S
authors.initials: IS
authors.lastname: Ogbonnaya
authors.affiliation: Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria.
authors.forename: Egi
authors.initials: E
authors.lastname: Isiwele
keywords: Chemical burns; Interpersonal assault; Lead-acid battery vendors; Modernization; Resource-limited country