Citation

Keshri VR, Jagnoor J. Lancet Public Health 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/S2468-2667(21)00256-5

PMID

34822774

Abstract

Globally, burns are one of the major causes of disability, with more than 8 million disability-adjusted life-years (DALYs). The burden of burns falls disproportionately on low-income and middle-income countries (LMICs). A trend of increased incidence of burns is observed in south Asia during the festive season of Diwali, celebrated each year in the months of October or November. The situation in India is particularly worrying. In 2019, more than 23 000 fire-related deaths were estimated in India, which is about 20% of the global mortality burden. Additionally, 1·5 million DALYs were attributed to burns. Burn survivors can be financially distressed, vocationally challenged, and socially excluded. The burden of burns among women (aged 15-49 years) in India is three-times higher than that among men. Women have differential exposure to risk, often arising from unsafe cooking and kitchen practices, suicides, and homicides associated with domestic violence and dowry-related conflict. Prevention of burns requires attention to gender-based inequities and upstream social determinants of health. The surge in burn cases during Diwali sees an increased representation of children. In high-income countries, the incidence, severity, mortality, and disability due to burns have reduced significantly due to advancement in prevention, management, and rehabilitation; whereas in LMICs, and particularly in south-Asian countries and India, the burden continues to be high.

In 2010, in response to this burden, a National Programme for Prevention and Management of Burns Injury was launched in India. However, the scope of the programme remains limited. Burn services in India are delivered primarily through a network of specialised tertiary care burn centres. There are 67 burn centres, of which 30 are in the public sector and 37 in the private sector. The geographical distribution of these centres and service availability are uneven and heterogeneous. In the public sector, many burn centres are constrained in terms of infrastructure and human resource capacity, and concerns have been raised about the quality of care. Another bottleneck in the public sector is out-of-pocket expenditures for dietary supplementation, medicine, transport, and rehabilitation services. Being a patient with burns and poor financial means can also lead to poor burn services and poor recovery outcomes.

Running a medical burn centre has a high cost, and thus the financial viability of running such services is a major challenge for the private sector. Besides, burn care in the private sector is mostly located in big cities. Patients with burns often require long treatment that can lead to very high out-of-pocket costs and catastrophic expenditure for the family...

Language: en