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      A systematic review of burn injuries in low- and middle-income countries: Epidemiology in the WHO-defined African Region Translated title: Revue systématique des cas de blessures par brûlure dans les pays à revenu faible et intermédiaire: épidémiologie dans la région africaine de l'OMS

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          Abstract

          Introduction

          According to the World Health Organization (WHO), burns result in the loss of approximately 18 million disability adjusted life years (DALYs) and more than 250,000 deaths each year, more than 90% of which are in low- and middle-income countries (LMICs). The epidemiology of these injuries, especially in the WHO-defined African Region, has yet to be adequately defined.

          Methods

          We performed a systematic review of the literature regarding the epidemiology of thermal, chemical, and electrical burns in the WHO-defined African Region. All articles indexed in PubMed, EMBASE, Web of Science, Global Health, and the Cochrane Library databases as of October 2015 were included.

          Results

          The search resulted in 12,568 potential abstracts. Through multiple rounds of screening using criteria determined a priori, 81 manuscripts with hospital-based epidemiology as well as eleven manuscripts that included population-based epidemiology were identified. Although the studies varied in methodology, several trends were noted: young children appear to be at most risk; most individuals were burned at home; and hot liquids and flame are the most common aetiologies.

          Discussion

          While more population-based research is essential to identifying specific risk factors for targeted prevention strategies, our review identifies consistent trends for initial efforts at eliminating these often devastating and avoidable injuries.

          Translated abstract

          Introduction

          Selon l'Organisation mondiale de la Santé (OMS), les brûlures résultent sur la perte d'environ 18 millions d'années de vie corrigées du facteur d'invalidité (AVCI) et sur plus de 250 000 décès chaque année, plus de 90% se produisant dans les pays à revenu faible et intermédiaire (PRFI). L'épidémiologie de ces blessures, notamment dans la région africaine de l'OMS, reste encore à définir adéquatement.

          Méthodes

          Nous avons procédé à une revue systématique de la documentation relative à l'épidémiologie des brûlures thermiques, chimiques et électriques dans la région africaine de l'OMS. Tous les articles indexés dans les bases de données de PubMed, EMBASE, Web of Science, Global Health et de la Cochrane Library à compter d'octobre 2015 ont été inclus.

          Résultats

          La recherche a produit 12 568 résumés potentiels. Par le biais de plusieurs séries de tri à l'aide de critères déterminés a priori, 81 manuscripts fournissant une épidémiologie dans le cadre hospitalier ainsi que 11 manuscripts incluant une épidémiologie basée sur la population ont été identifiés. Bien que les études variaient dans leur méthodologie, plusieurs tendances ont été observées: les jeunes enfants semblent constituer la population la plus à risque; la plupart des individus étaient brûlés à la maison; et les liquides chauds et les flammes constituent les étiologies les plus courantes.

          Discussion

          Si des études davantage basées sur la population sont essentielles pour identifier les facteurs de risque spécifiques en vue de stratégies de prévention ciblées, notre revue identifie des tendances constantes pour les efforts initiaux visant à éliminer ces blessures souvent dévastatrices et évitables.

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          Most cited references116

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          Severe burn injury in europe: a systematic review of the incidence, etiology, morbidity, and mortality

          Introduction Burn injury is a serious pathology, potentially leading to severe morbidity and significant mortality, but it also has a considerable health-economic impact. The aim of this study was to describe the European hospitalized population with severe burn injury, including the incidence, etiology, risk factors, mortality, and causes of death. Methods The systematic literature search (1985 to 2009) involved PubMed, the Web of Science, and the search engine Google. The reference lists and the Science Citation Index were used for hand searching (snowballing). Only studies dealing with epidemiologic issues (for example, incidence and outcome) as their major topic, on hospitalized populations with severe burn injury (in secondary and tertiary care) in Europe were included. Language restrictions were set on English, French, and Dutch. Results The search led to 76 eligible studies, including more than 186,500 patients in total. The annual incidence of severe burns was 0.2 to 2.9/10,000 inhabitants with a decreasing trend in time. Almost 50% of patients were younger than 16 years, and ~60% were male patients. Flames, scalds, and contact burns were the most prevalent causes in the total population, but in children, scalds clearly dominated. Mortality was usually between 1.4% and 18% and is decreasing in time. Major risk factors for death were older age and a higher total percentage of burned surface area, as well as chronic diseases. (Multi) organ failure and sepsis were the most frequently reported causes of death. The main causes of early death (<48 hours) were burn shock and inhalation injury. Conclusions Despite the lack of a large-scale European registration of burn injury, more epidemiologic information is available about the hospitalized population with severe burn injury than is generally presumed. National and international registration systems nevertheless remain necessary to allow better targeting of prevention campaigns and further improvement of cost-effectiveness in total burn care.
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            Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

            Background Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken. Methods Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations. Results Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%. Conclusion Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.
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              The problem of children's injuries in low-income countries: a review.

              Unintentional injuries are the cause of death and disability for millions of children every year in low-income countries. Challenging living conditions, heavy traffic, a lack of safe play space and an absence of child care options, together with a disproportionate vulnerability to injury, combine to put children at high risk. Inaccessible and unaffordable emergency services add to the number of resulting deaths and impairments. Yet this major public health problem receives relatively little attention. Because communicable disease and nutritional problems continue to rank higher as causes of child mortality and morbidity in most of the developing world, injury is perceived as a less serious problem. Existing research is scanty and is largely limited to hospital-based studies, which cannot present a comprehensive picture of either causes or outcomes. Development of preventive measures is hampered not only by limited health budgets, but by a tendency (not unique to low-income countries) to see injuries as random events, and hence as unpredictable and uncontrollable. There is an urgent need for more research that can contribute to effective analyses of the situation, and especially for locally-based research and record keeping, which is most likely to contribute to awareness and to practical and well-targeted prevention measures.
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                Author and article information

                Contributors
                Journal
                Afr J Emerg Med
                Afr J Emerg Med
                African Journal of Emergency Medicine
                African Federation for Emergency Medicine
                2211-419X
                2211-4203
                28 January 2017
                March 2017
                28 January 2017
                : 7
                : 1
                : 30-37
                Affiliations
                [a ]Department of Emergency Medicine, Boston Medical Center, Boston, MA, United States
                [b ]Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
                [c ]Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States
                [d ]Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States
                [e ]Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
                [f ]Department of Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD, United States
                [g ]Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
                [h ]Boston University School of Medicine, Boston, MA, United States
                [i ]Boston University Center for Global Health and Development, Boston, MA, United States
                Author notes
                [* ]Corresponding author. mrybarcz@ 123456alumni.nd.edu
                Article
                S2211-419X(16)30099-4
                10.1016/j.afjem.2017.01.006
                6234151
                30456103
                08d2e7b5-7b3b-46a5-987f-876534f7e807
                © 2017 African Federation for Emergency Medicine. Publishing services provided by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 9 August 2016
                : 3 November 2016
                : 10 January 2017
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