Factors contributing to childhood burn contractures in rural Kenya that present for corrective surgery

Jess Medland¹, Peter Oduor²,
¹Peninsula Health, Frankston, Victoria, Australia
²Nakuru Provincial General Hospital, Nakuru, Nakuru, Kenya

Abstract

Background
Exposure to the devastating outcomes of paediatric burns in rural Kenya, drove me to initiate a community burns prevention program. Limited literature and anecdotal observation of burn causes in this setting prompted me to carry out this research project in the operative setting.

Aim
To explore the circumstances that lead to childhood burn contractures that present for reconstruction.

Methods
Ethics approval was granted by Amref Health and NACOSTI Kenya. Plastic surgery operation lists from 2014 to 2019 were reviewed at Nyabondo Rehabilitation Centre, Sondu, Kenya. This case series includes 122 paediatric burn patients (aged 0-17 years).

Results
Burn injuries continue to disproportionately affect children under five years of age (Botchey et al. 2017; Mutsio et al. 2014), including 72 percent of cases in this series. The predominant cause of burns was scald, closely followed by flame burns. The youngest sibling was burned in 52 percent of cases. Patients travelled from one to 90 kilometres to a local hospital for acute care and up to 303 kilometres to seek surgical intervention. Eighty percent of operations focused on correcting upper limb burn contractures. Twenty children in the series underwent two or three operations, 12 of which were repeated to release the same contracture from six months to four years later.

Conclusion
Children under five years of age are at greatest risk of burns in rural Kenya. Predisposition to upper body burns in childhood (Albertyn, Bickler & Rode 2006) and the aim to restore function likely drives high upper limb operation numbers. Due to limited access to acute treatment (Holmer et al. 2015), reconstructive surgery and rehabilitation, modifying environmental factors remains key to prevention of debilitating burns.

References supplied on request (due to word limit)

Biography

Dr Jess Medland is currently a Senior Plastics resident at Peninsula Health. Prior to medicine she worked as a Hand Therapist and established a charitable organisation Mama Cynthia in rural Kenya. For over a decade Jess has focused on community burn prevention programs and improving post-operative rehabilitation.