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Paediatric burn and scald management in a low resource setting: A reference guide and review.

ABSTRACT: Introduction:The mortality rates and Disability Adjusted Life Years lost of burn injuries (including scalds) among children below 15 years of age in Africa are more than ten and 20 times higher, respectively, than in high-income countries. Prevention of injuries and timely optimal management will help to reduce these figures. Management guidelines that are locally relevant to low income settings, incorporating universal principles, are required. We aim to provide a reference guide for the management of paediatric burn injuries in settings with limited resources using a resource-tiered approach. Additionally, we would like to add our voice to the advocacy for improvements in primary, secondary and tertiary prevention. Methods:A literature review was carried out using Ovid Medline (1946 to present), Embase (1974 to November 2016) and Google Scholar (2012 to present) using the key words and Boolean terms Burn OR Scald, AND Paediatric, AND Management OR Treatment, AND Africa, AND Sub-Saharan Africa. Further references were found from citations. Results and discussion:In total, 78 papers were included in this review, along with the WHO injury book and the Burns Manual. Comprehensive primary prevention programmes should be set up and adequately funded. Assessment and immediate management of a burn patient should follow the ABCDE approach. Appropriate patients such as those with inhalational injury should be referred early. An escharotomy should be performed without delay at the facility where the patient has presented. Intravenous fluid management must be guideline-based, goal-directed and titrated to effect. Pain management should use multiple modalities including adequate and pre-emptive analgesia. Supplemental nutrition is required in patients with baseline malnutrition and/or burns greater than 10% Total Body Surface Area. Infections such as toxic shock syndrome and tetanus must be managed aggressively.

SUBMITTER: Broadis E

PROVIDER: S-EPMC6246875 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Paediatric burn and scald management in a low resource setting: A reference guide and review.

Broadis Emily E Chokotho Tilinde T Borgstein Eric E

African journal of emergency medicine : Revue africaine de la medecine d'urgence 20170922 Suppl

<h4>Introduction</h4>The mortality rates and Disability Adjusted Life Years lost of burn injuries (including scalds) among children below 15 years of age in Africa are more than ten and 20 times higher, respectively, than in high-income countries. Prevention of injuries and timely optimal management will help to reduce these figures. Management guidelines that are locally relevant to low income settings, incorporating universal principles, are required. We aim to provide a reference guide for th ...[more]

PMID: 30505671

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Project description:In low- and middle-income countries, nutrition support strategies are often suboptimal or non-existent in hospital settings. This is further compounded by high rates of malnutrition in these countries. The first four dietitians graduated in Malawi in 2017 providing a new opportunity to build capacity to introduce nutrition support in an acute care setting. A paediatric nutrition support program was implemented at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi including the hiring of a local dietitian. This capacity building paper explains the development and introduction of the nutrition support program including a description of perceptions of health professionals at QECH working alongside the dietitian. In the first four months of the program at QECH, the dietitian provided nutrition support to 183 different patients across paediatric wards. Nutritional interventions predominantly included infant formula and breastmilk fortification, provision of therapeutic feeds orally or via nasogastric tubes, increased dietary protein intake for children identified to be at high risk, and nutritional counselling to caregivers. More complex nutritional interventions were also given such as the insertion of gastrostomy tubes to deliver nutrition directly to the stomach. Following the introduction of the program, qualitative interviews were done with health professionals at QECH including nurses (n = 5) and physicians (n = 11). All participants emphasized the importance and impact of the nutrition support program in enhancing the care of hospitalized children, therefore improving outcomes such as tolerability of clinical interventions, decreased duration of stay, and reduced risk of hospital readmission. In conclusion, there is a need for nutrition support provided by a dietitian for different paediatric patients which was corroborated by positive feedback from health professionals at QECH. Integration of dietitians into the healthcare system by respective Ministries of Health will require advocacy around the potential for nutrition support to strengthen the quality of care of vulnerable children. A Chichewa abstract for this paper is available in a supplementary file.

Project description:BackgroundBreast surgery for breast cancer is associated with significant acute and persistent postoperative pain. Surgery is the primary type of treatment, but up to 60% of breast cancer patients experience persistent pain after surgery, and 40% of them develop acute postmastectomy pain syndrome. Preoperative stress, involvement of lymph nodes while dissecting, and the postoperative psychological state of the patients play vital roles in managing the postoperative pain of the patients. The objective of this study is to develop evidence-based guideline on the prevention and management of perioperative pain for breast cancer surgical patients.MethodsAn exhaustive literature search was made from PubMed, Cochrane Review, PubMed, Google Scholar, Hinari, and CINAHIL databases that are published from 2012 to 2022 by setting the inclusion and exclusion criteria. After data extraction, filtering was made based on the methodological quality, population data, interventions, and outcome of interest. Finally, one guideline, two meta-analyses, ten systematic reviews, 25 randomized clinical trials and ten observational studies are included in this review, and a conclusion was made based on their level of evidence and grade of recommendation.ResultsA total of 38 studies were considered in this evaluation. The development of this guideline was based on different studies performed on the diagnosis, risk stratification and risk reduction, prevention of postoperative pain, and treatments of postoperative pain.ConclusionThe management of postoperative pain can be categorized as risk assessment, minimizing risk, early diagnosis, and treatment. Early diagnosis is the mainstay to identify and initiate treatment. The perioperative use of a nonpharmacological approach (including preoperative positive inspirational words and positive expectation) as an adjunct to the intraoperative regional anesthetic technique with general anesthesia with proper dosage of the standard pharmacological multimodal regimens is the first-line treatment. For postoperative analgesia, an extended form of intraoperative regional technique, nonpharmacologic technique, and NSAIDs can be used with the opioid-sparing anesthesia technique.

Dataset Information

Paediatric burn and scald management in a low resource setting: A reference guide and review.

Publications

Paediatric burn and scald management in a low resource setting: A reference guide and review.

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