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Burn injuries are one of the most devastating of all injuries and a major global public health concern. Though burn injuries cause lots of morbidity and mortality in India, community-based interventions in the forms of multi-strategic and multi-focused preventive programs are however lacking. This study, undertaken in the North Eastern Indian state of Assam, aims at reducing the incidence of burn accidents, morbidity and mortality of burn injuries through focused attention towards sensitizing the community with well-structured preventive program.
Participatory community seminars, use of print, electronic and social media and lectures and demonstrations in schools were the tools used in the preventive programs.
Analysis of inpatient and outpatient records of burn injured patients treated in the burn unit and scoring system in school education program and social media participants helped in assessment of the impact of Burn Preventive Programs (BPP). For convenience of assessment, comparative analysis of the results in early (Block I) and later part (Block II) of the study period was made.
Results showed significant reduction of percentage of patients reporting from the areas where BPP was implemented. There was also reduction in %TBSA burn in majority patients in Block II in comparison to Block I. Water was used to extinguish fire in 48.9% patients in Block I and 78.0% patients in Block II. Water was also used to cool burn wounds by 52.3% patients in Block I, and 83.4% patients in Block II. While 80.9% people made inappropriate topical application on the wounds in Block I, only 34.6% did so in Block II. Increased awareness amongst general people was reflected by increased percentage of patients reporting to burn unit within 7 hours of injury and significant reduction of firecracker burns from 21.9% (Block I) to 7.8% (Block II). Similarly, improved awareness amongst the students was evident from the improved scoring by majority students and reduction in burns amongst them in the later part of Block II. The results indicate that BPP has got positive impact in the society.
1 . Introduction
Burn injuries are one of the most devastating of all injuries and a major global public health concern [1, 2] . Approximately 90 percent of burns occur in low and middle - income countries, regions that generally lack the necessary infrastructure to reduce the incidence and s everity of burns . [3, 4] However, reduction in preventable burn deaths can be achieved by investment in safe living conditions and equitable access to medical care.
Estimates of incidence of burn injuries in India are most likely to be informed guesses. J . W. L. Davis [ 5 ] quoted an incidence of two million burn injuries annually; 0.5 million of them receive clinic or hospital outpatient care, 0.2 million are admitted to hospitals and 50000 succumb to the injuries. The figures quoted may be a gross undere stimation as numerous burn injuries, especially from rural population remain unreported. According to the data published by National Health portal of India (Last updated in 2016) ( https://www. nhp.gov.in/disease/skin/burns #: ) 7 million people suffer from burn injuries every year with 1.4 lakhs (0.14 million) death and 2.4 lakh s (0.24 million) suffering from various disabilities. 75% of the burn injuries occur at home and 80% of the victims are the women and children [ 6 ]. In recent years, increase in the number of terrorist violence, bus, train and airplane accidents, fire in the high - rise buildings and industrial accidents have all contributed to the swelling in the number of casualties of burns [ 7 ] .
Inadequate treatment facilities in the country as a whole, compounded by ignorance, superstition and misconception prevailing in the community in general , have made the burns management far from adequate. About 60 existing burn units, mostly located in the major cities of the country, are grossly insufficient to provide burn care to the large number of burn injured patients [ 8 ]. The scenario in the North East India, consisting of seven states (where this study was done) is still worse. A large number of patients of this region are still deprived of proper care because of the poor facilities for burn care in the government and private institutions.
Burn injuries are therefore better prevented than treated. There are encouraging reports of reduction of incidence and mortality of burns in developed countries due to effective implementation of Burn Prevention Program [ 9, 10 ]. The author published a study on the positive impact of Burn Prevention Program (BPP) on the community as a whole in respect of Fir st Aid and Prevention of burn accidents [ 11 ] . This study was conducted in two hospitals in the state of Assam, namely Indian Oil Corporation (Assam Oil Division) Hospital, Digboi and Guwahati Refinery Hospital , in a period of 13 years (1994 to 2007). Subse quently, t he BPP was continued through the Burn Unit of Burn Care Foundation, in the city of Guwahati ( the capital city of Assam ) , with addition of more prevention tools. In the COVID 19 pandemic year (2020), due to loss of social contact amongst the peop le, BPP had to be carried out digitally and through social media. BPP was implemented with some changed concept, namely , Primary, Secondary and Tertiary Prevention Program, aimed at reduction of incidence through education of people , reduction of severity by proper use of first aid measures and reduction of complications of burns by appropriate tertiary care.
The Burn Unit of Burn Care Foundation, a trust of NEMCARE Hospital, Guwahati, is a 10 bedded tertiary B urn C are U nit, catering to the needs of the sev en North – Eastern states of India. This unit, equipped with ICU beds, operation theatre and all modern burn care equipments , is manned by a dedicated and trained burn care team . Use of advanced burn management protocols in the burn unit, like proper fluid r esuscitation, use of modern burn wound covers and routine use of Early Excision and Skin Grafting in full thickness burns, have improved morbidity and mortality of burn patients. P atients with majors burns , referred from different neighboring states and th ose from the state of Assam and the city of Guwahati are the beneficiaries of the b urn unit. There being other hospitals in the city, which treat burn injured patients, the number of patients treated in this unit do not represent the incidence of burns in the region.
The Burn unit is also engaged in Burn Prevention Programs like - Public Awareness P rograms, School Education Programs, e rection of hoardings (with writings on First aid and Prevention of Burns) at public places, publication of articles in news pa pers and journals , T alks and Interviews o n television and T alks and W ritings in Social M edia. Most of the tools of Burn Prevention were being used by the author since 1994 , with addition of Annual Burn Care Day and use of social media in recent past. The b urn u nit also organize d Training Programs for doctors , nurses and paramedics on Essential Burn Care in the entire North East India to boost up the burn care in the region.
The present study was the analysis of the records of the BPP undertaken by the B urn U nit of Burn Care Foundation, aiming at ascertaining the impact of the program on the community as a whole. The inpatient records of the burn unit and the records of school education and public awareness program s from 2010 to 20 20 (1 0 years) were analyzed. These records of the two periods - namely 2010 to 2015 (Block I) and 2016 to 2020 (Block II) were com p ared to have a feed back on improved impact of the program on the society.
2. Materials and Methods
A data base was created on the admitted patient s as regards to their nature of injury, circumstances leading to the injuries, the social, educational and economic status of the patients, nature of first aids received, treatment modalities and the results of treatment received. The records of each patie nt were collected from the format used by Burn Unit and later on from format provided by WHO for World Burn Registry. These formats were filled up by doctors and nurses while the patient s were undergoing treatment in the burn unit. The records of the patie nts treated in Out Patient Department (OPD) were collected from the filled - up formats used in the burn unit.
The structured preventive programs of the present study were designed to cover 3 million population of the city of Guwahati only. As the awareness level on burns of the targeted people was low and the incidence of burns was high among st all groups, the prevention program was designed to cover topics on general awareness on the subject.
The study was approved by the hospital ethical committee.
The tools for prevention program used are described below:
2 .1 . Seminars and discussions
Participatory community sessions were organized at public places in the entire city of Guwahati. A total of 35 such sessions were organized. Adult males and females f rom all socio - economic status participated. Following topics were discussed by audio - visual means in those sessions.
a. Causation, types and first aid in burns, with emphasis on use of water for extinguishing fire and cooling the burn wounds.
b. Avoidance of any topical application on burn wounds as first aid .
c. Preventive measures to be adopted in the kitchen, other places at home and in the industry to prevent fire accidents.
d. Identification of hazards of fire and burn accidents that looms large at household and a t workplace.
e. Importance of early reporting to hospital after occurrence of burn injuries.
2 . 2. School Education Program
A total of 70 schools were included in the program. Thirty - five schools were covered in each Block. Two programs were conducted in eac h school annually at a gap of six months. The participating students were from VIII, IX and X standards. Audio - visual presentations on various aspects of burns were the main tool of prevention p rogram in all the schools covering 4200 students in both the Blocks. Seventeen schools in each Block were also provided with reading materials on burns on first visit. Eighteen schools in each block received only audio - visual presentation. The students of these schools did not receive reading materials.
Students at each school were provided with written questionnaire, containing ten questions (Appendix I) , to be answered immediately, on the second visit . They were also given five tasks on burn prevention for implementation at home (appendix II). The questionnaire had 10 scores and the tasks on preventive measures had 10 scores. These were evaluated on the basis of performance of the participating students.
2.3. Publication of articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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