Think global, act local: Burn care in a resource-limited setting

Summary The few studies that are available show that the burden of burn injuries remains disproportionally high in resource-limited settings. These settings have a high incidence of burns, and due to limited access to safe burn care the mortality and morbidity remains high in these settings. Of all fire-related cases of mortality worldwide, 95% occur in resource-limited settings. Patients who survive are likely to face serious complications, such as burn scar contractures. During my work as a global health specialist, we, the Tanzanian doctors and I, were indeed confronted with a high incidence of burn injuries. We had limited treatment options available and experienced high mortality and morbidity due to burns. From the literature it became evident that little evidence was available regarding burn care in resource-limited settings. Few studies are available on the outcomes of skin grafting procedures, no studies were available that showed how often burn scar contractures developed, and none of the studies were able to prove whether contracture release surgery was effective in the longer-term. There are valuable and useful treatment guidelines available from the International Society for Burn Injuries, specifically aimed for resource-limited settings. However, the Society also pointed out that the evidence for the guidelines was scarce and recommendations were frequently based on expert opinion. Outline of this thesis To evaluate the current state of burn care and to guide future improvements in burn care of underserved populations in resource-limited settings, insight into current treatment and its outcomes is of vital importance. The studies described in this thesis concentrate on three areas: short-term reconstructive surgical missions (Part I); acute burn care (Part II); and burn scar contracture release surgery (Part III).