BURN CARE AND PREVENTION JOURNAL

Burns constitute a major public health problem, especially in low- and middle-income countries (LMICs) where over 95% of all burn deaths occur. Around 200 000 people die each year from burns, and many more are disabled, accounting for an estimated 10 million disability adjusted life years lost globally each year. The great majority of injuries occur in the home, chiefly to women and children.¹ For this reason, I will concentrate on domestic burns, exploring some of the reasons and some of the potential solutions to these preventable injuries.
Estimates from the Global Burden of Disease 2019 study, conducted between 2009 and 2017, confirmed a downward trend in the global incidence of burns in recent years, especially in high-income countries (HICs), possibly due to improvements in living standards and burn prevention measures. In many regions of the world, the prevention of burn injuries has lagged behind, and, in some countries, such as Argentina, China, and Vietnam, prevalence has actually increased, possibly due to urban crowding, unsafe infrastructure, and population increase.²
The overwhelming determinant of burn injury and death is poverty, in LMICs and HICs alike. Classically, economic development has been linked to the “energy ladder” of fuel, first postulated by Hosier and Dowd³ in a study on burn epidemiology in Zimbabwe, and widely quoted since. In this concept, as countries develop, household energy sources progress from wood and coal and then through kerosine and liquefied petroleum gas to electrical energy.³ However, this is an oversimplification. Gas and electricity in particular require safer systems, from source to kitchen stove, and safe cooking stoves are available for all types of fuel.
The foremost additional contributing factor is domestic insecurity. Excluding war itself, the consequences for affected populations are catastrophic and include the mass displacement of people. If resources are available, refugee camps can be established along UNHCR guidelines, which include provision of fire breaks and adequate distancing of dwellings.⁴ However, most refugee camps are haphazard, crowded, and dangerous, and fires are common.⁵ Even in the absence of conflagrations, displaced refugees have an increased risk of burn injuries, especially around cooking.⁶
Other events that disrupt domestic security can also increase the risk of burn injury, including the Earthquake in Turkey in 2023, where flame burns predominated during the first week, followed by tent fires in the second week.⁶ With Hurricane Sandy, which struck the United States in 2012, 5% of deaths were caused by burns, many of which were electrical.⁷ Homelessness is also a scourge in many HICs, where housebuilding has stagnated in recent years and social inequality has increased. Temporary accommodations do not encourage durable investments either by owners or occupiers. Unsurprisingly, an excess of burn injuries is observed in the homeless.⁸
The first requirement of any government is the security of its people, including safe energy provision and durable housing. The essential requirements are modest: raising cooking from the floor, providing a stable work surface, and planning a designated cooking area. Therefore, promotion of the socioeconomic argument for improvements in living conditions is imperative. The World Health Organization estimates that up to 10 million disability adjusted life years are lost each year from burns. The cost of burn treatment, excluding consequent disability, has been estimated for various countries, mainly HICs. The total cost of hospital treatment for burns in the United States ranged from (in US dollars) $111 217 to $301 516 for adults, depending on burn size; in Spain, the average cost per patient, including care and indirect costs, was estimated at $99 733, with a total annual cost of to the country of $313 million; in Turkey, the direct cost of hospital treatment alone per patient was estimated at $15 250.^9-11
In HICs, favorable cost-benefit analyses of fire-resistant nightwear and the installation of smoke alarms have led to their widespread implementation and a consequent reduction in burn injuries.^12,13 Unfortunately, studies relevant to LMICs are lacking. In their systematic review of burn prevention programs in LMICs, Price and colleagues¹⁴ identified 23 relevant publications, most of which were unreproducible or substandard. The group concluded that “there is a lack of published literature describing large-scale burn prevention programmes in LMICs that can demonstrate sustained reductions in burn incidence. Population-level, collaborative projects are necessary to drive forward burn prevention through specific environmental or legislative changes and supplementary educational programmes.”¹⁴ This conclusion is emphasized in the World Health Organization guidelines contained in the “Factsheet on Burns.”¹
In conclusion, the decline in the global incidence of burn injury has been observed particularly in HICs; similar declines in LMICs have remained lagging behind. Poverty and domestic insecurity are major factors. There is a strong socioeconomic argument to be made for the improvement of infrastructure, especially housing, to encourage legislation and regulations for the domestic environment, but sound epidemiological studies are needed. Finally, the International Society for Burn Injury definition of prevention includes the prevention of deformity and disability. There has been a welcome expansion in recent years of internet resources providing global standards and education in the care of burn patients. A similar increase in resources aimed at preventing burns in the first place would be equally welcome.

Volume: 5 Issue: 3 September 2025

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