Role of the World Health Organization

A Consultation Meeting on the Prevention and Care of Burns was held at WHO Headquarters in Geneva, CH, on April 3–4, 2007. The goal was to promote the development of the spectrum of burn control measures, to include improvements in burn prevention and strengthened burn care, as well as better information and surveillance systems, and more investment in research and training. A broad-based strategic plan was created and published in a document that describes what is seen as the important steps towards the global goal of decreasing the rates of burn injuries and death, as well as the minimizing the sequelae of burns, such as disfigurement and disability [143]. This Burn Plan is organized into seven main components which correspond to the challenges in burn prevention and care:

For each component, there are full descriptions of areas of work needing to be done, expected products and output, and timeline. The full document can be accessed on-line at http://whqlibdoc.who. int/publications/2008/9789241596299_eng.pdf.

For example, the goal for the Policy Component is to increase the enactment and implementation of effective, sustainable burn prevention and care policies worldwide, including action plans, legislation, regulations and enforcement. The first area of work includes incorporating burn prevention and care into national and local health plans and injury control plans, as well as supporting the development of appropriate policy and legislation for burn prevention and care by countries. The expected products and outputs for these areas of work are policy statements and guidelines on burn prevention legislation, regulations, and enforcement, and appropriate information to support policy recommendations, such as estimates of cost-effectiveness of burn prevention and treatment strategies.

The next area of work for the Policy Component is to increase the number of countries that have and are implementing legislation and policies on burn prevention. To this end, the expected products and outputs are increased number of countries with national health insurance plans that include burn prevention and care and that receive and utilize guidance from WHO on policies, strategies and regulations on burn prevention and care.

To further these goals, the International Society of Burn Injuries is currently advocating for a resolution on the Prevention of Burn Injuries and Fire Deaths to the World Health Assembly, whose passage would ensure that burn prevention would be given priority among other health concerns at the WHO. In addition, the Department of Violence and Injury Prevention and Disability is currently creating a Best Practices manual demonstrating the most effective burn prevention programs known throughout the world.

Conclusions and recommendations

Surveillance

The approach to injury prevention includes four stages: surveillance, analysis, intervention and evaluation. Precise description of the problem(s) is the basis to planning effective interventions, yet in many LMIC, data on burns are scarce, inaccurate, or both. In some countries, a lack of reliable data on risk factors further hampers the development and enactment of effective burn prevention strategies, while in others, incomplete description of burn incidents leads to underassessment of the magnitude of the public health problem. There is a need for better surveillance with formal epidemiologic studies, which will more accurately assess the true incidence in vulnerable populations. A model for such a system can be found in Taiwan, ROC, where the support of the Childhood Burn Foundation provides resources to all 43 hospitals in the country to collect data on hospitalized burn patients. This comprehensive database, which utilizes the Internet for data entry, captured information on over 12,000 patients from 1997 to 2003 [221].

Smoke alarms

The effectiveness and reliability of smoke alarms can be improved through improvements in technology, including 1) greater waking effectiveness for certain populations, 2) quicker, more certain responses to the range of fire types coupled with reduced nuisance alarms, 3) more cost-effective ways to interconnect alarms in existing homes. In addition, contin-

ued research is needed to improve measurement and performance of smoke alarms. Improvements must be made in educational approaches that change behavior in regards to home escape planning, inspection and maintenance of smoke alarms, and developing safe options for dealing with nuisance alarms. Human behavior in residential fires requires more research to determine effective cues, increase in the perception of the value of immediate escape, development of exit skills under stress, and strategies to reduce the learned irrelevance of alarms [174].

Transition away from open fires and kerosene appliances

There is an assumption held by some that the inevitable transition from open fires and kerosene appliances toward more sophisticated devices for cooking, heating and lighting will result in a diminution of burn injuries in LMIC. However , the current experience suggests that this transition period is not without hazard. In Delhi, for example, LPG-related burns accounted for less than 1 % of admissions to a single burn center from 1993 to 2000, but from 2001 to 2007 were responsible for over 10 % of admissions [7]. Electrification can certainly reduce the risk of disasters caused by malfunctioning kerosene stoves, but can also lead to a whole new set of haz-

ards from electrical injury because of substandard wiring techniques, unsafe practices, illegal poaching of power and scavenging copper from overhead lines, and inadequate barriers around high-voltage poles and towers. Thus as developing communities convert to more common use of LPG and electricity, steps must be taken to ensure the safety of the residents.

Gender inequality

In LIC the burden of burns falls mostly on women and female children, who are at risk of “occupational” injuries while they tend fires and prepare food. Sadly, they are also selected as victims of horrific assaults, such as acid throwing or “bride burning” [86]. The latter is a phenomenon related often to the dissatisfaction of the husband with the wife’s dowry, and may occur either as self-immolation or as assault by the husband’s family [107]. Clearly these particularly tragic events deserve focus above and beyond usual burn prevention efforts. Elimination of acid attacks and bride burning require a multitude of coordinated actions involving passage and enforcement of protective legislation, education of men and boys about appropriate behavior toward women, and resources for women in need of shelter or care.