Emily Broadis Kirsty Munro Peter Raine

Howard StevensonEmily BroadisKirsty MunroPeter Raine

£1.25 million awarded annually by Dfid (Dept. forInternational Development) to - “strengthen thecapacity of Health Services in developing countriesby supporting the work of Health Links” 3 year funded project (2010 – 2013) - £ 180,000awarded to Tayside/QECH,Blantyre Administered by the British Council/THET (TropicalHealth and Education Trust)

Scotland – Tayside Health BoardHoward Stevenson, Consultant Plastic Surgeon, DundeePeter Raine, (ret’d) Consultant Paediatric Surgeon, GlasgowEmily Broadis, Spr, Paediatric SurgeryKirsty Munro, Spr, Plastic SurgeryMalawi – Queen Elizabeth Central HospitalEric Borgstein, Consultant Surgeon, QECH, BlantyreDevor Kumiponjera, Consultant Surgeon, Head,Burn Unit,QECH, BlantyreAubrey Filmoni, Clinical Officer, QECH, Blantyre

32 bedded Burn Unitopened in QueenElizabeth CentralHospital, Blantyre inSeptember 1993 A result of 3 yearsplanning andconstructionReference: Stevenson JH, Borgstein E, Van Hasselt E, et al: The establishment of a burns unit in Malawi. Br J Plast Surg 1999; 52:488-94

5 year retrospectiveaudit of burn and scaldinjuries in children Burn Injuries are a bigproblem Large number ofadmissions High mortality rate Recurring injury patterns

5 year retrospectiveaudit of burn and scaldinjuries in children Burn Injuries are a bigproblem Large number ofadmissions High mortality rate Recurring injury patternsREDUCTION OFMORTALITYPREVENTION

Reduction ofIncidence of Burnand Scald Injuriesin Children inMalawi Reduction ofMortality andMorbidity ofThermal Injuries inChildren in Malawi

To design an effective burns prevention strategy it is important to define clearly thesocial, cultural and economic factors, which contribute to injury causation 1,2,3,4 Training of a nurse indata collection Commenced July 2009 Continually updatedand reviewedReferences: 1 Atiyeh BS, Costagliola M, Hayek SN: Burn prevention mechanisms and outcomes: Pitfalls, failures and successes. Burns 2009; 35:181-93, 2 Tse T, Poon CH, Tse KH, et al:Paediatric burn prevention: an epidemiological approach. Burns 2006; 32:229-34, 3 Werneck GL, Reichenheim ME: Paediatric burns and associated risk factors in Rio de Janeiro, Brazil.Burns 1997; 23:478-83, 4 Haberal M, Ucar N, Bilgin N: Epidemiological survey of burns treated in Turkey and desirable burn-prevention strategies. Burns 1995; 21:601-6

Peak Incidence at age 1 – 2 years

• Young girls (6-8 years) keeping warm by the fire• Babies left under mosquito nets by a paraffin lamp• Toddlers reaching out to open fires used for cooking• Older boys (9 -12 years) playing with footballs• Children with epilepsy allowed unaccompanied by fires

Reduction of Incidence Nanzikambe CommunityMobilisation Programme Funsani Art Local and National Radioand Television Play Soccer Malawi The National FootballAssociation of Malawi School PorridgeProgrammesReduction of Mortality/Morbidity Full time Clinical Officer Two bedded HighDependency Unit Burn managementcourses Analgesia protocol anddistraction techniques Supplemental nutrition Educational posters Prospective database

Nanzikambe Drama GroupMonitoringScenario presentationQuestions and answers

Scenario Presentation

Question & AnswerSessions

Matthias Funsani Artist

Play Soccer Malawi

Football Association of MalawiMalawian NationalTeamThe FLAMES

Training Courses/Mentoring Increased Staffing (ClinicalOfficer/Nurses/Physiotherapists Equipment – Dermatome/Blades Establishment of HDU Earlier surgery/additional lists Change in “Culture” –Teams,Leadership,Responsibility Audit

Recruiting/working withestablished organisations inpartnership Regular visits, networkingand frequent meetings Clinical Officer Post Regular local steering groupmeetings Prospective data collection Provides relevant preventionmessages Enables departmental audit

Lack of good local team working High turn over of staff in Burn Unit Lack of local leadership Cultural obstacles

Communityworkshops Courses Equipment Pain Relief andNutrition HDU Nurse stafftraining

Governmentrallying/awareness… Continued project“visibility” Publication of Data Linking up with Centraland Northern Malawi Delegation of courseorganisation locally SustainabilityAdmissions to QECH Burn Unit byRegionNorth (None)Unknown (4%)Central (1%)Southern (93%)Mozambique (2%)

United Nations Millenium DeclarationGeneral Assembly – 8 th September 2000Section 3: development and povertyeradication -Article 19:...”by the year 2015,to have reduced under 5child mortality by two thirds of the currentrate”

Millenium development goals report 2010 -Goal 4: Reduce under 5 mortality rate by twothirds by 2015...Sub-Saharan Africa1990 ..........................184 / 1000 live births2008 ..........................144 / 1000 live birthsDeveloped Regions1990 ............................12 / 1000 live births2008 .............................6 / 1000 live births