Paediatric burn injuries in Cape Town, South Africa : Context, circumstances, and prevention barriers

Abstract: Despite concerns about the impact of childhood burns, there remains a paucity of systematic descriptions of its epidemiology, contexts of occurrence, and preventability. This information is essential for the development of prevention interventions in Cape Town, South Africa. The thesis sought to identify the individual patterns and circumstances of the burn injury, neighbourhood determinants of risk, caregiver accounts of these injury events and their mechanisms, and the barriers and enablers to prevention. It comprises four studies, two of which use currently available register data, one of these in combination with South African census data, while two utilise interviews as a basis for qualitative studies into the burn event and counter-measure barriers and enablers. The first study describes the epidemiology and patterns of moderate to severe childhood burn injuries in the surrounding Western Cape province. Burn injury incidence is particularly high for toddlers and infants, for boys, and for African children. There are four burn injury patterns of occurrence: infant scalding , toddler scalding , injuries among older children with an over-representation of flame-related burns and other causes of burns sustained to the head and neck region . The second study is an ecological investigation into the impact of local circumstances of living in Cape Town on childhood burn injury levels. The main dimensions of contextual exposure were defined as housing conditions, socio-economic barriers and child dependency. All have associations, and the first two even graded relationships with injury level. The third study reports on the testimonies of caregivers whose children have recently been hospitalised with burn injuries. They highlighted the multi-factorial nature of the injury event; contexts of extensive exposure to adverse environmental, domestic and personal conditions; and environmental, spatial and supervision strategies for future prevention. The fourth study identifies caregiver and stakeholder representations of scalding countermeasures, and barriers and enablers to its implementation, in response to depictions of typical scalding scenarios. Counter-measures included: changes to home practices, safety enhancements to the home environment, and improvements of individual competence. Barriers to these focused on limitations in the physical environment, product limitations, executive hinderers, and hardship, most of which are not easily modifiable. The proposed enablers involved the reversal or alleviation of the identified barriers. In conclusion, the thesis highlights the need for burn injury prevention efforts that address the physical aspects of the home environment, such as spatial layout, storage and working facilities, and heating appliances that incorporate safety technology. This may require concerted efforts and advocacy given the various needs of impoverished and marginalized communities.