Abstract
Background: Burns remained a major health problem in most developing countries which have increased the mortality and morbidity among the people. This study aimed to describe the epidemiology and outcomes of burn among females at reproductive age and investigate the factors that associated with mortality during the study period in in Baghdad/Iraq. Methods: A retrospective cohort study was undertaken at Al-Karama academic Hospital in Baghdad. Four hundred and thirty-seven females were admitted to this center from 1st of January 2017 to the end of October 2018. Data were collected from the records and patient file at the department of statistics. The information was including the age, education, marital status, occupation, TBSA, degree of burn, length of stay in hospital, causes, and patient condition. Software of STATA version 13 was used to analysis this data. Results: The mean age was 27.1 and SD 0.34 with 95% CI (26.4358 to 27.8067). the fire 64.8% (283/437) were the most cause of burn among females. Housewives 65% (284/437) were more probably exposed to burn than others with the mechanism of burning and females with primary education 42.8% (187/437) were more probability of burn than others group. Regard to length of stay, the mean was 7 days and the 95% CI [6.489-7.629]. Thus, 79.2% (346/437) of females that stayed in the hospital for less than 10 days had higher percentage of burn comparing with another period. Mean and SE of TBSA was 57.8 and 1.2 with the 95% CI [55.4051-60.2516]. A significant relationship was found between occupation, education status, TBSA, length of stay, causes of burn and outcomes at the p. value <0.05. The time at risk was 3085 with the incidence rate. 14. The survivor function in one day (Kaplan Meier estimate) was 0.8970 and SE 0.0144 with 95% CI [0.8645-0.9221]. Conclusion: The patients at age 26-45 years have equal hazard ratio of death (HR=1) at all the times of follow-upping. There is not statistically significant have been found at the (p. value =0.486), the 95% CI for the HR includes the null value of 1. As well the causes of burn, the patients with fire cause have a higher hazard of death HR=1.1 with the (p. value =0.012). Half of cases were single. A significant relationship has been found between the marital status and the age groups of the p. value 0.000. Also, a significant result of the intent status with causes of burn at the p. value 0.000.
Keywords: Epidemiology, female, burns, Iraq, retrospective study, survival, Kaplan
Introduction
In spite, the increasing of development in most countries, burns remained a major health problem in most developing countries which have increased the mortality and morbidity rate among people [1].
Therefore, the WHO reported that more than one thousand and eighty deaths happened by burning every year [1]. Further, the wars, poverty, unemployment, violence and other factors led to an increase in mortality rate among females and adults rather than another groups [2]. In Iraq the total number of burn patients was 92,734 patients per year (250 patients per day) and regarding to the side effects after burn as the bacterial and viral infections, ulcers and other diseases, it was one of the causes for death and its approximately 37% of the total number of deaths [3]. In Baghdad, the prevalence of burn injuries in 2016 was 1.2% per 100,000 population [4]. In Basra 2017, the researcher reported that the most common mechanisms of burns were respectively flame scalds, electrical burns and chemical burns [1].
In addition, the 2nd and 3rd degree of burns are the most dangerous and common among burned cases and the main causes for losing the humanity and disfigurements [5]. Therefore, females who survived from the process of burning, they are living in a state of isolation and deprived from their most basic rights, which is living in a normal life [6]. It has been reported that women at reproductive age are often the victims of intentional burning due to their low socioeconomic status, living in crowded houses and using unsafe cooking appliances [6]. This study aim at describing the epidemiology and outcomes of burn among female at reproductive age and investigate the factors that associated with mortality during the study period in in Baghdad/Iraq.
Methods
A retrospective cohort study was undertaken at Al-Karama Academic Hospital in Baghdad. it’s one of the largest hospitals in Baghdad, which has fourteen private burn wards and two operation rooms. Four hundred and thirty-seven females were admitted to this centre from 1st of January 2017 to the end of October 2018. before starting to collect the data, the ethical clearance was obtained from Ministry of health and from Al-Karama hospital to collect our data. Data were collected from the records and patient files at the department of statistics. then, entered in the Microsoft Excel sheet daily. the information obtained from the record were including the age, education, marriage, Job, TBSA, degree of burn, length of hospital stay, causes, and patient condition data. The inclusion criteria of cases were the females at the reproductive age (15-45). females in the age less than 15 years and more than 45 years and if there is any empty field in the record or in the patient’s file were excluded from our study. in addition, the patients in emergency ward were excluded from this study. STATA version 13 was used to analysis this data, Frequency and percentage was used for summarizing the category variables. The Chi Square statistic was used to find the relationships between categorical variables. MLR was used to explain the relationship between one variable and two or more independent variables. the Kaplan-Meier method was used to compare the survival curve in two or more groups, Cox regression (or PHR) was used to analyse the effect of several risk factors on survival.
Results
Four hundred and thirty-seven females were admitted to the Burns Units during the study. The mean age was 27.1 and SD 0.34 with 95% CI (26.4358 to 27.8067). According to our results, the fire 64.8% (283/437) were the most cause of burn among females. In the age group of 15-25 years, the highest percentage of burn cause were fire 65.3% (141/283); the hot liquid cause 21.3% (46/283); chemical cause in 9.3% (20/283) electricity cause in 4.2% (9/283), respectively no statistically significant relationship has been found between the age groups and causes of burn at the p. value <0.05. Housewives 65% (284/437) were more probably exposed to burn than others with the mechanism of burning. Also, no statistically significant relationship has been found between the occupation and causes of burn at the p. value <0.05. For education status, females with elementary education 42.8% (187/437) were more at risks of burn than others group. Also, there is no statistically significant relationship has been found between the education status with causes of burn at the p. value <0.05. Regard to length of stay, the mean was 7 days and the 95% CI [6.489-7.629]. Thus, 79.2% (346/437) of females that stayed in the hospital for less than 10 days has higher percentage of burn comparing with another periods. A statistically significant relationship has been found between the length of stayed in the hospital and causes of burn at the p. value <0.05 (Table 1). Mean and SE of TBSA was 57.8 and 1.2 with the 95% CI [55.4051-60.2516]. Therefore, the highest percentage of TBSA was 30.7% (134/437) between the range of 50.1% and 75% from the total body surfaces. There is statistically significant relationship has been found between the TBSA and causes of burn at the p. value <0.05. The highest percentage of females was 69.7% (122/175) who died by the fire. There is statistically significant relationship has been found between outcomes and causes of burn at the p. value <0.05 (Table 1).
Table 1.
Characteristic of study sample in relation to causes of burn
| Causes of burn | p. value | |||||
|---|---|---|---|---|---|---|
|
|
||||||
| Number % | Number % | Number % | Number % | Number % | ||
| Fire | Hot liquid | Chemical | Electricity | Total | ||
| Age groups (years) | ||||||
| 15-25 | 141 | 46 | 20 | 9 | 216 | 0.669 |
| 65.3 | 21.3 | 9.3 | 4.2 | 100 | ||
| 26-35 | 100 | 37 | 12 | 11 | 160 | |
| 62.5 | 23.1 | 7.5 | 6.9 | 100 | ||
| 36-45 | 42 | 9 | 5 | 5 | 61 | |
| 68.9 | 14.8 | 8.2 | 8.2 | 100 | ||
| Occupation | ||||||
| Housewife | 187 | 55 | 24 | 18 | 284 | 0.695 |
| 65.9 | 19.4 | 8.5 | 6.3 | 100 | ||
| Employee | 57 | 26 | 7 | 5 | 95 | |
| 60.0 | 27.4 | 7.4 | 5.3 | 100 | ||
| Student | 39 | 11 | 6 | 2 | 58 | |
| 67.2 | 19.0 | 10.3 | 3.5 | 100 | ||
| Education status | ||||||
| Elementary | 127 | 39 | 13 | 8 | 187 | 0.300 |
| 67.9 | 20.9 | 6.9 | 4.3 | 100 | ||
| Secondary | 80 | 34 | 16 | 8 | 138 | |
| 58.0 | 24.6 | 11.6 | 5.8 | 100 | ||
| Collage | 76 | 19 | 8 | 9 | 112 | |
| 100 | 16.9 | 7.1 | 8.0 | 100 | ||
| Length stay | ||||||
| 1-10 day | 207 | 85 | 34 | 20 | 346 | 0.000 |
| 59.8 | 24.6 | 9.8 | 5.8 | 100 | ||
| >10 day | 76 | 7 | 3 | 5 | 91 | |
| 83.5 | 7.7 | 3.3 | 5.5 | 100 | ||
| TBSA | ||||||
| <25% | 18 | 38 | 12 | 6 | 74 | 0.000 |
| 24.3 | 51.4 | 16.2 | 8.1 | 100 | ||
| 25-50% | 67 | 19 | 18 | 6 | 110 | |
| 60.9 | 17.3 | 16.4 | 5.5 | 100 | ||
| 50.1-75% | 99 | 21 | 6 | 8 | 134 | |
| 73.9 | 15.7 | 4.5 | 5.9 | 100 | ||
| >75.1% | 99 | 14 | 1 | 5 | 119 | |
| 83.2 | 11.8 | 0.8 | 4.2 | 100 | ||
| Outcomes | ||||||
| Death | 122 | 28 | 19 | 6 | 175 | 0.000 |
| 69.7 | 16.0 | 10.9 | 3.4 | 100 | ||
| Recovery | 92 | 61 | 17 | 11 | 181 | |
| 50.8 | 33.7 | 9.4 | 6.1 | 100 | ||
| Transfer to another unit | 26 | 1 | 0 | 1 | 28 | |
| 92.9 | 3.6 | 0.0 | 3.6 | 100 | ||
| Discharge by her own | 43 | 2 | 1 | 7 | 53 | |
| 81.1 | 3.8 | 1.9 | 13.2 | 100 | ||
A significant relationship was found between occupation, education status, TBSA, length of stay, causes of burn and outcomes (p. value <0.05) (Table 2). The case fatality rate was 40% (# deaths assigned to a specific disease during a given year/# new cases of that disease reported during the same year *100) (Table 2). Regarding to marital status, the 58.1% (254/437) was single status, followed by 32% (140/437) were married. A significant relationship has been found between marital status and age groups of the Pearson chi2 38.3 and p. value 0.000 (Table 3). As well, a significant relationship has been found between intent status and causes of burn with the Pearson chi2 47.8; degree of freedom (3) and p. value 0.000 (Table 4).
Table 2.
Characteristic of study sample in relation to outcomes
| Outcomes | p. value | |||
|---|---|---|---|---|
|
|
||||
| Number % | Number % | Number % | ||
| Died | Survivors | Total | ||
| Age groups | ||||
| 15-25 | 96 | 120 | 216 | 0.078 |
| 44.4 | 55.6 | 100 | ||
| 26-35 | 53 | 107 | 160 | |
| 33.1 | 66.9 | 100 | ||
| 36-45 | 26 | 35 | 61 | |
| 42.6 | 57.4 | 100 | ||
| Occupation | ||||
| Housewife | 140 | 144 | 284 | 0.000 |
| 49.3 | 50.7 | 100 | ||
| Employee | 12 | 83 | 95 | |
| 12.6 | 87.4 | 100 | ||
| Student | 23 | 35 | 58 | |
| 39.7 | 60.3 | 100 | ||
| Education status | ||||
| Elementary | 102 | 85 | 187 | 0.000 |
| 54.6 | 45.5 | 100 | ||
| Secondary | 44 | 94 | 138 | |
| 31.9 | 68.1 | 100 | ||
| Collage | 29 | 83 | 112 | |
| 25.9 | 74.1 | 100 | ||
| Length stay in hospital | ||||
| 1-10 day | 150 | 196 | 346 | 0.006 |
| 43.4 | 56.7 | 100 | ||
| >10 day | 25 | 66 | 91 | |
| 27.5 | 72.5 | 100 | ||
| TBSA | ||||
| <25% | 3 | 71 | 74 | 0.000 |
| 4.1 | 95.9 | 100 | ||
| 25-50% | 19 | 91 | 110 | |
| 17.3 | 82.7 | 100 | ||
| 50.1-75% | 44 | 90 | 134 | |
| 32.8 | 67.2 | 100 | ||
| >75.1% | 109 | 10 | 119 | |
| 91.6 | 8.4 | 100 | ||
| Causes of burn | ||||
| Fire | 122 | 161 | 283 | 0.026 |
| 43.1 | 56.9 | 100 | ||
| Hot liquid | 28 | 64 | 92 | |
| 30.4 | 69.6 | 100 | ||
| Chemical | 19 | 118 | 37 | |
| 51.4 | 48.7 | 100 | ||
| Electricity | 6 | 19 | 25 | |
| 24.0 | 76.0 | 100 | ||
Table 3.
Distribution of studied sample according to marital status and age groups
| Marital status | Age groups | Total | ||
|---|---|---|---|---|
|
| ||||
| Number % | Number % | Number % | Number % | |
| 15-25 | 26-35 | 36-45 | ||
| Single | 155 | 79 | 20 | 254 |
| 61.0 | 31.1 | 7.87 | 100.0 | |
| Married | 46 | 61 | 33 | 140 |
| 32.9 | 43.6 | 23.6 | 100.0 | |
| Divorce | 15 | 20 | 8 | 43 |
| 34.9 | 46.5 | 18.6 | 100.0 | |
| Total | 216 | 160 | 61 | 437 |
| 49.4 | 36.6 | 13.9 | 100.0 | |
Pearson chi2(4)=38.3, p. value =0.000.
Table 4.
Distribution of studied sample according to intent status and causes of burn
| Intent | Causes of burn | Total | |||
|---|---|---|---|---|---|
|
| |||||
| Number % | Number % | Number % | Number % | ||
| Fire | Hot liquid | Chemical | Electrical | ||
| Intentional | 186 | 38 | 6 | 8 | 238 |
| 78.15 | 15.97 | 2.52 | 3.36 | 100 | |
| Unintentional | 97 | 54 | 31 | 17 | 199 |
| 48.74 | 27.14 | 15.58 | 8.54 | 100 | |
Pearson chi2(3)=47.8041; Pr=0.000.
Multiple linear regression was performed on 437 females. Six independent predictors of death were identified: age, TBSA, occupation, education, causes of burn and length of stay in hospital (Table 5). There is a relationship has been found between TBSA, occupation, education, causes of burn, length stay in hospital with the outcomes at the p. value 0.000 (Table 5).
Table 5.
Multiple linear regression analysis of factors associated with outcomes
| Outcomes | Coef. | Std. Err. | z | P>z | [95% Conf. Interval] | |
|---|---|---|---|---|---|---|
| Age | -.0002571 | .0025968 | -0.10 | 0.921 | -.0053468 | .0048326 |
| TBSA | -.013537 | .0006651 | -20.35 | 0.000 | -.0148407 | -.0122334 |
| Occupation | .0813175 | .0226134 | 3.60 | 0.000 | .036996 | .125639 |
| Education | .0861449 | .0233936 | 3.68 | 0.000 | .0402944 | .1319955 |
| Causes of burn | -.0775645 | .0191262 | -4.06 | 0.000 | -.1150512 | -.0400777 |
| Length stay in hospital | .0166713 | .0026648 | 6.26 | 0.000 | .0114485 | .0218942 |
| _cons | 2.281366 | .0883883 | 25.81 | 0.000 | 2.108128 | 2.454604 |
The time at risk was 3085 with the incidence rate .14. the 25th and 75th shown in the table [6]; the 25th percentile is 2 days and its mean 25% of participants have survival times less than 2 days and in 75% the participants have been survival time at least 9 days (Table 6).
Table 6.
Time and incidence rate of study sample
| Time at risk | Incidence rate | No. of subjects | Survival time | ||
|---|---|---|---|---|---|
|
| |||||
| 25% | 50% | 75% | |||
| 3085 | .1416532 | 437 | 2 | 6 | 9 |
And when use the comments lists to estimate the survivor function and get the Kaplan-Meier Estimates (Table 7). In one day the survivor function (Kaplan Meier estimate) was 0.8970 and SE 0.0144 with 95% CI [0.8645-0.9221]. while in forty-nine days, the survivor function was 0.000 (Table 7).
Table 7.
Kaplan-Meier estimates
| Time | Beg. Total | Fail | Net lost | Survivor function | SE | 95% CI |
|---|---|---|---|---|---|---|
| 1 | 437 | 45 | 0 | 0.8970 | 0.0145 | 0.8645-0.9221 |
| 2 | 392 | 70 | 0 | 0.7368 | 0.0211 | 0.6929-0.7755 |
| 3 | 322 | 27 | 0 | 0.6751 | 0.0224 | 0.6290-0.7168 |
| 4 | 295 | 28 | 0 | 0.6110 | 0.0233 | 0.5636-0.6549 |
| 5 | 267 | 35 | 0 | 0.5309 | 0.0239 | 0.4830-0.5764 |
| 6 | 232 | 38 | 0 | 0.4439 | 0.0238 | 0.3969-0.4899 |
| 7 | 194 | 33 | 0 | 0.3684 | 0.0231 | 0.3233-0.4135 |
| 8 | 161 | 21 | 0 | 0.3204 | 0.0223 | 0.2771-0.3644 |
| 9 | 140 | 32 | 0 | 0.2471 | 0.0206 | 0.2078-0.2884 |
| 10 | 108 | 17 | 0 | 0.2082 | 0.0194 | 0.1715-0.2475 |
| 11 | 91 | 28 | 0 | 0.1442 | 0.0168 | 0.1131-0.1788 |
| 12 | 63 | 11 | 0 | 0.1190 | 0.0155 | 0.0907-0.1513 |
| 13 | 52 | 6 | 0 | 0.1053 | 0.0147 | 0.0787-0.1362 |
| 14 | 46 | 8 | 0 | 0.0870 | 0.0135 | 0.0629-0.1157 |
| 15 | 38 | 3 | 0 | 0.0801 | 0.0130 | 0.0571-0.1080 |
| 16 | 35 | 5 | 0 | 0.0686 | 0.0121 | 0.0475-0.0949 |
| 17 | 30 | 6 | 0 | 0.0549 | 0.0109 | 0.0362-0.0790 |
| 18 | 24 | 2 | 0 | 0.0503 | 0.0105 | 0.0325-0.0737 |
| 19 | 22 | 6 | 0 | 0.0366 | 0.0090 | 0.0218-0.0573 |
| 20 | 16 | 1 | 0 | 0.0343 | 0.0087 | 0.0201-0.0545 |
| 21 | 15 | 2 | 0 | 0.0297 | 0.0081 | 0.0167-0.0489 |
| 22 | 13 | 3 | 0 | 0.0229 | 0.0072 | 0.0118-0.0403 |
| 23 | 10 | 3 | 0 | 0.0160 | 0.0060 | 0.0072-0.0314 |
| 24 | 7 | 1 | 0 | 0.0137 | 0.0056 | 0.0057-0.0284 |
| 27 | 6 | 1 | 0 | 0.0114 | 0.0051 | 0.0044-0.0253 |
| 29 | 5 | 1 | 0 | 0.0092 | 0.0046 | 0.0031-0.0221 |
| 35 | 4 | 1 | 0 | 0.0069 | 0.0039 | 0.0019-0.0188 |
| 38 | 3 | 1 | 0 | 0.0046 | 0.0032 | 0.0009-0.0155 |
| 41 | 2 | 1 | 0 | 0.0023 | 0.0023 | 0.0002-0.0122 |
| 49 | 1 | 1 | 0 | 0.0000 | - | - |
For Cox PH model, the patient with the age group 26-45 years have equal hazard ratio of death (HR=1) during the follow-up. There is not statistically significant have been found at the (p. value =0.486) with 95% CI for the HR includes the null value of 1. For the total body surfaces area, the patient with TBSA more than 25% having of equal hazard of death (HR=.989 ≈ 1) at all the times of follow-up, there are statistically significant have been found at the (p. value =0.000). Thus, the causes of burn, the patients with fire cause having a higher hazard of death HR=1 and there is statistically significant have been found at the (p. value =0.012). therefore, the married patients have lower HR=.94 and there is not statistically significant p. value =0.820. in addition, the patients with length of stay in hospital less than 10 days have lower HZ=.99 of death with 95% CI (.9830-1.0145) (Table 8).
Table 8.
Cox PH model regression
| T | Haz. Ratio | Std. Err. | z | P>|z| | [95% Conf. Interval] | |
|---|---|---|---|---|---|---|
| Age | 1.004577 | .0065856 | 0.70 | 0.486 | .9917525 | 1.017568 |
| TBSA | .98965 | .002480 | -4.15 | 0.000 | .98481 | .994532 |
| Occupation | .8779079 | .058099 | -1.97 | 0.049 | .7711118 | .999495 |
| Education | 1.020794 | .0603241 | 0.35 | 0.728 | .909151 | 1.146146 |
| Causes | 1.137271 | .058242 | 2.51 | 0.012 | 1.028661 | 1.257349 |
| Marital status | .9842376 | .0686968 | -0.23 | 0.820 | .8583979 | 1.128525 |
| Length stay | .9986535 | .0080467 | -0.17 | 0.867 | .9830062 | 1.01455 |
| Outcomes | .7842665 | .0382297 | -4.99 | 0.000 | .7128057 | .8628914 |
Plots of Kaplan-Meier product limit estimates of survival patients of burning (Figures 1 and 2).
Figure 1.
Plots of Kaplan-Meier product limit estimates of survival of a group of patients who that survive after burning.
Figure 2.
Plots of Kaplan-Meier product limit estimates of survival of patient with burning who dead and survived during the study period.
Discussion
The aims of our study are describing the epidemiology and outcomes of burn among females at reproductive age and investigating the factors associated with mortality during the study in Baghdad/Iraq, the case fatality rate of this study was 40.1%. Studies reported to investigate the mortality rate by the burn injuries included Iran [7], India [8,9], Nigeria [10], Iraq [11], Turkey [12], Colombia [13], Pakistan [14] and Nepal [15] with mortality rate of 64%, 39.88%. 23.2%, 22%. 14%. 1.270%. 36.12% and 18.6%, respectively. The age of female is considered the one of the risk factor especially among the youngest group. In this study the mortality was higher in the age groups 15-25 years. A study from Iran [7] reports the highest frequency of burns (53.5%) occurs to the age groups 16-25-year-old. An Indian [9] proposes the highest incidence of the burns was 47.01% in the 21-30-year age group. This could be due to different economic and psychological situations in different countries, especially among countries with instability due to wars. Moreover, the mortality was higher among housewives, because of household equipment and standing. An Indian [8], the authors indicated that 47.01% of female burns patients are housewives and this is because of poverty and customs in which countries force women to work at home.
A mortality rate of 62.3% occurred in patients with more than 75% TBSA involved in burns. An Iranian [7] studied showed the Mean (SD) of the TBSA burnt across all patients was 56% (28.5%), with a survival rate of 29% (13.4%). The relationship between TBSA and mortality was statistically significant. another Indian studied [8] reported a mortality rate of 65.67% in patients with 80%-100% of their body burnt, and 19% in patients with 60-79% of their body burnt. Another study reports a mortality rate of 35% in patients with more than 60% of total body surface area involved in burns [16]. This is due to kind of materials which were used by them to burn themselves. The mortality rate was 85.7% of cases that stays in the hospital for less than ten days while the survival case was 74.8%. Literature reports the different mortality rates. For example, An Iranian study to report a mean (SD) length of stay in hospital stayed as 13 days [16], An Indian [8] study reports that 47% of patients that died within 24 hrs and 28.4% survived with the two to seven days and the longest survival day was 55, with the most of patients (75.35%) dying within 1 week. The type of treatment, severity of the burns, the patient’s response to treatment and available facilities to treat the patients played significant roles in the patient outcome. This study found that most burns 54.5% was a result of intentional burned. These results agree with previously studies from India and Pakistan [9,14]. Most patients were burnt while using old-fashioned cooking methods and a poor understanding of how to use them safely.
Naked flame was the cause of the highest percentage of mortality, 78.9%, among females at reproductive age. Several studies in the literature also report this finding in countries including Iran 98.2% [16], Nigeria 49.1% [17], Iraq 51% [1], Nepal 41.7% [15], Pakistan 89.3% [14] and Bangladesh 88% [18]. However, a study in Colombia [13] it has been reported that electricity is the leading cause of burn related death (49.5%), followed by fire (28.5%).
Conculsion
The patients at age 26-45 years have equal hazard ratio of death (HR=1) at all the times of follow-upping. Not statistically significant have been found at the (p. value =0.486), the 95% CI for the HR includes the null value of 1. As well the causes of burn, the patients with fire cause have a higher hazard of death HR=1.1 with the (p. value =0.012). Half cases were single. A significant relationship has been found between the marital status with the age groups of the p. value 0.000. Also, a significant result of the intent status with causes of burn at the p. value 0.000. It is necessary to increase the public awareness in the treatment of burns, particularly for specialized and urgent care. This requires specialized infrastructure to cope with the large number of burn injuries which occur annually. Therefore, the economic burden of treatment is a major obstacle due to the length and high cost of treatment. Although the general medical sector provides most of these medical services, concerted efforts are needed to increase the treatment and support of patients with burns.
Acknowledgements
The researchers would like to thank all the staff of Al-Karama teaching Hospital, especially the staff in the Center of burns, in addition to thanks the head of the Statistics Department for its continuous cooperation with researchers and facilitating the work of the team.
Disclosure of conflict of interest
None.
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