Department of Surgery, University of North Carolina School of Medicine, CB# 7228, Chapel Hill, NC, USA.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Burns. 2020 Dec;46(8):1952-1957. doi: 10.1016/j.burns.2020.06.013. Epub 2020 Jun 21.
Burn injury is a significant contributor to mortality, especially in low and middle-income countries (LMICs). Patients in many communities throughout sub-Saharan Africa use traditional health practitioners for burn care prior to seeking evaluation at an allopathic burn center. The World Health Organization defines a traditional health practitioner as "a person who is recognized by the community where he or she lives as someone competent to provide health care by using plant, animal and mineral substances and other methods based on social, cultural and religious practices based on indigenous knowledge and belief system." The aim of this study is to determine the prevalence of prior traditional health practitioner treatment and assess its effect on burn injury mortality.
A retrospective analysis of the prospectively collected Kamuzu Central Hospital (KCH) Burn Surveillance Registry was performed from January 2009 through July 2017. Pediatric patients (<13 years) who were injured with flame or scald burns were included in the study and we compared groups based on patient or family reported use of traditional health practitioners prior to evaluation at Kamuzu Central Hospital. We used propensity score weighted multivariate logistic regression to identify the association with mortality after visiting a traditional healer prior to hospitalization.
1689 patients were included in the study with a mean age of 3.3 years (SD 2.7) and 55.9% were male. Mean percent total body surface area of burn was 16.4% (SD 12.5%) and most burns were related to scald injuries (72.4%). 184 patients (10.9%) used traditional medicine prior to presentation. Only a delay in presentation was associated with prior traditional health practitioner use. After propensity weighted score matching, the odds ratio of mortality after using a prior traditional health practitioner was 1.91 (95% CI 1.09, 3.33).
The use of traditional health practitioners prior to presentation at a tertiary burn center is associated with an increased odds of mortality after burn injury. These effects may be independent of the potential harms associated with a delay in definitive care. Further work is needed to delineate strategies for integrating with local customs and building improved networks for burn care, especially in rural areas.
烧伤是导致死亡的一个重要原因，尤其是在低收入和中等收入国家（LMICs）。在撒哈拉以南非洲的许多社区，患者在前往西医学烧伤中心就诊之前，会先寻求传统医疗从业者进行烧伤治疗。世界卫生组织将传统医疗从业者定义为“在其居住的社区中，因其使用植物、动物和矿物质以及其他基于社会、文化和宗教实践的本土知识和信仰体系的方法来提供医疗保健而被公认为有能力的人”。本研究旨在确定之前接受传统医疗从业者治疗的比例，并评估其对烧伤死亡率的影响。
对 2009 年 1 月至 2017 年 7 月期间前瞻性收集的卡姆祖中心医院（KCH）烧伤监测登记处进行回顾性分析。纳入研究的患者为<13 岁的因火焰或烫伤而受伤的儿科患者，我们根据患者或家属在前往卡姆祖中心医院就诊之前是否使用传统医疗从业者来比较组间差异。我们使用倾向评分加权多变量逻辑回归来确定在住院前就诊于传统医疗从业者与死亡率之间的关联。
研究纳入 1689 例患者，平均年龄为 3.3 岁（标准差 2.7），55.9%为男性。平均烧伤总面积百分比为 16.4%（标准差 12.5%），大多数烧伤与烫伤有关（72.4%）。184 例（10.9%）患者在就诊前使用过传统药物。只有就诊延迟与之前使用传统医疗从业者有关。在进行倾向评分加权评分匹配后，使用传统医疗从业者后的死亡率比值比为 1.91（95%置信区间 1.09，3.33）。
在前往三级烧伤中心就诊之前，使用传统医疗从业者与烧伤后死亡率增加相关。这些影响可能独立于因延迟接受确定性治疗而导致的潜在危害。需要进一步研究，以确定整合当地习俗和建立更好的烧伤护理网络的策略，特别是在农村地区。
