P0277 - Use of Traditional Medicine in Prehospital Treatment for Burns in Haiti: A Single Center Study

Purpose: In low-and middle-income countries (LMICs), the management of pediatric burns remains challenging: it requires specialized care that few hospitals can provide, and the access to surgical care is not widespread. Therefore, in LMICs, such as Haiti, the use of prehospital treatment, including but not limited to traditional medicine from local healers, is not uncommon. However, the type of treatment, if it delays accessing specialized burn care, and the overall effect on patient outcomes is not well understood. Therefore, the aim of this study was to describe a pediatric burn cohort admitted to the general surgery department at a tertiary teaching hospital in Port-au-Prince, Haiti. With a specific emphasis on analyzing the association between prehospital burn treatments and infection, delays in reaching care, and the need for surgery.

Methods: In this retrospective study we included all patients with burns under 16 years of age admitted from 2011 to 2015 to the general surgery department at a tertiary in Haiti. All data was extracted from hospital records including age, sex, TBSA%, causes of burns, time to admission, what was used as a prehospital treatment, presence of infection at the time of admission and need for surgical intervention .Descriptive data were analyzed in Stata and for this analysis a delay in hospital arrival was defined as reaching the hospital >24 hours after the child’s burn occurred.
Findings: Over the study period, 119 children with burns were admitted to the general surgery service. The median age was 2 (IQR 1.3,3) and 56% (67/119) of patients were male. The median TBSA was 10 % (IQR 7,16), and in-hospital mortality was 3% (4/119). Scalds were the most frequent mechanism of injury in 75% of patients (89/119). Before reaching the hospital, 23% (27/119) of children received prehospital burn treatment. This ranged from treatment with home remedies, including aloe, toothpaste, or animal excrement and the use of traditional medicine from a local healer. Prehospital treatment of burns in this patient population was associated with a delay in arrival to the hospital, presence of an infection upon arrival, and need for surgical intervention (p<0.05).

Conclusion: Almost one fourth of pediatric burns patients admitted to a general surgery department at tertiary hospital in Haiti. 23% of patients received some form of prehospital burn treatment. Prehospital burn treatment in this cohort was associated with a delay in reaching the hospital, infection, and need for surgical intervention. These findings highlight the need to further explore the type of remedies used in the prehospital setting and the development of educational programs working with families and traditional healers aimed at improving prehospital treatment for burns in Haiti.