Epidemiological Profile and Factors Influencing Post Burn Contractures Formation in Rwanda.

Abstract

BACKROUND: Burn injuries cause loss of 18 million of days adjusted life years (DALYs) and 180 thousand deaths per year. In developing countries, the inevitable complications of post burn scarring are associated with added contractures of single or multiple joints. The purpose of this study was to describe the epidemiological profile, identify factors influencing post burn contractures formation in patients with burn in 2 tertiary hospitals of Rwanda. METHODS: A retrospective Cohort study was designed, patients who consulted plastic surgery unit in the University Teaching Hospital of Kigali (CHUK) and Rwanda Military Hospital (RMH) for post burn complications were included. Contractures were classified using MASSCA classification. Data were collected using a pre-established questionnaire, electronically captured and analyzed using SPSS version 205. Descriptive statistics were used to generate frequencies and percentages. Bivariate and multivariate analysis was done to assess correlations between variables and factors associated with post burn contractures formation. Odd ratio, a confidence interval of 95% and p-value of less than 0.05 were used for the statistical significance. RESULTS: 387 patients have been included in this study. 74.4% were children and 52.4 % of them were female. 313(80.9 %) developed post burn contractures. The majorities of PBC was MASCCA type B (53.4%). Factors influencing PBC formation included lack of performing self exercises (OR: 0.33, p-value < 0.048), lack of physiotherapy (OR: 0.34, value < 0.044), lack of regular physiotherapy (OR: 0.33, p-value < 0.002) split thickness skin graft over the burned joint (OR: 3.89, p-value < 0.004). However, lack of education on self-physiotherapy exercises (OR: 0.31, p-value: 0.092 respectively), daily application of splint (OR: 0.56 p-value: 0.143) and missed follow-up (OR: 1.84, p-value: 0.11) were not statistically significant.

CONCLUSIONS: Affecting mostly children, families with low socio-economic status, PBC constitute a huge burden in Rwanda. Lack of physiotherapy, exercises and split thickness skin graft over the burned joints are the major contributors to post burn contractures formation. Improving access to physiotherapy, early exercises and better choice of reconstructive options may improve the outcomes