Epidemiological study of burns in a government tertiary hospital of No

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 265 IJAMSCR |Volume 4 | Issue 2 | April - June - 2016 www.ijamscr.com Research article Medical research Epidemiological study of burns in a government tertiary hospital of North Western Rajasthan-Bikaner Dr. Vijay haralgat seetharamaiah 1 Dr. Mohammed Salim 2 Dr. Avinash mahavar 3 Department of General Surgery S.P.M.C Bikaner Bikaner Rajasthan -334001 India. Corresponding author: Dr. Vijay. H.S Email: vijayharalgatgmail.com ABSTRACT Back ground Burns is a one of the major form of trauma faced by the surgeon. A variable numbers of demographic factors influence the burn in a particular region thus demanding for the epidemiological study of burns. Aims and objectives To know the epidemiological demographical and socio economic factors influencing the burn cases in the North Western part of Rajasthan and to know the pattern of burn in this area. Material and methodology A prospective study of all burn patients admitted as per admission criteria in the PBM hospital during the period of one year. 2015-2016. we studied a total of 177 patients with burns. Admission criteria were: 1 Patients who had sustained burn15 total body surface area second degree burn. 2 Third degree burns. 3 Burns sustained from chemical or electric burn. 4 Facial burns. 5 Inhalation burns. Results Young aged people between 20-40 years of age accounted for the majority 64.96 cases. Higher incidence was seen in rural population 70.05 married people 81.92 illiteracy 39.54 and low socioeconomic status 44.63. Flame burns were the most frequent form of burns 81.92 followed by electrical burn 10.73. Incidence of the burn was highest in residence kitchen accounting for 86.44 and an overall mortality rate of 45.19 was noted 80 cases out of 177. Outcome of the patient was directly proportional to the TBSA of burn. Extremes of age older age and younger group had a higher mortality rate. Keywords: Burn Epidemiological Factors Demographic Factors Socio Economic Factors INTRODUCTION Fire is a double edge weapon which can serve humans and can also cause damage. WHO calls burn as “Forgotten Global Public Health Crisis”. 1 It is the 4 th most common cause of traumatic death worldwide. 2 3 the developing world accounts for about 90 of burns worldwide. 4 In the world South East Asian countries form the epicenter for burns. Of 3 20000 global deaths due to burn injuries more than half around 1 84000 deaths occur in this region. 5 According to the Union health ministry of India about 70 lakh burn injuries were recorded annually of which 1.4 lakh people die every year which makes burn as the second most common injury next to road traffic accidents. 6 ISSN:2347-6567 International Journal of Allied Medical Sciences and Clinical Research IJAMSCR

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 266 The number of fatal burns has increased from 2 80000 in 1990 to 3 38000 in 2010. 7 nonfatal burn injuries are a leading cause of morbidity. Burn injuries are one of the leading causes of death in all medico-legal cases in India and the most common manifestation of dowry death. In many countries of the developing world however females have twice the risk of males. This is often related to accidents in the kitchen or domestic violence. 8 From the 1980s to 2004 many countries have seen decreases in the rates of both fatal burns and in burns generally. 8 In India about 7 00000 to 8 00000 people per year sustain significant burns though very few are looked after in specialist burn units. 9 The highest rates occur in women 16–35 years of age. 9 Part of this high rate is related to unsafe kitchens and loose-fitting clothing typical to India. 9 It is estimated that one-third of all burns in India are due to clothing catching fire from open flames. 10 Intentional burns are also a common cause and occur at high rates in young women secondary to domestic violence and self- harm. 8-11 The most commonly affected age group fall in the productive age group. This accounts for about 70 of all burn injuries. Every four out of five burnt cases are women and children. This may be just the tip of the iceberg as all burn incidents are medico legal cases as per the law so most of the burn cases are not reported to the police. Either in developed or developing countries burn injury causes not just mere medical and psychological problems but it also causes severe economic consequences for families and even on society. Deaths are only a part of the problem for every person who dies as a result of their burns but many more are left with lifelong disabilities and disfigurements and living with the stigma and rejection that often comes with disability and disfigurement. The etiological factors of burn injuries vary considerably in different communities and regions and hence there is a need for detailed epidemiological studies to understand the problem status in different regions. The causes vary in different communities and so this study was conducted to know the epidemiology socio economic burden and outcome of burn injuries in North Western Rajasthan. MATERIALS AND METHODOLOGY This prospective study was conducted in the Department of general surgery PBM AG Hospital Bikaner for a period of 1 year from January 2015 to December 2015. This included the patients with burn referred to our center who was more than 15 years of age. These patients were initially received and primarily managed in the casualty and then patients were shifted to the burn ward. Admission criteria were 1. Patients who had sustained burn15 total body surface area second degree burn. 2. Third degree burns. 3. Burns sustained from chemical or electric burn. 4. Facial burns. 5. Inhalation burns. Patients were excluded from this study with the exclusion criteria of 1. Age below 15 years. 2. Burns less than 15 TBSA of second degree burn. 3. First degree burns. The TBSA of the burn was calculated using the “Rule of Nine” of Wallace. For all practical purposes these burn patients were being divided into 5 groups depending on the percentage of TBSA of burn as follows: Group 1: TBSA 20 Group 2: TBSA 20-40 Group 3: TBSA 40-60 Group 4: TBSA 60-80 Group 5: TBSA 80 Any burn more than 40 TBSA of the burn was considered as a major burn and burns less than 40 TBSA as a minor burn. At the time of admission to burn unit a standardized Performa’s were dedicated to all the patients. The Performa’s had following details: Epidemiological profile including age sex religion occupation economic status according to modified Kuppuswamy’s Classification 2014 12 educational status marital status of the individual etiology of burn circumstances leading to burn timing of burn any psychiatric illness and any drug abuse causing burns duration of hospital stay pre-morbid conditions

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 267 initial treatment received by the patient prior hospitalization. The educational status was defined as illiterate if patient dint knows to do signature in the mother language primary education till class VΙΙ higher education till plus two and graduate with graduation in any field. This Performa also recorded the initial condition of the patient including vitals. According to “the rule of 9” of Wallace TBSA of the burn was calculated and the body parts involved in the burn was recorded. Statistical methodology Information collected was tabulated on windows excel and statistical significance was calculated in the form of percentage mean median mode range etc. Results Age and gender In this a period of one year it was noted the maximum number of burns were noted among the individuals aged between 20-40 years with 56 31.63 males and 59 33.33 females. n177. The least commonly involved age group was 80 years with only 5 cases 2.81 n177. Table I Females and males were almost equally involved with only slight preponderance of females 50.28 n177 over males Female to male ratio of 1.011:1. Table 1 Table 1: Distribution of cases according to patient’s gender and age AGE IN YEARS MALE Number of patients FEMALE Number of patients 20 04 2.2 09 5.08 21-40 56 31.63 59 33.33 41-60 20 11.29 13 7.34 61-80 06 3.38 05 2.982 80 02 1.12 03 1.69 TOTAL 88 49.71 89 50.28 Religion Hindu’s had the highest incidence of burn 84.74 Hindu females accounted for 44.06 n177 cases and Hindu males for 40.67 n177. The least number of burn cases was noted in the Sikh community. No cases in the Christian religion were noted. Table 2 Table 2: Distribution of cases according to location of residence DISTRICT URBAN RURAL Bikaner 38 21.46 39 22.03 Churu 03 1.69 32 18.07 Sikar 01 0.56 01 0.56 Hanumangarh 04 2.25 33 18.64 Sriganganagar 05 2.82 14 7.90 Nagore 01 0.56 05 2.82 Others 01 0.56 00 0.00 TOTAL 53 29.94 124 70.05 Residence Out of 177 cases significant numbers of cases were from the rural population 70.05 in comparison to urban population 29.94. Table 3

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 268 Table 3: Distribution of cases according to religion SEX/ RELIGION MALE FEMALE TOTAL Hindu 7240.67 7844.06 15084.74 Muslim 073.95 084.51 158.47 Sikh 095.08 031.69 126.77 Literacy status Illiterate population 39.54 had the maximum involvement followed by the primary education 32.76 secondary education 15.81 and graduates 11.86 respectively. Table 4 Table 4: Distribution of cases according to patient’s educational status EDUCATIONAL STATUS/SEX DISTRIBUTION MALE FEMALE TOTAL Illiterate 27 15.25 43 24.29 70 39.54 Primary education 27 15.25 17.51 9.89 58 32.76 Secondary education 19 10.73 09 5.08 28 15.81 Graduate 15 8.47 06 3.38 21 11.86 Occupation House wives were most commonly involved in burn injuries 37.85 n177 followed by the farmers 27.11 labourers 15.25 other occupations 12.99 respectively and the least number of cases were noted among the students 6.77. Table 5 Table 5: Distribution of cases according to patient’s occupational status OCCUPATION TOTAL NO OF BURN House wife 67 37.85 Farmer 48 27.11 Labourer 27 15.25 Student 12 6.77 Others 23 12.99 Economic status The class 4 economic group had the maximum number of cases 44.63 n177 and the class 1 had the least number of cases 12.42. Table 6 Table 6: Distribution of cases according to economic classification ECONOMIC CLASS According to Kuppuswamy classification 2014 TOTAL NO OF BURN CASES Class 1 22 12.42 Class 2 34 19.20 Class 3 42 23.72 Class 4 79 44.63

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 269 Marital status Married people were majority in numbers with 81.35 in comparison to unmarried/single people 18.64. Table 7 Table 7: Distribution of cases according to marital status MARITAL STATUS/ GENDER MARRIED UNMARRIED/SINGLE MARRIED7YRS OF MARRIED LIFE MARRIED7 YRS OF MARRIED LIFE Male 7 3.95 56 31.63 2514.12 Female 20 11.29 61 34.46 084.51 TOTAL 2715.25 11766.10 3318.64 Seasonal variation Months like January March April had maximum number of cases noted 18 10.16 and least number of cases 10 5.64 in October. Slight preponderance was seen in a winter climate October – March 90 50.85 in comparison to the summer climate April- September Table 8 9 Table 8: Distribution of cases according to the month of incidence MONTH OF INCIDENCE NUMBER OF CASES Janurary 18 10.16 Febraury 17 9.60 March 18 10.16 April 18 10.16 May 16 9.04 June 16 9.04 July 13 7.34 August 12 6.78 September 12 6.78 October 10 5.64 November 12 6.78 December 158.47 Table 9: Distribution of cases according to seasonal variation SEASON NUMBER OF CASES Winter october-march 90 50.85 Summer april-september 87 4.92 Location of incidence and circumstances of burn The residence was the most common place of incidence of burn with 86.44 cases n177 when compared to the working place was involved in 12.42 cases and other places was 1.13. Out of 140 accidental cases 117 cases 83.57 n140 occurred at the residence and all the suicidal burns occurred in residences 36 cases 100. Table 10

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 270 Table 10: Distribution of cases on the basis of location of incidence and cause of burn PLACE OF INCIDENCE/ CAUSE OF BURN NUMBER OF CASES IN RESIDENCE NUMBER OF CASES IN WORKING PLACE NUMBER OF CASES IN OTHER PLACES TOTAL Accidental 117 22 01 n140 Suicidal 36 00 00 n36 Homicidal 00 00 01 n1 TOTAL 153 86.44 22 12.42 02 1.13 N177 Source of burns Out of 177 cases flame burns were 145 81.92 followed by electric burn 19 10.73 and scald burn 13 7.34. No cases of chemical and inhalation burn were noted. One hundred forty cases were due to flame burn. Out of these 145 cases 108 cases were accidental in nature 36 cases were suicidal and a single case was homicidal in nature. In males kerosene was the most common source of flame burn with 25 cases 17 n145 in females LPG was the most common source of burn with 49 cases 34 n145. In overall the most common source of flame burn was LPG with a total of 70 cases 48.27 out of 145 cases 100. Table 11 Table 11: Distribution of cases according to type of burn TYPES OF BURN NUMBER OF CASES Flame burn 145 81.92 Electric burn 19 10.73 Scald burn 13 7.34 TOTAL BURN N 177 100 Cause of flame burns Out of total 145 flames burn cases accidental burn was the most common cause in 108 cases 74.48 N145 followed by suicidal 24.82 n145 and homicides 0.7 n145. Out of 145 flames burn cases male accounted for 66 cases 45.51 n145 and female for 79 cases 54.4 Table 12 Table 12: Classification of flame burn on the basis of cause of the burn and source of burn REASON OF FLAME BURN/SOURCE OF BURN ACCIDENTAL Male female SUICIDAL Male female HOMICIDAL Male female TOTAL Petrol 12 02 07 00 01 00 22 Lpg 19 35 02 14 00 00 70 Kerosene 22 18 03 10 00 00 53 TOTAL N145 53 36.55 55 37.93 12 8.27 24 16.55 01 0.69 00 145 100 Electric burns In 177 cases only 19 cases were due to electric burning and all the electric burns were accidental in nature. Low voltage electric burns was the most common source of electric burn in 10 cases 52.63 n19 followed by the high voltage electric burns in 8 42.10 n19 and injuries caused due to lightening were only 5.23 Table 13 Table 13: Distribution of Cases on type of electrical burn TYPE OF ELECTRIC BURN HIGH VOLTAGE LOW VOLTAGE LIGHTENING MALE 07 36.84 10 52.63 00 0 FEMALE 01 5.23 00 0.00 01 5.23 TOTAL n19 08 42.10 10 52.63 01 5.23

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 271 Scald burns Total number of scald burns were 13 out of 177. All the thirteen scald burns were accidental in nature and occurred in residence. Of the 13 cases 8 were females 61.53 and 5 were males 38.46 n13. Suicidal burns 36 cases were due to suicide burns. All the suicidal burns were flame burn in nature. All these suicidal attempts occurred in residence. Females were most commonly involved with 24 cases 66.66 and males were in 12 cases 33.33. Petrol was the most common source of suicidal burn in males with 7 cases 19.44 but not even a single case of petrol burn in female was noted. On overall LPG in both the male and female population accounted for 16 cases 44.43 and was the most common source of suicidal burn. Table 14 Table 14: Distribution of suicidal burn cases according to the gender and source of burn N36 GENDER DISTRIBUTION SOURCE OF BURN MALE FEMALE Petrol 07 19.44 00 0 LPG 02 5.55 14 38.88 Kerosene 03 8.33 10 27.77 TOTAL n36 12 33.33 24 66.66 TBSA of burn 6.20 cases 11patients had burn less than 20 TBSA 24.85 cases had burn between 20- 40TBSA. Maximum numbers of cases were noted in the range of 40-60 TBSA with27. 68 27 females and 22 males. 18.07 cases and 23.16 cases were noted in the range of 60-80 and 80 TBSA of burn respectively. Out of total 89 female burn cases 69cases 77.52 n89 had major burns 40TBSA and in 88male burn case 53 cases 60.22 n88 had major burns 40 TBSA. Table 15 Table 15: Gender Distribution according to TBSA of burn GENDER DISTRIBUTION/ TBSA OF BURN NUMBER OF MALE PATIENTS NUMBER OF FEMALE PATIENTS TOTAL PATIENTS N177 20 08 03 N11 20-40 27 17 N44 40-60 22 27 N49 60-80 11 21 N32 80 20 21 N41 Body parts involved in the burn The most common body part involved in burn was upper limb seen in all 177 cases 100 followed by trunk in 139 cases 78.53 face 136 cases 76.83 lower limb 100 cases 56.49 and genitalia only 33 cases 18.64 n177. Table 16 Table 16: Distribution of cases according to body parts involved in burn BODY PARTS INVOLVED IN BURN NUMBER OF PATIENTS TOTAL NUMBER OF PATIENTS Face 136 76.83 177 Upper limb 177 100 177 Lower limb 100 56.49 177 Trunk 139 78.53 177 Genitalia 033 18.64 177

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 272 DISCUSSION The various variables collected from the Performa’s of all the 177 patients admitted in the burn unit during a one year period were epidemiologically studied. Young to middle aged population was the most commonly involved in the burns with about 84.96. This young age population being involved in various works both in the household and occupation is more prone to burn hazards and accidents. The Male population had burns mostly in the occupational places where as the female had the maximum number of burns in the residence. 57 burns in Amir Paray et al study 13 67 burns in Singh D study of Chandigarh 14 78.4 burns in Kumar V 15 burns study had similar results noted in age group of 20-40 years. Female to male ratio of about 1.011:1 was noted. This result was in part of other studies conducted by Amir Paray et al 13 in Jammu in 2015 with female to male ratio 1.167:1 and also with the study of Mzezewa S et al 16 in Harare with female to male ratio of 1.17: 1. This slight preponderance of female towards burn in the Indian society is due to the involvement of the female population in kitchen works and lack of safety measures adopted by individuals while cooking. Besides to the cooking females are victims of burn due to the prevalence of dowry harassments. Maximum cases were recorded in the Hindu community 84.74 n177 followed by the Muslim religion 8.47 n177. Similar results were noted in the study of Jammu by Amir Paray in 2015 13 . A Study in South West Coast of India by Bhagwan B. Darshan of KMC Mangalore 17 in 2014-2015 showed Hindu’s accounting for 89 of cases which was similar to our results but a disparity was noted that the Christian population had a significant number of burns in that where as in our study not even a single case from Christian population was recorded. These differences in the distributions of cases according to religion were probably due to diversities in each state and each region. Society in our zone consists of a large number of Hindu and Muslim community people with rare numbers in Sikh and Christian communities. As per census of 2011 Mangalore Karnataka has 1.87 of the population made up of Christian whereas Rajasthan has only 0.14 population made up of Christian. 18 Illiterates were commonly involved in the burns with a total of 70 cases 39.54 out of 177 cases. Lower socio economic status population had higher incidence of burn. Class 4 population under Kuppusawmy’s classification 12 2014 had the highest number of recorded burns in our study 79 cases 44.63 n177. A decreasing pattern of burn incidence was noted with respect to that of education status of the individuals and socio economic classifications with least cases in highly educated population and Class 1 socio economic group. These results were similar in pattern with that of epidemiological study of Gandhari Basu et al 19 conducted in JNM Hospital West Bengal study of Gupta M 20 in Jaipur and study of Golshan A 21 . The rural population was the major population involved in the burn with 70.05. This difference in the occurrence of burn in rural and urban population is due to the high number of illiterates low socioeconomic status lack of safety measures in rural population in comparison to urban populations. As per the 2011 census India the literacy rate of rural population was 68.91 in comparison to urban population literacy rate of 84.98 Married people had higher incidence of burn with 144 cases 81.36 n177 in comparison to that of single or unmarried population. These kinds of results were also noted in other studies like Gandhari Basu at JNM hospital 19 West Bengal Bhagwan B Darshan of KMC Mangalore in South West Coastal region 17 Gupta M study in Pink city 20 Ashok K Gupta study in Punjab 22 . As noticed earlier highest number of burn cases occurred in the age group of 20-40years and as this group contained a number of married people burn incidence was more in married people. A seasonal variation in incidence of burn cases was noted. Total number of burn cases were more in winter season October – March with 50.85 whereas summer season had 49.15 cases April- September. Usage of flame heaters camp fires and other modes of heat to keep surrounding and oneself warm during winter increases the susceptibility of population for burn accidents. Maximum incidents occurred in the months of January and March 10.16 and minimum during the month of October 5.64. Flame burns 145 cases 81.92 n177 formed the majority of cases in our study

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 273 followed by electric burn 19 cases 10.73 n177 and scald burns 13 cases 7.34 n177. No cases of inhalation and chemical burns were recorded. Kumar et al 23 of South West India 82.2 Hashmi M et al 24 of Karachi 62 51 in Mzezewa S et al 16 of Harare Singh D 14 study 83 94.1 in Kumar V 15 study of Manipal had flame burn as a major form of burn. In all types of burns accidental burns were the most common form 140 cases 79.09 n177. Kumar et al 23 studied had 80 accidental burn Hashmi M et al 24 had 72 Kumar V 15 of KMC Manipal had 75.8 Mehmet Tahir Gokdemir et al 25 of Turkey had 69.3 all these studies had similar results in comparison with our study. The carelessness among the house wives while cooking is the major cause of accidental burn. Wearing of loose fitted clothing while cooking improper maintained LPG cylinders and stove absence of any service of LPG in the recent 5 years improperly planned kitchen closed kitchen preoccupied and disturbed mind leading to decreased concentration while cooking were the most common causes of accidental burns in house wives. In cases of occupational and electrical burns unavailability of safety precautions and lack of interest among the individuals to consider precautions while working were the main cause of accidental burns. In residence the kitchen is a place in common for both the male and female population where they are routinely exposed to flame thus increasing the chances of incidence of burn in the kitchen. Residence kitchen was the common place where the incidence of burn occurred in our study. All the suicidal burns occurred in the residence 100 n 36. The similar findings were noted in the studies of Hashmi M et al 24 Gandhari Basu et al at JNM Hospital 19 West Bengal Gupta M 20 studies in pink city study had 82.65 burns in the kitchen. Electrical burns accounted for only 10.72 19 cases. Males were commonly involved 89.47 n19. All electrical burns low voltage was the common source of electric burn 52.63 n19. Incidences of electrical burns in adult males were high compared to female population due to patterns of distribution of work. Males are exposed to electric machineries at working places because of which there is a higher incidence of occupational hazard in the form of electrical burn. CONCLUSION Suicidal burns were noted in only 36 cases out of 177 cases just accounting for 20.33 of cases. All the suicidal burns occurred by flame and all these burns occurred in residence. In suicidal burns 66.66 cases were accounted by females. LPG was the most common source involved in suicidal burn. Domestic conflicts as a predisposing factor were present in all the cases of suicidal burns. Family burden household’s conflicts emotional and financial instability and domestic violence faced by females predisposes the females for the increased incidence of suicidal tendency among the women. As per statistics family problems and marriage related issues accounts for the major cause of suicides in India. 26 68.92 cases had major burns 40 TBSA. Maximum number of cases had burns in the range of 60-80 TBSA 49 cases 27.68. Females had maximum number of major burns 69 cases 38.98 had burns 40 TBSA. Usage of hands and upper limbs in house hold works and in occupation predisposes them for a majority of burns. In this study cent percent involvement of the upper limbs in burns followed by facial burns 76.83 cases was noted. REFERENCES 1. Amir Parray: Burns in Jammu Retrospective Analysis. Current Medicine Research Practice volume 5 issue 2 March April 2015. 2. World Health Organization. The Global Burden of Disease: 2004 Update. World Health Organization Geneva 2008 www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf 3. For Health Metrics and Evaluation. The Global Burden of Disease: 2010 Update. IHME Seattle 2012. viz.healthmetricsandevaluation.org/gbd-compare/. Accessed on July 01 2013.

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Vijay. H.S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-42 2016 265-274 274 4. Murray CJL Lopez AD. The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020 World Health Organization Swizerland 2006. 5. Mock C Peck M Peden M Krug E eds. A WHO Plan for Burn Prevention And Care Geneva: WHO 2008 6. Global Urban Vision – July 2012 - Glocal Leaders Network. glocalleadersnetwork.com 7. Lozano R Dec 15 2012. "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.” Lancet 380 9859 2095–128. 8. Peck MD November 2011. "Epidemiology of burns throughout the world. Part I: Distribution and risk factors". Burns: journal of the International Society for Burn Injuries 37 7 1087–100. 9. Ahuja RB Bhattacharya S Aug 21 2004. "Burns in the developing world and burn disasters.". BMJ Clinical research ed. 329 7463 447–9. 10. Gupta 2003. Textbook of Surgery Jaypee Brothers Publishers. 42 11. Peck MD August 2012. "Epidemiology of burns throughout the World. Part II: intentional burns in adults.” Burns: journal of the International Society for Burn Injuries 385 630–7. 12. Indian journal of public health http://www.ijph.in/viewimage.aspimgIndianJPublicHealth_ 2015_59_2_156_ 57540_t3.jpg 13. Parry a Ashraf M Sharma R Saraf R. Burns in Jammu: Retrospective Analysis From A regional Centre. Curr Med Res Prac 2015 5 14. Singh D 1 Singh A Sharma AK Sodhi L Burn mortality in Chandigarh zone: 25 years autopsy experience from a tertiary care hospital of India. 1998 242 150-6 15. Kumar V 1 Mohanty MK Kanth S Fatal burns in Manipal area: a 10 year study. J Forensic Leg Med. 2007 141 3-6 16. Mzezewa S 1 Jonsson K Aberg M Salemark L A Prospective study on the epidemiology of burns in patients admitted to the Harare burn units. Burns. 1999 256 499-504. 17. Bhagwan B darshan study http://www.scopemed.org/jft109ft109-1443028596 Int J Community med public health. 2015 2 4 677-680 18. Indian population census 2011 http://www.census2011.co.in/religion.php 19. Gandhari basu et al study http://njcmindia.org/uploads/5-3_311-315.pdf 20. Burns. 1993 191 47-51. Burn epidemiology: the Pink City scene. GuptaM 1 21. Golshan A 1 Patel C Hyder AA A systematic review of the epidemiology of unintentional burn injuries in South Asia. J Public Health Oxf. 2013 353 384-96. 22. J Emerg Trauma Shock. 2011 Jan-Mar 41: 7–11. doi: 10.4103/0974-2700.76820 Ashok K Gupta A clinico-epidemiologic study of 892 patients with burn injuries at a tertiary care hospital in Punjab India 23. Kumar N 1 Kanchan T Unnikrishnan B Rekha T Mithra P Venugopal A et al Clinico- epidemiological profile of burn patients admitted in a tertiary care hospital in coastal South India : J Burn Care Res. 2012 335 660-7. 24. Hashmi M 1 Kamal R Management of patients in a dedicated burns intensive care unit BICU in a developing country. 2013 393 493-500. 25. Mehmet Tahir Gokdemir Mustafa Aldemir Ozgur Sogut Cahfer Guloglu c Mustafa Burak Sayhan Murat Orak Clinical Outcome of Patients With Severe Burns Presenting to the Emergency Department Manuscript accepted for publications 26. Suicide in India https://en.wikipedia.org/wiki/Suicide_in_India How to cite this article: Dr. Vijay haralgat seetharamaiah Dr. Mohammed Salim Dr. Avinash mahavar Epidemiological study of burns in a government tertiary hospital of North Western Rajasthan-Bikaner Int J of Allied Med Sci and Clin Res 2016 42: 265-274. Source of Support: Nil. Conflict of Interest: None declared.

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