Llanto por la muerte de su hermano Gerardo

About half of child burns were rated as minor and the rest required hospitalization. There were no child deaths as a result of burns.

Figure 10.4. Severity levels of burn injury by age group

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% < 1 1-4 5-9 10-14 15-19 <20 Severe Major Moderate Minor

Figure 10.5. Severity level of burns for children 57% 23% 15% 5% Minor Moderate Major Severe

Major burns were significant in all age groups except infancy. The majority of burns were scalds (over 80%) and this skewed the severity of the burns. Scalds in young children characteristically have high severity rates due to the nature of the exposure and the large areas of the body involved (children often pull scalding liquids onto themselves and scald their face, arms and torso simultaneously).

Figure 10.6. Severity of child burn injury by venue, urban vs. rural

0 10 20 30 40 50 60 70 80

Minor Moderate Major Severe Death

Urban Rural

There was a tendency for minor burns to be more common in rural areas and major burns to be more common in urban areas, but the differences were not significant. Thus, statistically, children in both urban and rural areas are at a similar risk of burn injury.

Figure 10.7. Major burns injury among children by age group 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1-4 5-9 10-14 15-19 <20 Chermical Scald

Looking only at major burns, the vast majority were due to scalds. Extremities (upper mainly) accounted for the largest proportion of body locations.

Figure 10.8. Activities when children were burned

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1-4 5-9 10-14 15-19 <20 Other In house activities Outdoor activities

Most burns in children occurred in the locations associated with the child age groups: young children were burned indoors and older children were burned outdoors. The oldest age group was mainly indoors due to the large predominance of females in this group, and they were engaged indoors in domestic activities.

One-third of burn cases were in hospital an average of 12 days; and two-thirds of burned children missed an average of 16 school days.

About 5% of child victims from burns suffered permanent disability. Most of this was due to dysfunction in walking or handling as a result of the severe and extensive scarring that typically accompanies scald injuries in young children. The remainder was as a result of blindness caused by corneal scarring from the scalding liquid.

About 60% of families with a burned or scalded child experienced an impact on their SES. About three percent of families had a permanent impact that was rated as strong (2%) or moderate (1%). Almost one-quarter (22%) were strongly or moderately affected, but the economic impact was not permanent.

10.4. Discussion

Burn ranked as the fifth leading cause of morbidity in Vietnam, and there were no deaths. However, over 65,000 children were burned in the year 2001, significantly enough to require medical attention or suffer serious consequences, including permanent disability. This is almost 180 children each day. Burns were a major cause of permanent severe disability in children. Even in cases of non-permanence, it was a significant cause of loss of school, hospitalization days, and medical expense for families at a point where they are usually not in their peak earning years. There is also the very real social burden incurred through burn injury: the scarring and disfigurement associated with burns of young children have major effects on their lives as adults.

While fires and burns did not account for any child deaths, this is likely due to the fact that fire deaths from flames are relatively uncommon given the nature of house construction in most rural areas. Children and other occupants of one-room rural houses may be at higher risk of fire as cooking and heating is often done with an open flame, but they are easily escaped from when on fire. Multistory dwellings, much more likely to lead to entrapment are relatively infrequent in rural areas. These physical environment issues, coupled with the sample size issue, are most likely the reason that there were no child fatalities found from fire in VMIS.

However, the lack of child fatalities does not mean that fire is not a major public health and safety issue for Vietnamese children. It is important to understand that the most common fire injury in children is scalding which causes severe morbidity, but is not usually fatal. Scalding, as a cause of serious morbidity is an extremely serious child health problem of a magnitude that can only be described as epidemic in Vietnam. Considering only scalds in children that were rated as major or severe, the numbers are enormous: over 13,000 children in 2001, or over 35 children each day. As a result, the significance of burns in children is greatly underestimated if only looking at fatality rates. From a public health perspective, scalding is one of the largest child health problems due to the enormous burden in direct medical costs as well as later, the high social costs from the disfigurement and permanent disability. These are preventable.

In Vietnam, most homes in rural areas do not have separate rooms for kitchens, and thus young children are in very close proximity to cooking fires, which often have pots filled with hot or boiling water. In urban areas, kitchens typically have a raised platform at one-meter height for stoves and pots, pans and thermos jugs. This height is a deadly height as it is just at arm’s length for toddlers and very young children. When left unsupervised and when pots are simmering, very young children often pull the contents of the pans directly on to themselves. This results in severe injury as large areas of the body are scalded when this happens. Since the toddler is looking up when pulling the pot down, severe facial burns accompanied by blindness often occur. Relocation of the cooking surface at a different height or place, isolation of the cooking area from the place where the toddler is active, and increased supervision of the child by other caretakers while cooking is taking place are all potentially appropriate, cheap and effective prevention measures.

Whether urban or rural, Vietnamese families have a habit of keeping very hot water always nearby in electric kettles or thermoses to allow the ready making of tea. Many of the thermoses are quite large, and being tall and thin, with a narrow base, and capped with a simple cork, they are easy to tip over and spill scalding hot liquids on young children. Simple and cheap prevention methods are available such as wide- based thermos bottle holders, or even more simply and cheaply, large rings cut from bamboo and attached to table legs to serve as secure thermos holders. The average Vietnamese mother or father does not understand the need for these. Habits, customs and low levels of economic development as well as a lack of safety awareness in parents all make most Vietnamese homes high-risk environments for burn injuries. Infants and young children are especially at risk in this environment. They will remain so without intensive education and social marketing efforts focused on their parents.

Developed countries have recognized the enormous toll associated with scald injury and other burns in children. Most countries have building codes that specify safe counter heights for kitchens, legislate maximum temperatures for hot water heaters, and mandate that sleeping clothes for children be resistant to fire. As a result, burn injuries in children are several orders of magnitude less than those seen here in the VMIS survey. There are cheap and low-technology alternatives to the prevention practices in developed countries that could be easily and effectively adopted and the resulting social, behavioral and environmental effects would have a major impact on burn rates in children in Vietnam. Many of these would be opportunities for micro- enterprise development as part of village-based sustainable child safety programs (bamboo room gates, wide-based wooden thermos holders, or bamboo retainers, etc.), and when combined with parental education and care-taker behavioral modification programs would likely produce sustainable reductions in child scalding rates.

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