LMIC burn care delivery: capacity, workforce, and health policy

Overview¶

The defining fact of global burn care is a mismatch between where burns happen and where the capacity to treat them sits. In 2019 there were an estimated 9 million burn cases and 111,000 burn deaths worldwide, and the mortality-to-incidence ratio was highest in low- and middle-income regions, reaching 40.1 per 1,000 in southern sub-Saharan Africa compared with 1.9 for Australasia ^[1]. Over 95% of fire-related burns occur in low- and middle-income countries ^[2], and over 90% of burn-related fatalities occur in developing or low- and middle-income countries, with south-east Asia alone accounting for over half of fire-related deaths ^[4]. This is a knowledge base about burn care delivery rather than about any single patient encounter: how services are built, staffed, funded, and governed where formal burn care is scarcest.

The literature on this topic is uneven. The vast majority of burn wounds occur in low- and middle-income countries, yet international consensus guidelines are largely based on highly resource-intensive practices used in high-income countries ^[79], and most published work is low-level evidence: in one scoping review, 95% of papers regardless of geographical location were level 3 or below ^[75]. The result is a field rich in descriptions of what is missing and thinner on rigorously tested solutions. What follows is organized around the levers a health system can actually pull: capacity and infrastructure, workforce and training, policy and registries, financing, telemedicine, and the outcome and equity signals that tell whether any of it is working.

Epidemiology and Burden Context¶

The burden falls on the poor. The burden of suffering from fire is disproportionately distributed among the poor ^[5], and a nation's income level is negatively correlated with burn mortality: the lower the income level, the higher the burn mortality, and within-country income inequality also correlates with burn mortality ^[3]. In developing countries burn injuries are far more common than in high-income countries, owing to poverty, overcrowding, and illiteracy, and they carry higher mortality ^[4]. Recorded global figures almost certainly understate the problem: although burn and smoke inhalation were documented as responsible for over 322,000 deaths worldwide in 2002, that figure is most likely a gross underestimate ^[5], and the true epidemiologic burden is underestimated given limited and fragmented high-quality data from many regions ^[40].

Two features of the burden shape how services must be designed. First, the etiology is domestic and preventable: a large proportion of burns in developing countries relate to the cooking, heating, and lighting appliances used at home, often involving kerosene, petroleum, and similar fuels ^[5]. Risk factors include lapses in child supervision, storage of flammable substances in the home, low maternal education, and overcrowding ^[6]. Second, the demography skews young. In African settings the strongest risk factors for burn morbidity are young age (especially 1 to 3 years), the home environment around cooking fires, and epilepsy during seizures ^[2]. Because so much of the burden is domestic, preventable, and concentrated in children, prevention and care-delivery strategy are inseparable.

Health System Capacity and Infrastructure¶

Capacity surveys repeatedly find the same pattern: initial burn management is broadly available, but advanced care is not. Burn care across Africa is hampered by inadequate facilities, inadequate infrastructure, and inadequately trained staff, with few burn units staffed by burn teams ^[8]. In a fourteen-country review of 458 hospitals, 82.3% had the capacity to provide basic resuscitation and 84.9% acute burn management, yet endotracheal intubation was available at only 38.3%, and only about a third could provide skin grafts (35.6%) or treat burn complications (37.9%) ^[9]. Pediatric capacity is similarly bounded: across surveyed LMIC facilities 86% performed acute burn care but only 37% could consistently provide intravenous fluids ^[12]. A multi-country LMIC survey found that the majority of facilities (77.5%) could perform acute burn management, but only 36.6% could carry out skin grafts and contracture release; the main reasons for referral were lack of skills (53.4%) and non-functioning equipment (52.2%) ^[10]. A Rwandan facility assessment found that early excision and grafting were not performed in any of the nine hospitals studied and no physicians had specialty training in burn care, so none could deliver comprehensive care ^[11].

Geography compounds the equipment gap. Burn centers are concentrated in large cities and are inadequate for the high incidence of injuries ^[83]. Spatial-access studies quantify the result. In Nepal, only 20.3% of the population had access to organized burn care within two hours of travel, and modeling showed that developing capabilities in just three to five hospitals could provide most of the population with access to acute burn care ^[14]. In rural Ghana, only 29.9% of the population could reach specialist burn care within one hour ^[15]. In India, more than a billion citizens live within two hours of a burn center, but only 15.9% live within two hours of a center with both an intensive care unit and a skin bank ^[13]. Without coordinated trauma systems, referral itself becomes a marker of risk: in rural Kenya, referred patients had longer travel times and larger burns, and referral represented a substantial share of presentations ^[16]. Access barriers compound geography: lack of money, healthcare providers, and rural living each sharply reduce the odds of receiving care after a burn ^[7].

These structural deficits are not static. A global survey across the COVID-19 pandemic found that burn units in LMICs and low-income countries were more likely to be closed after adjustment, and low income was independently associated with reduced access to burn care ^[18]. The throughline is consistent: where burns are most common, the units, intensive care, operating-room access, and skin banks needed to treat them severely are least available.

Workforce, Training, and Capacity Building¶

A trained, retained workforce is the scarcest resource of all. In South Africa, where the burden is high, there are few dedicated burn surgeons and properly equipped units; only 30% of surveyed providers were dedicated to burn care alone, and the most commonly cited need to recruit future providers was better facilities and resources ^[19]. Across 31 low-income countries, an estimated 63 self-identified plastic surgeons were found in 15 countries and none in the remaining 16, and only 5% believed there were enough plastic surgeons to handle their country's burden ^[20]. The Lancet Commission on Global Surgery framed the stakes: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed ^[34].

Migration, or brain drain, steadily erodes whatever workforce is trained. In one Nigerian cohort of doctors and dentists followed fifteen years after graduation, 48.9% had migrated, the overwhelming majority outside the African continent; leading drivers were insecurity, concerns about children's futures, and limited career development ^[21]. Local, accredited training programs are one structural answer: a Malawi-based residency was explicitly designed to limit brain drain by keeping future surgeons in their country of origin ^[22]. Nursing faces a parallel crisis. Burn nursing is a vital specialty facing significant workforce challenges as nurses leave and recruitment becomes harder ^[23], the work imposes a high and measurable workload ^[25], and nurses describe burden, an education gap, and work-life imbalance ^[24]. Early, structured exposure can move the needle: a two-day shadowing experience raised nursing students' likelihood of pursuing burn nursing from 30% to 85% ^[23].

Standardized short courses are the most studied training intervention. A resource-limited training strategy must be adapted to local conditions ^[26], and courses such as Emergency Management of Severe Burns have created communities of practitioners who report using and valuing the skills learned ^[27]. A "Basics of Burn Care" course in Uganda significantly improved knowledge that remained above baseline at six months ^[28], and a course adapted from a high-income to a low-income setting met its objectives for end users ^[29]. Tele-education extends this reach: a distance Master's in Burn Care was delivered to professionals in the occupied Palestinian territories with academic achievement comparable to historical cohorts ^[30]. Sustained, multidisciplinary engagement appears to produce the most durable change. A two-year multifaceted intervention in Vellore, India produced integrated, sustained changes across medical, nursing, wound, operative, and rehabilitation care, suggesting educational partnerships can induce durable change regardless of local language, culture, or resources ^[31].

Surgical missions are common but contested. Short-term reconstructive missions are often criticized because evidence of value is lacking, and reviews indicate missions should develop toward sustainable partnerships that provide quality aftercare, perform outcome research, and build local surgical capacity ^[32]. Where economic analysis has been done, trips emphasizing education carried a net economic benefit ^[33]. The emerging consensus is that high-income actors must abandon colonial narratives and work alongside low- and middle-income partners to build surgical systems rather than substitute for them ^[34].

Health Policy, Registries, and Quality Measurement¶

Burn care is frequently invisible in national health policy, and making it visible is itself an intervention. The WHO launched a global initiative in 2005 to address inadequate surgical capacity as a public-health issue, spreading to over 35 countries with materials for training, infrastructure enhancement, and capacity monitoring ^[35]. National programs offer a coordinating frame: India's proposed National Programme for Prevention of Burn Injuries set out to ensure prevention and capacity building of infrastructure and manpower at all levels and to establish a central burn registry ^[36]. Referral structure matters as much as facilities. China had no national referral criteria for burns, prompting experts to develop a national standard ^[37], and where official referral guidelines are absent it is simply unknown whether patients are appropriately referred, making the statement of national referral criteria essential to timely access ^[17].

Registries and minimum data sets are the measurement backbone, and they are thin in exactly the places that need them most. Comprehensive, uniform burn data did not exist in Iran, motivating development of a minimum data set to standardize and improve management ^[38]. Dedicated burn registries are few in low- and middle-income countries, and incomplete data are common: in one cohort 64.2% of records had missing data, and missingness itself was associated with in-hospital mortality ^[39]. The WHO Global Burn Registry was piloted across 30 countries, where a large majority of users rated it highly valuable for prioritizing, developing, and monitoring prevention programmes ^[41]; still, uptake has been low and inconsistent, with barriers around awareness, stakeholder buy-in, resource constraints, and process management ^[40]. Resource-constrained, hospital-based registries such as the South Asia Burn Registry have been built specifically to assess outcomes where capacity is limited ^[42]. Quality measurement is also maturing: efforts to define burn quality indicators highlight access to intensive care, burn surgeons, and dedicated nurses, 24-hour access to services, protocol-based care, and outcomes such as in-hospital mortality and severe infection ^[43].

Financing and Economic Burden¶

Burn care is expensive to deliver and catastrophic to receive. Costing studies from tertiary centers in India put inpatient burn management at roughly US$1,000 per patient, with almost 70% of cost driven by salaries ^[44]; a high-volume model demonstrated comprehensive care at lower cost than other LMIC centers, sustainable with moderate funding ^[45]. The burden on families is the central policy problem. Despite healthcare being reported as free, 60% to 90% of surgical patients incurred catastrophic health expenditures when all costs were considered, and out-of-pocket spending persisted for medicines and anesthesia ^[47]. In Iran, qualitative work on single-specialty burn hospitals identified high direct and indirect costs, incomplete insurance coverage, and unsustainable budgeting as core financing failures, pointing toward improved resource mobilization and scaled-up insurance coverage ^[46]. Cost-effectiveness can coexist with unaffordability: in Nigeria, burn management was cost-effective at roughly US$527 per DALY averted yet cost about US$7,123 per patient, more than the average income, so it remains too expensive for most to afford ^[48]. Financing is also structurally fragile, with literature reporting exclusive government funding and no dedicated trauma or burn financing lines ^[49].

Telemedicine and mHealth¶

Telemedicine and mobile health are among the most promising delivery innovations for spreading scarce expertise. A Turkish hub-and-spoke model managed 187 patients at a peripheral burn unit entirely by audiovisual consultation with a single referral-center surgeon, transferring only 11.2%, and concluded telemedicine is appropriate and cost-effective for units with limited experience ^[50]. A WhatsApp-based referral and triage program reduced unnecessary referrals and outpatient visits and was estimated to avoid over 150 unnecessary admissions, freeing scarce specialist resources ^[51]. Purpose-built tools, such as a smartphone application transferring wound images and data to a remote expert who responds with structured advice, extend the same idea ^[52]. Adoption is not automatic: in one teleconsultation study clinician acceptability ratings were neutral-to-agreeable but showed no significant relationship to actual use ^[53], underscoring that technology alone does not change behavior. Mixed models that decentralize care through eHealth can extend specialist coverage, as in rural Ghana where eHealth raised one-hour specialist coverage from 29.9% to 45.3% of the population ^[15].

Outcomes in Resource-Limited Settings¶

Outcomes track resources. Significantly higher mortality is seen in LMICs than in high-income countries (17% versus 9%), and LMIC hospitals had fewer resources available, which could explain the increased mortality given similar total body surface area ^[54]. A multi-center pediatric craniofacial study found mortality substantially higher in lower-income settings (26.14% versus 8.02%), with an 88.5% lower adjusted risk of death in higher-income settings ^[55]. The signal that this is a systems problem rather than an injury problem is that resource availability predicts survival: mortality is lower in facilities with sophisticated nutritional supplementation, critical-care access, dedicated burn units, and advanced reconstructive skills, with limited critical-care availability the single strongest predictor of death in one analysis ^[76]. Comprehensive, integrated programs can move outcomes: a three-year cycle of comprehensive, integrated improvement produced sustained gains where outcomes had lagged ^[56].

Several inequities are well documented. Female burn patients suffer higher mortality and are less likely to receive surgery, a disparity that persists after adjustment ^[59]. Pre-hospital pathways matter: prior use of traditional health practitioners before reaching a tertiary center is associated with nearly double the odds of mortality ^[60]. Predictive scoring developed in high-income settings often needs recalibration; in resource-scarce settings mortality-prediction breakpoints are lower, and validated scores can still triage patients usefully when adjusted ^[82]. The recurring lesson is that in these settings outcomes are shaped at least as much by where and how care is delivered as by the burn itself.

Special Settings: Disaster, Conflict, and Pediatric¶

Burn mass-casualty incidents expose the thinness of capacity. Most countries where such events occur lack established plans, prompting a consensus framework of 22 recommendations to guide national and international teams ^[62]. The political stakes are real: a review of 23 major burn incidents across 15 countries found that 35% led to the resignation of governments or key figures, and many revealed insufficient resource allocation, leading the authors to argue that governments should maintain healthy funding and staffing of burn services as disaster preparedness ^[63]. Conflict and crisis settings strain already-thin systems further. The Russo-Ukrainian war abruptly halted prevention work and left a healthcare system in disarray ^[64], and emergency responses to mass burn events have exposed shortages of intensive-care and specialized burn beds and the need for standardized medical-evacuation and burn-care protocols ^[65].

Children are the dominant population and a recurring policy priority. Across LMIC settings children carry a disproportionate share of the burden, and rehabilitation, often the missing link, remains fragmented, underfunded, and largely excluded from national burn guidelines and universal-health-coverage benefit packages across many sub-Saharan African countries ^[71]. The published research on burns rehabilitation is very limited, and little is known about current practices in LMIC settings, even though multiple studies stress the need for rehabilitation and multidisciplinary teams ^[72]. Where rehabilitation is reliable it changes outcomes, but in one multi-country analysis its protective effect on physical impairment was significant only in higher-income countries, a reminder that an intervention's benefit can depend on the surrounding system ^[73].

Controversies and Evidence Gaps¶

The central methodological gap is that guidance is built on the wrong setting. International consensus guidelines are largely based on resource-intensive high-income practices despite most burns occurring in low- and middle-income countries ^[79], and most LMIC burn literature is low-level evidence with few therapeutic and economic studies, under-representation of certain regions, and little long-term follow-up ^[75]. This has prompted dedicated resource-limited guidelines covering initial evaluation, airway management, burn-size estimation, resuscitation, wound care, and definitive surgical management ^[79][80], and global research-priority exercises designed to include lower-income perspectives ^[77].

Several clinical questions are genuinely unsettled in this setting. Early excision and grafting, a high-income standard of care, has not consistently improved survival when applied in LMICs: one analysis found that improved survival in the early-excision cohort was not seen among LMIC burn victims ^[57], and a review concluded it is not possible to draw accurate conclusions on the role of early excision in low- and middle-income countries ^[58]. One controlled comparison even reported lower mortality with a conservative system of spontaneous eschar separation and delayed grafting than with early excision for high-risk patients in a low-resource setting ^[81]. Routine systemic antibiotic prophylaxis remains common despite being abandoned in high-income countries, and on limited evidence its use cannot be recommended for LMIC patients presenting soon after injury ^[66]. Resuscitation practice diverges by necessity: colloids are unavailable in many parts of Africa, enteral resuscitation is more widely used ^[67], and the WHO Technical Working Group recommends a simplified mass-casualty fluid formula of 100 mL/kg/24 h for burns over 20% TBSA ^[68].

Resource gaps also constrain definitive treatment. LMIC health systems rarely have access to skin allografts, which may contribute to limited survival of patients with large burns; barriers include high cost, insufficient training, opt-in donation schemes, and sociocultural stigma ^[69]. Locally built skin banks have proven feasible and replicable, as in Mumbai ^[70]. Whether high-volume specialist centers reliably outperform non-specialist care in middle-income settings is also contested: one study found no adjusted survival difference between specialized and non-specialized centers, while acknowledging uncounted bias ^[78]. Finally, the research enterprise itself is inequitable: African countries produce less than 1% of global output, and nearly a quarter of LMIC burn papers had both first and senior authors from high-income countries ^[74]. Closing these gaps will require evidence generated in, and led by, the settings where most burns occur.

References¶

[1] Gerstl JVE; Ehsan AN; Lassarén P; et al.. "The Global Macroeconomic Burden of Burn Injuries." Plastic and reconstructive surgery. 2024. PMID: 37093034 ↩

[2] Outwater AH; Ismail H; Mgalilwa L; Justin Temu M; Mbembati NA. "Burns in Tanzania: morbidity and mortality, causes and risk factors: a review." International journal of burns and trauma. 2013. PMID: 23386982 ↩

[3] Peck M; Pressman MA. "The correlation between burn mortality rates from fire and flame and economic status of countries." Burns : journal of the International Society for Burn Injuries. 2013. PMID: 23768720 ↩

[4] Atiyeh B; Masellis A; Conte C. "Optimizing burn treatment in developing low- and middle-income countries with limited health care resources (part 1)." Annals of burns and fire disasters. 2009. PMID: 21991167 ↩

[5] Peck MD; Kruger GE; van der Merwe AE; Godakumbura W; Ahuja RB. "Burns and fires from non-electric domestic appliances in low and middle income countries Part I. The scope of the problem." Burns : journal of the International Society for Burn Injuries. 2008. PMID: 18206314 ↩

[6] Forjuoh SN. "Burns in low- and middle-income countries: a review of available literature on descriptive epidemiology, risk factors, treatment, and prevention." Burns : journal of the International Society for Burn Injuries. 2006. PMID: 16777340 ↩

[7] Davé DR; Nagarjan N; Canner JK; Kushner AL; Stewart BT. "Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries." Burns : journal of the International Society for Burn Injuries. 2018. PMID: 29475744 ↩

[8] Sowemimo GO. "Burn care in Africa: reducing the misery index: the 1993 Everett Idris Evans Memorial Lecture." The Journal of burn care & rehabilitation. 1993. PMID: 8300693 ↩

[9] Gupta S; Wong EG; Mahmood U; Charles AG; Nwomeh BC; Kushner AL. "Burn management capacity in low and middle-income countries: a systematic review of 458 hospitals across 14 countries." International journal of surgery (London, England). 2014. PMID: 25152443 ↩

[10] Joseph K; Trehan A; Cherian M; Kelley E; Watters DA. "Assessment of Acute Burn Management in 32 Low- and Middle-Income Countries." World journal of surgery. 2016. PMID: 26661635 ↩

[11] Calland JF; Holland MC; Mwizerwa O; et al.. "Burn management in sub-Saharan Africa: opportunities for implementation of dedicated training and development of specialty centers." Burns : journal of the International Society for Burn Injuries. 2014. PMID: 23850364 ↩

[12] Thomson IK; Iverson KR; Innocent SHS; Kaseje N; Johnson WD. "Management of paediatric burns in low- and middle-income countries: assessing capacity using the World Health Organization Surgical Assessment Tool." International health. 2020. PMID: 31613329 ↩

[13] Ranganathan K; Mouch CA; Chung M; et al.. "Geospatial Mapping as a Guide for Resource Allocation Among Burn Centers in India." Journal of burn care & research : official publication of the American Burn Association. 2020. PMID: 31875220 ↩

[14] Li K; Mehta K; Wright A; et al.. "Identifying Hospitals in Nepal for Acute Burn Care and Stabilization Capacity Development: Location-Allocation Modeling for Strategic Service Delivery." Journal of burn care & research : official publication of the American Burn Association. 2021. PMID: 33891676 ↩

[15] Lo S; Ampomah O; Ankrah L; Darko K; Bertozzi-Villa A. "Quantifying Inequitable Access to Rapid Burn and Reconstructive Care through Geospatial Mapping." Plastic and reconstructive surgery. Global open. 2020. PMID: 32983811 ↩

[16] Hunter MA; Sylvester K; White RE; Harrington DT; Vivier PM; Parker RK. "Referral Patterns of Burn Injury in Rural Kenya." Journal of burn care & research : official publication of the American Burn Association. 2021. PMID: 33095863 ↩

[17] Nezerwa Y; Miranda E; Velin L; et al.. "Referral of Burn Patients in the Absence of Guidelines: A Rwandan Study." The Journal of surgical research. 2022. PMID: 35636196 ↩

[18] Laura P; José A; Nikki A; et al.. "Impact of COVID-19 on global burn care." Burns : journal of the International Society for Burn Injuries. 2022. PMID: 34903416 ↩

[19] Allorto NL; Zoepke S; Clarke DL; Rode H. "Burn surgeons in South Africa: A rare species." South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 2016. PMID: 26821900 ↩

[20] Truche P; Moeller E; Wurdeman T; et al.. "The Plastic Surgery Workforce and Its Role in Low-income Countries." Plastic and reconstructive surgery. Global open. 2021. PMID: 33912368 ↩

[21] Wariri O; Toyin-Thomas P; Akhirevbulu ICG; et al.. "Understanding the exodus: a 15-year retrospective cohort study on the pattern and determinants of migration among Nigerian doctors and dentists." Global health action. 2024. PMID: 39611329 ↩

[22] Qureshi JS; Young S; Muyco AP; et al.. "Addressing Malawi's surgical workforce crisis: a sustainable paradigm for training and collaboration in Africa." Surgery. 2013. PMID: 23063312 ↩

[23] Johnson D; Pickering T; Nevarez C; et al.. "Fixing the Leaky Pipeline of Burn Nurses." The American journal of nursing. 2026. PMID: 42020983 ↩

[24] Shivanpour M; Firouzkouhi M; Abdollahi Mohammad A; Naderifar M; Mohammadi M. "Nurses Experiences in the Burn Unit: A Qualitative Research." Iranian journal of nursing and midwifery research. 2020. PMID: 32724769 ↩

[25] Amadeu LM; Dell'Acqua MCQ; Castro MCN; Palhares VC; Serafim CTR; Trettene ADS. "Nursing workload in burn intensive care unit." Revista brasileira de enfermagem. 2020. PMID: 32667481 ↩

[26] Potokar T; Ali S; Bouali R; Walusimbi M; Chamania S. "Training of medical and paramedical personnel in burn care and prevention." Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. 2010. PMID: 21321646 ↩

[27] Biswas A; Rahman F; Maitz P; Baset KU; Hossain J; Mashreky SR. "An evaluation of Emergency Management of Severe Burn (EMSB) course in Bangladesh: a strategic direction." Burns & trauma. 2017. PMID: 28466024 ↩

[28] Simon MH; Kazibwe S; Kambiz S; et al.. "Effectiveness of 'The Basics of Burn Care Course' in Uganda." Burns : journal of the International Society for Burn Injuries. 2026. PMID: 41819652 ↩

[29] Spiwak R; Lett R; Rwanyuma L; Logsetty S. "Creation of a standardized burn course for Low Income Countries: meeting local needs." Burns : journal of the International Society for Burn Injuries. 2014. PMID: 24685348 ↩

[30] Theodorakopoulou E; Goutos I; Mason K; Ghanem AM; Myers S. "London calling Gaza: The role of international collaborations in the globalisation of postgraduate burn care education." Scars, burns & healing. 2019. PMID: 30815281 ↩

[31] Light TD; Latenser BA; Heinle JA; et al.. "The partnership of the American Burn Association, Children's Burn Foundation, and the Pediatric Burn Team in Vellore, India - a progress report." Journal of burn care & research : official publication of the American Burn Association. 2009. PMID: 19060771 ↩

[32] Hendriks TCC; Botman M; Rahmee CNS; et al.. "Impact of short-term reconstructive surgical missions: a systematic review." BMJ global health. 2019. PMID: 31139438 ↩

[33] Billig JI; Nasser JS; Sue GR; Chang J; Chung KC. "Economic Benefit of Hand Surgical Efforts in Low- and Middle-Income Countries: A Cost-Benefit Analysis." Plastic and reconstructive surgery. 2020. PMID: 31985644 ↩

[34] Ng-Kamstra JS; Greenberg SLM; Abdullah F; et al.. "Global Surgery 2030: a roadmap for high income country actors." BMJ global health. 2016. PMID: 28588908 ↩

[35] Abdullah F; Troedsson H; Cherian M. "The World Health Organization program for emergency surgical, obstetric, and anesthetic care: from Mongolia to the future." Archives of surgery (Chicago, Ill. : 1960). 2011. PMID: 21576615 ↩

[36] Gupta JL; Makhija LK; Bajaj SP. "National programme for prevention of burn injuries." Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India. 2010. PMID: 21321659 ↩

[37] Luo GX; Yuan ZQ; Peng YZ; Wu J; Huang YS. "[Chinese burn referral criteria (2018 version)]." Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns. 2018. PMID: 30440143 ↩

[38] Ahmadi M; Alipour J; Mohammadi A; Khorami F. "Development a minimum data set of the information management system for burns." Burns : journal of the International Society for Burn Injuries. 2015. PMID: 25561018 ↩

[39] Miranda E; Velin L; Ntirenganya F; et al.. "Recording Patient Data in Burn Unit Logbooks in Rwanda: Who and What Are We Missing?." Journal of burn care & research : official publication of the American Burn Association. 2021. PMID: 33128370 ↩

[40] Hebron C; Mehta K; Stewart B; Price P; Potokar T. "Implementation of the World Health Organization Global Burn Registry: Lessons Learned." Annals of global health. 2022. PMID: 35646613 ↩

[41] Peck M; Falk H; Meddings D; Sugerman D; Mehta S; Sage M. "The design and evaluation of a system for improved surveillance and prevention programmes in resource-limited settings using a hospital-based burn injury questionnaire." Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2016. PMID: 27044496 ↩

[42] Zia N; Latif A; Mashreky SR; et al.. "Applying quality improvement methods to neglected conditions: development of the South Asia Burn Registry (SABR)." BMC research notes. 2019. PMID: 30696469 ↩

[43] Dash S; Pompermaier L; Lavrentieva A; Rogers AD; Depetris N. "Quality indicators in burn care: An international burn care professionals survey to define them." Burns : journal of the International Society for Burn Injuries. 2023. PMID: 36764840 ↩

[44] Ahuja RB; Goswami P. "Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India." Burns : journal of the International Society for Burn Injuries. 2013. PMID: 23523069 ↩

[45] Gallaher JR; Mjuweni S; Cairns BA; Charles AG. "Burn care delivery in a sub-saharan african unit: A cost analysis study." International journal of surgery (London, England). 2015. PMID: 26003120 ↩

[46] Amini-Rarani M; Mohammadi F; Shaarbafchizadeh N; Yazdi-Feyzabadi V. "'Poverty's scar: A qualitative inquiry of financing shortcomings in specialized burn hospitals." Burns : journal of the International Society for Burn Injuries. 2021. PMID: 33293154 ↩

[47] Okoroh JS; Riviello R. "Challenges in healthcare financing for surgery in sub-Saharan Africa." The Pan African medical journal. 2021. PMID: 33995804 ↩

[48] Okafor CE; Onunka O; Idoko LN. "Cost-utility of burns management in Nigeria: a case study of the National Orthopaedic Hospital, Enugu." Annals of burns and fire disasters. 2017. PMID: 28592927 ↩

[49] Aminu K; Adegbile OE; Omobowale O; et al.. "Financing of Trauma and Burn Prevention and Care in Malawi: A Scoping Review." Health science reports. 2026. PMID: 42058570 ↩

[50] Turk E; Karagulle E; Aydogan C; et al.. "Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units." Burns : journal of the International Society for Burn Injuries. 2011. PMID: 21146313 ↩

[51] Martinez R; Rogers AD; Numanoglu A; Rode H. "The value of WhatsApp communication in paediatric burn care." Burns : journal of the International Society for Burn Injuries. 2018. PMID: 29395403 ↩

[52] Wallis LA; Fleming J; Hasselberg M; Laflamme L; Lundin J. "A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care." PloS one. 2016. PMID: 26918631 ↩

[53] Bettencourt AP; Davis TM; Aryal S; et al.. "Using Implementation Science to Understand Barriers to Telemedicine Use for Burn Care During a Crisis." Journal of burn care & research : official publication of the American Burn Association. 2025. PMID: 40599041 ↩

[54] Jacobs C; Vacek J; Many B; Bouchard M; Abdullah F. "An Analysis of Factors Associated with Burn Injury Outcomes in Low- and Middle-Income Countries." The Journal of surgical research. 2021. PMID: 32892143 ↩

[55] Gimenez Lynch C; Spiegelman L; Castro G; Thaller S. "Global Disparities in Pediatric Craniofacial Burns: The Influence of Income Level, Supervision, and Access to Care." The Journal of craniofacial surgery. 2026. PMID: 42294755 ↩

[56] Potokar T; Bendell R; Chamania S; Falder S; Nnabuko R; Price PE. "A comprehensive, integrated approach to quality improvement and capacity building in burn care and prevention in low and middle-income countries: An overview." Burns : journal of the International Society for Burn Injuries. 2020. PMID: 32616426 ↩

[57] Purcell LN; Banda W; Williams B; Gallaher J; Charles A. "The Effect of Surgical Intervention on Pediatric Burn Injury Survival in a Resource-Poor Setting." The Journal of surgical research. 2020. PMID: 32335395 ↩

[58] Wong L; Rajandram R; Allorto N. "Systematic review of excision and grafting in burns: Comparing outcomes of early and late surgery in low and high-income countries." Burns : journal of the International Society for Burn Injuries. 2021. PMID: 34303572 ↩

[59] Bryski MG; Azad CL; Etchill EW; Rhee DS. "Global Disparities in Burn Outcomes: Does Gender Predict Mortality in the Global Burn Registry?." The Journal of surgical research. 2023. PMID: 36434842 ↩

[60] Gallaher JR; Purcell LN; Banda W; Charles A. "The effect of traditional healer intervention prior to allopathic care on pediatric burn mortality in Malawi." Burns : journal of the International Society for Burn Injuries. 2020. PMID: 32631652 ↩

[61] Aditianingsih D; Sinaga YB; Kartolo WY; Adiwongso ES; Madjid AS. "Respiratory and coagulation dysfunctions on admission as independent predictors of in-hospital mortality in critically ill burn patients." Annals of burns and fire disasters. 2019. PMID: 31528149

[62] Hughes A; Almeland SK; Leclerc T; et al.. "Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020." Burns : journal of the International Society for Burn Injuries. 2021. PMID: 33041154 ↩

[63] Shokrollahi K; Tridente A; Dempsey N. "The Political and Human Impact of Major Burn Incidents: A Global Analysis of Mass Casualty Events Between 2010 and 2020." Annals of plastic surgery. 2025. PMID: 40434217 ↩

[64] Dabek RJ; Decik M; Driscoll DN; Fuzaylov G. "Global Burn Prevention: Ukraine." Journal of burn care & research : official publication of the American Burn Association. 2023. PMID: 37596852 ↩

[65] Melkonyan A; Oyugi B; Conovali E; et al.. "A review of the response and the emergency medical teams (EMTs) deployment in Armenia following an explosion at a fuel depot near Stepanakert (Nagorno-Karabakh)/ in Armenia." Conflict and health. 2025. PMID: 39966893 ↩

[66] Stewart BT; Gyedu A; Agbenorku P; Amankwa R; Kushner AL; Gibran N. "Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)." International journal of surgery (London, England). 2015. PMID: 26260622 ↩

[67] Rode H; Rogers AD; Cox SG; et al.. "Burn resuscitation on the African continent." Burns : journal of the International Society for Burn Injuries. 2014. PMID: 24560434 ↩

[68] Leclerc T; Potokar T; Hughes A; et al.. "A simplified fluid resuscitation formula for burns in mass casualty scenarios: Analysis of the consensus recommendation from the WHO Emergency Medical Teams Technical Working Group on Burns." Burns : journal of the International Society for Burn Injuries. 2021. PMID: 33707086 ↩

[69] Roberson JL; Pham J; Shen J; et al.. "Lessons Learned From Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-Income Countries: A Systematic Review." Journal of burn care & research : official publication of the American Burn Association. 2020. PMID: 32504535 ↩

[70] Keswani SM; Mishra MG; Karnik S; et al.. "Skin banking at a regional burns centre-The way forward." Burns : journal of the International Society for Burn Injuries. 2018. PMID: 29661552 ↩

[71] Omari SK; Mosses LI. "Strengthening rehabilitation to reduce burn contractures and disability in sub Saharan Africa." Frontiers in rehabilitation sciences. 2026. PMID: 42131471 ↩

[72] Jagnoor J; Lukaszyk C; Fraser S; et al.. "Rehabilitation practices for burn survivors in low and middle income countries: A literature review." Burns : journal of the International Society for Burn Injuries. 2018. PMID: 29290511 ↩

[73] Parry I; Bell J. "Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry." Burns : journal of the International Society for Burn Injuries. 2024. PMID: 38503574 ↩

[74] Wall SL; Velin L; Abbas A; et al.. "Who tells the story of burns in low-and-middle income countries? - A bibliometric study." Burns : journal of the International Society for Burn Injuries. 2023. PMID: 35787966 ↩

[75] Bresler RM; Barksdale E; Hansen EN. "Pediatric Burn Care in the Developing World: Where Are the Gaps in Research and What Can Be Done?." Journal of burn care & research : official publication of the American Burn Association. 2022. PMID: 35172326 ↩

[76] Puthumana JS; Cooney CM; Hultman CS; Redett RJ. "Global Hospital Infrastructure and Pediatric Burns." Journal of burn care & research : official publication of the American Burn Association. 2022. PMID: 35986447 ↩

[77] Richards HS; Staruch RMT; Kinsella S; et al.. "Top ten research priorities in global burns care: findings from the James Lind Alliance Global Burns Research Priority Setting Partnership." The Lancet. Global health. 2025. PMID: 40286806 ↩

[78] Ede CJ; Kruger D; Libhaber E; et al.. "A comparative study of outcomes of burns across multiple levels of care." Burns : journal of the International Society for Burn Injuries. 2023. PMID: 37827938 ↩

[79] Egelko A; Stewart B; Curtis E; Nsaful K; Rae L; Yadav M. "Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Burn Management in Low-Resource Settings." World journal of surgery. 2026. PMID: 41578417 ↩

[80] [No authors listed]. "ISBI Practice Guidelines for Burn Care." Burns : journal of the International Society for Burn Injuries. 2016. PMID: 27542292 ↩

[81] Allorto N; Bishop DG. "Selective Early Excision Versus a Conservative Surgical Approach. Management of Deep Burn Injury in a Resource-Restricted Setting: A Prospective, Observational Study." World journal of surgery. 2026. PMID: 41664426 ↩

[82] Smith MT; Allorto NL; Clarke DL. "Modified first world mortality scores can be used in a regional South African burn service with resource limitations." Burns : journal of the International Society for Burn Injuries. 2016. PMID: 27143339 ↩

[83] Forbinake NA; Ohandza CS; Fai KN; Agbor VN; Asonglefac BK; Aroke D; et al.. "Mortality analysis of burns in a developing country: a CAMEROONIAN experience." BMC public health. 2020. PMID: 32819340 ↩