More than 75 percent of severely burned patients lose up to a quarter of their pre-admission weight and end up malnourished.
Burns are a serious global issue, leading to around 180,000 deaths each year, mostly in low- and middle-income countries like Ethiopia. Non-fatal burns often cause long hospital stays and significant health problems.
Take Amar, for example, a seven-year-old boy from the rural part of the Oromia region. He suffered severe burns to his head, face, and back when he accidentally knocked over a cooking pot.
In just two weeks, he lost 12 kilograms and spent over 100 days in the hospital undergoing multiple surgeries, his weight dropping from 21 kg to 9.7 kg at his worst. Proper and adequate nutrition can help burn patients like Amar to be fit for surgery earlier, receive their life-saving surgeries and embark on their recovery in a short time. Swift recovery gives burn victims like Amar a fighting chance to live a relatively normal and productive life. Unfortunately, access to adequate nutritional services remains a major roadblock for burn patients in Ethiopia.
Severe burns like Amar's drastically increase the body's need for nutrients and energy, sometimes even doubling these crucial needs. Without proper nutrition, burn patients can suffer significant weight loss and serious health complications, which hinder their recovery.
Ethiopia has five public burn units, with only 74 beds for over 100 million people. These under-equipped units struggle with a lack of specialised nutritional supplements and trained nutrition staff. Hospital staff often try to boost the calorie content of meals by adding eggs and milk, but this isn't enough to meet the additional nutritional requirements of burn victims. Typically they need twice the calorie requirements of healthy people, and diets high in carbohydrate and protein to help them recover optimally.
As a Plastic Surgeon specialising in burn care in Ethiopia, I attest that more than 75 percent of the severely burned patients I come across in burn units lose up to a quarter of their pre-admission weight in 2-3 weeks and end up malnourished. Patients, who receive good nutrition, respond to treatment better, recover quicker and prove more resilient to the multiple treatments they are typically required to undergo compared to the undernourished patients.
Ethiopia's Food and Nutrition Policy (FNP), established in 2018, aims to ensure food and nutrition security. It has helped to steadily reduce stunting over the past two decades from 58% in 2000 to 34% in 2022. Despite this and other national nutrition programs, the specific nutritional needs of severely burned patients remain unmet. While the focus on primary malnutrition is essential, we must also consider secondary malnutrition due to burns, trauma, and diseases
In 2022, the Ministry of Health introduced guidelines for Intensive Care Unit (ICU) nutrition support, but these do not address the unique requirements of burn patients in Ethiopia's burn units. Burn victims are further marginalised by the lack of a national policy that caters for their unique needs. This neglect impacts the ways in which they can access nutrition, and influences their overall care, ranging from specialised dressings to surgical care and specialised treatment. Therefore, Ethiopia's Ministry of health urgently needs a comprehensive burn care policy to govern and guide these interventions.
In the interim, however, we need partnerships between national and international nutrition organisations and hospitals with burn units to provide ready-to-use therapeutic food (RUTF), RUTF can be lifesaving for malnourished burn patients while easing the strain on government resources.
RUTF is made according to a standard, energy-rich composition defined by the World Health Organisation (WHO). The factory grade RUTF is also produced here in Ethiopia and has low moisture content, and a long shelf-life without needing refrigeration. It requires no preparation, making it an ideal alternative in resource-limited settings, such as government-owned burn units, where special nutritional preparations are not feasible.
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Such pragmatic approaches can go a long way for burn victims like Amar, who, in remote areas, need quality and reliable access to nutrition and surgical care. Amar and the many other burn victims deserve to heal, survive, and recover. Therefore, the thousands of patients suffering from severe burns deserve a National Burn Care Policy and tangible improvements in their care and recovery pathways, enabling them to become healthy and productive citizens.
Dr. Metasebia Worku Abebe, is an Associate Professor of Plastic and Reconstructive Surgery, leading the Plastic and Reconstructive Surgery Unit at Saint Paul Hospital Millennium Medical College in Addis Ababa, Ethiopia. Within her role, she oversees the 20-bed burn unit at AaBET Hospital, an affiliate of Saint Paul Hospital Millennium Medical College.
