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Burns Associated with Household Energy Use


Table of Contents

In April 2007, a WHO Consultation Meeting on the Prevention and Treatment of Burns was held in Geneva. The meeting was intended to review current global activities and needs, and to develop a WHO strategy and action plan for burn prevention, care and recovery. One of the issues addressed was the risk of burns from household energy use, and the link with current efforts to reduce exposure to indoor air pollution.

This document draws on a brief introductory presentation given by E. Rehfuess and on a poster documenting evidence from a major study conducted in Guatemala. (Bruce et al 2004). It is intended to raise awareness about the linkages with burns and scalds, and to stimulate others to provide input into a lively discussion.

[top] [end]Background

Some 3 billion people rely on solid fuels (e.g. dung, wood, agricultural residues, charcoal, coal) for their basic energy needs. Cooking and heating with inefficiently burned solid fuels can leads to high levels of indoor smoke, a complex mix of health-damaging pollutants (e.g. small particles, CO). Every year, more than 1.5 million people die from pneumonia, chronic obstructive pulmonary disease and lung cancer attributable to indoor air pollution.

To alleviate this situation, as people become more affluent, they tend to move up the 'energy ladder' using less polluting fuels. Although this mitigates the dangers caused by balancing pots on three stones over open fires, each type of fuel has its own associated problems. Table 1 illustrates the various arrangements for cooking and their associated risks.

[top] [end]Stove Types



[top] [end]Open fires

There are serious risks attached to open fires. Embers can escape, pots can tip over or can be pulled over by inquisitive toddlers, who can be seriously scalded from the contents. The stove is at ground level so it is within easy reach. Where fuel is damp, the wood can spit out tiny pieces of hot wood. The sticks are easily pulled out from the flame, both destabilizing the whole arrangement and dangerous in themselves with one end red hot.





[top] [end]Traditional stoves

Children stay close to their mothers and, where fuel is poorly contained, they can get burned on hot embers when they are crawling or walking unsteadily in the kitchen. Here the fire is reasonably well protected, and the pot sits on a tripod. Nevertheless, hot ash can escape from the fire onto the hearth.







[top] [end]Improved stoves - the plancha stove

Here the fire is contained, which reduces the risks from the flames. The raised cooking surface is also safer. The hidden flame, however, may make the stove look completely cold and children can catch their fingers on the hotplate or the flue pipe





[top] [end]Kerosene

Kerosene is considered a cleaner-burning fuel but has been associated with a high risk of burns and explosions, in particular in South Africa.Moreover, the inappropriate selling (as shown in this image) and storage of kerosene in soft drink bottles can lead to poisoning among children..

Burns from paraffin and LPG are described and assessed in the publication "Burns and Fires from Flammable Non-electric Domestic Appliances", Peck et al, available to download here (PDF 548KB).

[top] [end]Bottled gas

Burn from water
Bottled gas is an excellent fuel insofar as it is clean-burning, it saves time, and the cook likes using it. However, it must be used safely as it burns with a very hot flame. Bottled gas should never be sold without the cook being given instruction in safe practices, otherwise gas leaks (which can lead to explosions) may not be perceived as a risk, and inflammable materials may be left too close to the flames and lead to house fire.



[top] [end]The risk of burns

A number of reports have highlighted the danger of burns that these cooking arrangements pose for young children, based mainly on hospital experience (Courtright 1993; Onuba 1987). Burns from falling into open fires and scalds caused by knocking over cooking pots can be very serious, and with limited access to treatment services often leave children at risk of serious infection and deformity.

Severely burnt arm and hand Severely burnt arm and hand

Deformity and severe injury resulting from accidents with open fires Photos courtesy of Don O'Neal, HELPS International

Data from the First Annual Report of the National Injury Mortality Surveillance System for 1999 conducted by the Violence and Injury Surveillance Consortium which represents approximately 25% of the total estimated fatal injuries in South Africa indicates the following:

Accidental deaths due to external causes accounted for 34% of all fatal injuries, 9% were due to burns. Accidental deaths other than transport related, indicate that 41% were due to burns, which is the highest in this category. Burns were the second leading cause of accidental deaths. Burns were the leading external cause of death in infants under one year of age. Burns was the second leading external cause of death in children from 1 to 4 years of age. For children between 5 and 9 years burns was the 4th leading external cause of death. Burn related deaths occurred most frequently in private homes and were the leading cause of death in residential institutions (e.g. hostels) and on farms. The highest incidence of burn deaths occurs between August and October. The proportion of burn deaths involves more females than males. The highest frequency of burn deaths occurred during "sleeping hours" at night at from 22:00
Burn from water
Burn from water
Severely burnt arm and hand
Severely burnt arm and hand


[top] [end]Intervention studies

There is little information available on the true incidence of burns in rural communities, nor on the impact that improved stoves might have in preventing the most serious of these burns. However, several studies, particularly those looking at indoor air pollution, have tried to ensure that the newer technologies are leading to greater safety, or at least not exacerbating existing risks.

As part of the randomised trial of the health impacts of an improved wood stove (the plancha, shown in table above) in rural Guatemala, the principal outcome was to research acute lower respiratory infections (ALRI) in children aged up to 18 months. (http://ehs.sph.berkeley.edu/guat/). This study has also provided an excellent opportunity to study the incidence of burns in these young children and their older siblings in a community traditionally using 3-stone fires on the floor, and the impact of an improved stove which
  • encloses the combustion chamber and
  • has the cooking surface at waist height out of reach of young children.

Table1 shows the impact of the change in cooking practices on children aged 18 months to 8 years.

Table 1: Impact of changing cooking practices on children under 8 years of age
Baseline rate Follow-up rate
Open fire 42.1 per 1000 per year35.2 per 1000 child years
Plancha stove 18.1 per 1000 child years

Severely burnt arm and hand

Table 2 indicates the main causes of burns, and shows a marked reduction in the number of children falling into the fire (which is likely associated with the most serious injury).

What about the data for the younger children aged less than 18 months?

Practical Action's work on pathways to sustainable smoke alleviation in Kenya, Sudan and Nepal has looked at the baseline data for around 200 households in each country. This data (Bates, 2007) shows a wide variation in the number of burns cases dependent on country, although the sample size is small.

Perhaps the key data records the common reasons identified by mothers:
  • Touched hot object
  • Pot fell over
  • Fell into fire/pot

Severely burnt arm and hand

[top] [end]Need for action

[top] [end]Research and surveillance

This is needed to develop harmonized questions and to provide data on the causes of burns through health surveillance system, surveys and research, as there is very limited population-based data available. An M.S. Thesis (Johnson, 2006) from Iowa State University has provided a good baseline for standardised questions in the development of such standards http://www.vrac.iastate.edu/~atlas/safety.htm .

[top] [end]Burn prevention

A campaign to alleviate the dangers of burns should provide households with comprehensive health information on household energy (both on indoor air pollution and safety). This could be delivered through the health sector, media, stove and fuel companies, etc.

[top] [end]Stove design

Good stove design principles should ensure that stoves are both clean-burning and safe to use.

Burns from paraffin and LPG are described and assessed in the publication "Burns and Fires from Flammable Non-electric Domestic Appliances", Peck et al, available to download here (PDF 548KB).

[top] [end]See also


[top] [end]Resources and References

Bates, E. Researching pathways into sustainable alleviation of kitchen smoke - (Ongoing research, 2007)

Bruce N et al. Prevention of burns among children In wood fuel using homes In rural Guatemala. Poster presented at ISEE 2004, New York.

Courtright, P., Haile, D., & Kohls, E. 1993, The epidemiology of burns in rural Ethiopia, Journal of Epidemiology and Community Health, vol. 47, pp. 19-22.

Johnson, N, G, Risk Analysis and Safety Evaluation of Household Stoves in Developing Nations (Feb, 2006)

Onuba, O. & Udoidiok, E. 1987, The problems of burns and prevention of burns in developing countries., Burns, vol. 13, pp. 382 - 385.

Bizzo, W.A. and de Calan, B., Safety issues for clean liquid and gaseous fuels for cooking in the scope of sustainable development, Energy for Sustainable Development Vol. 8, No. 3, pp. 60-67. To gain access to this article follow the link and register (a paid subscription will be necessary)

Street J.R., Wright J.C.E., Choo K.L., Fraser J.F., & Kimble R.M. (2002) "Woodstoves uncovered: a pediatric problem", Burns, 28:5, pp. 472-474.

http://www.firechildren.org/index2.asp?include=fireburns.htm&catID=4

HELPS International

International Society for Burn Injuries (ISBI)
Categories: Health| Safety


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Page created: 10 April 2007; Last edited: 17 August 2007; Version: 7
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Pagename: Burns @HEDON: QGEA