Burn wound infection: Challenges of topical application of traditional medicine in acute burns in Sub-Saharan Africa

• A comparative study of orthodox and traditional first aid treatment of burn wounds. • That traditional topical application of first aid is common in the sub-region. • A statistically significant wound infection occurs in burn wound treated with traditional medicine. • That wound infection from this means could be prevented by health education. • That different topical materials grew different types of bacteria. Varieties of substance were applied on acute burn wounds before they presented to Teaching Hospital. To compare wound infection rate between burn wounds that had traditional medicine applied and those without before admission. A prospective, descriptive, single – center study that admitted 149 patients that presented to the Burns and Plastic Unit between January 2015 and December 2020 , out of which ninety-six patients had applied traditional substances while 53 others did not. The socio-demographic data, materials applied, Total burns surface area, wound culture, wound infection and mortality rate, duration of hospital stay were documented. The exclusion criteria were patients comorbidities such as heart disease, kidney disease, diabetes mellitus or mental illness. Ninety-six patients (64.4 %) who applied topical materials on acute burns had wound infection with increased mortality compared with 53 (35.6 %) out of 149 patients who did not apply traditional agents that had burn wound infection. It was statistically significant with a p < 0.005. Table 1 shows patient’s age, number of patients, mean total body surface area [TBSA] and mortality rate. The peak age ranges were 21–30 % and 31–40 %. This shows that increasing age and large TBSA are determinants of burn wound morbidity and mortality. Table 2 shows the comparison of the mechanisms with flame burns leading followed by scald burns. Comparing the male-to-female ratio, males were prone to burn injuries with high male to female ratio. Table 3 shows that sample size of 149 was adequate, the number of persons using each topical materials used seem to be inadequate, hence the need for a multi-center study for generalization. Different topical agents and common pathogens were compared and the degree of morbidity and mortality established. These results of wound biopsies for microscopy, culture and sensitivity could be influenced by the availability of culture media and the experience of the Laboratory scientist or their preferences. Table 4 shows the prevalence of bacterial isolates in the culture results. This still proved that staphylococcus aureus followed by streptococcus pyogenes are the common pathogens. Table 5 shows the mechanisms of injuries, comparing the infected and noninfected burns wounds and their mortality rate. This table proved the high rate of burn wound infection and the corresponding rate of burn wound mortality. The rate of burn wound infections varied with the materials applied: water of fermented cassava (5.4%), herbal concoction 6 (4.0%), egg albumin 11 (7.4%), etc. Certain pathogens were associated with each material applied. Six cases of fungal isolates carried high mortality rate of 4/6 (66.7%) in combination with bacterial infection. Topical application of traditional materials on acute burns had increased rate of wound infection and mortality compared with the without group. Fungal infection increased mortality when it was superimposed on bacterial pathogens. Thus, this practice should be discouraged in Sub-Saharan Africa.