Burn fluid resuscitation in a resource-limited setting: knowledge, adherence, and challenges among healthcare workers at a tertiary hospital in Malawi

Burn injuries remain a significant health concern, both globally and in Malawi. Timely and appropriate fluid resuscitation is critical for preventing shock, organ failure, and mortality in patients with burns. This study assessed healthcare workers’ knowledge, adherence, and challenges in implementing burn fluid resuscitation protocols at a tertiary hospital in Malawi. A facility-based cross-sectional study was conducted among 79 healthcare workers using a structured questionnaire. Data were analysed using the Statistical Package for Social Sciences (SPSS), version 22, employing descriptive statistics and chi-square tests, with the significance level set at p ≤ 0.05 Most participants were nurses (82.3 %) with a mean age of 34 ± 7.7 years old. Good knowledge of burn fluid resuscitation was observed in (73.4 %) of participants, with (93.7 %) correctly identifying the Parkland formula. However, only (26.6 %) knew the correct urine output (1–2 ml/kg/hour) for paediatric patients. Adherence to fluid resuscitation protocols was generally good, with (84.8 %) using the Parkland formula and (75.9 %) administering the recommended crystalloids (Ringer’s Lactate). Demographic variables were not significantly associated with the participants’ knowledge levels. Key challenges included lack of formal training (82.3 %) and absence of a dedicated burns unit (67.1 %). Although healthcare workers demonstrated good knowledge and adherence, gaps remain in paediatric urine output knowledge, documentation, and fluid adjustment practices. Strengthening continuous professional development, establishing dedicated burn units, and protocol standardisation are recommended to improve outcomes.