The treatment of paediatric burns using topical papaya
Introduction
Burns are a major source of morbidity and mortality in the developing world. In Africa, burns commonly affect children and occur mainly in the home around the kitchen and fireplace [1], [2]. The large number of paediatric burn patients in developing countries combined with limited resources make management of this group of patients difficult. Economic and logistics dictate that alternatives to the relatively expensive burns dressings available in the Developed World are required.
The Gambia, one of Africa's smallest and poorest countries is situated on the Atlantic coast of Africa, bordered by its larger neighbour Senegal. A former British colony much of its administration and health system was originally based on a British model, and continues along those lines.
The Gambia with a population estimated at 1.25 million, has a crude birth rate of 46 per 1000 population. The infant mortality rate and under five mortality are 85 and 137, respectively, and 44% of the population are aged less than 14 yr. The gross national product (GNP) is US$ 360 per capita.
The Royal Victoria Hospital (RVH) in Banjul is the main government referral hospital for the Country. The Paediatric Unit at RVH has 120 beds, and admitted 6807 children during 1996. During 1996 there were 133 children less than 15 yr of age admitted for burn care. This comprised 19% of the total admissions to the children's surgery ward. Child health care is free, but additional expenses are met by the family, such as dressing which are available on the open market.
The paediatric unit comprises four wards, the largest (Fig. 1) being the main surgical ward. The three other wards are of similar size (Fig. 2), the burns unit being arbitrarily designated as such. There is no adequate ventilation, lighting or water supply for the paediatric unit. Cold water is available from a central location in the unit.
Acute burns are managed on the burns ward if possible, allowing for bed availability. During the winter period, when there are increased numbers of burns admissions, they are located on the general ward. Conversely during the summer period general surgical cases including chronic osteomyelitis, soft tissue infections, and trauma are located in the burns unit. Bed occupancy can also be as high as three per bed. With no formal infection control policy for the unit and limited aseptic techniques for wound care management due to nursing constraints and limited facilities the situation is further compounded by the parents having to do some of the dressings unsupervised in less than ideal circumstances (Fig. 3).
Early debridement and grafting is being introduced but is limited by the availability of blood, resources such as dressings, and limited surgical experience. These issues are being addressed.
At the Royal Victoria Hospital in Banjul, The Gambia, we have incorporated a traditional medicine practice for treating burns into the care of paediatric burn patients. This paper describes our method of using topical papaya to treat burn wounds and reviews the existing literature.
Section snippets
Method
All full thickness and infected burns admitted during 1996 were treated with papaya (n=32).No side effects were recorded. Initially, problems were encountered with burns which were only partial thickness and dressed with papaya. Some of these wounds were subsequently found to be full thickness. It is, however, not clear whether they were full thickness originally or were converted to full thickness wounds by the papaya. Superficial and partial thickness burns are now treated by the exposure
Comment
Papaya seems to have several advantages over other topical antibiotic agents in the environment in which we are currently using it. Papaya is readily available and inexpensive. As it is applied only once a day in the majority of burn patients, nursing requirements are not high and dressing techniques are simple and easy. A major advantage is that topical papaya obviates the need to debride burn wounds surgically, with limited theatre time, blood and inherent risks to the patient. Since adopting
Acknowledgements
This research was supported by the Denis Burkitt Fellowship of the Royal Society of Tropical Medicine.
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