The individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns (WHO, 1997)

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Description

OPERATIONAL DEFINITIONS

Quality of life:  The individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns (WHO, 1997)

Upper limbs burn: is an injury that affects the region extending from the deltoid region up to the hand and including the arm, axilla and shoulder and primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals

Social relations: a social relation or social interaction is any relationship between two or more individuals

 

Poor quality of life: lack of fulfillment of basic needs as well as social physical needs.

ABSTRACT

Introduction: upper limbs burns can result in number of devastating functional impairment and social consequences that can hamper quality of life. Burns are among the leading causes of disability adjusted years of life (DALYs) in LMICs and majority of burn patients had burns that involved upper limbs. Upper limbs burn has long lasting impact on the quality of people’s lives with persisting problems related to scarring, contractures and weakness these will lead to limitation of range of movements and social wellbeing.

General objective: To determine the quality of life among patients with burns of the upper limbs at KNRH.

Methods: This was a cross-sectional study recruited 107 participants of 5 years and above who have been discharged between June 2019 to December 2019 from Kiruddu National Referral Hospital with burns of upper limbs. Recruitment was consecutive from burns unit clinic following ethical approval from School of Medicine Research and ethics Committee (SOMREC). Participants were given a burn related QOL questionnaire. Data was then entered into Epidata 4.2 and imported into STATA 15.1 for analysis. Factors associated with poor quality of life were determined by modified Poisson regression to generate prevalence ratios with their 95% confidence intervals.

Results: A total of 108 participants were recruited for the study, 97 (89.8%) were adults and responded to the adult QOL questionnaire while the rest were pediatrics. The mean age of the adults was 28 years (SD=8.6) while the median age of the pediatrics was 8 years (IQR =6-10) and 61.1% were male. The upper extremity function (physical) quality of life was good while the social aspect quality of life was poor. The factors associated with poor quality of life were degree(deep) of burns, number of surgeries, age above 55 years and being divorced.

Conclusions and recommendations:

There is generally poor upper extremity function or physical QOL among both adults and children while there is generally good social aspects QOL among adults and children

Recommendations

We recommend a multidisciplinary team approach while managing patient with upper limbs burns. We recommend scaling up clinic days for follow up visits for patients with burn injuries to assess their upper extremity function and social aspects quality of life and establish management appropriately.


CHAPTER ONE

Introduction and background

A burn is an injury to the skin or other organic tissue primarily caused by heat or due to radiation, radioactivity, electricity, friction or contact with chemicals(“WHO | Burns,” n.d.).

Upper limbs have major role  in the body movements it carries out  many functions such as prehension, manipulation and wide range of movement which play an important role for successful integration into the society and professional life(Kitzinger et al., 2012). Therefore they need adequate management for enable physical functioning(Harvey et al., 1996; Luce, 2000).

Literature reported that upper limbs burns patients had poor quality of life due to scarring, contractures, weakness, thermoregulation, itching, pain, body image and psychosocial wellbeing(Moi et al., 2016).  Burns are one of the most common causes of disability in LMICs WHO, 2018. In Mulago National referral hospital burn injuries represents16.7% of total injuries (Renee Y. hsia, 2010). In kawempe division, Uganda burns were the leading cause of severe injuries in children or younger 41% .(Kobusingye et al., 2001).

Upper limbs injuries had an incidence of 1130 per 100,000 per year in United States, injuries to the fingers account for 38.4% and upper limbs injuries due to burn account for1.6%(Ootes et al., 2012).

Study showed that age, sex, low social economic status, low education levels,  and occupation are associated with poor quality of life (Shahid et al., 2017). Burns of upper limbs affected significantly the activities of daily living by limiting the movements of the upper limbs joints (Nanayakkarawasam P P et al., 2015).

After hospital discharge, most patients of upper limbs burn showed abnormal behaviors such as preferring to be lonely due to scars and bodily changes caused by the burn especially in the first year (Ciofi-Silva et al., 2010)


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