Children Burn While UTH Waits for a Burns Unit

• The University Teaching Hospital (UTH), the country’s main referral hospital, does not yet have a fully functional, dedicated burns unit. Patients are managed in overcrowded general wards, where infection rates are high and survival outcomes are poor.

• Mortality for children with burns under 30% of body surface area remains unacceptably high, showing that the existing infrastructure cannot guarantee safe returns on any intervention without parallel systemic strengthening.

• Zambia currently lacks specialist burn surgeons, trained nurses, and sustainable supply chains. Reliance on donor-funded or pilot projects raises concerns about long-term continuity once external support diminishes.

By MakanDay Contributor

In Zambia, burns are a silent but devastating public health crisis. At the University Teaching Hospital (UTH)—the country’s main referral facility—there is still no fully functional, dedicated burns unit. Children suffering burns are treated in overcrowded general wards, where infection rates soar and survival outcomes remain poor.

Despite being Africa’s second-largest copper producer, Zambia has no specialist burn surgeons, few trained nurses, and fragile supply chains that depend on short-term donor projects. Deaths among children with burns covering less than 30% of their body—injuries considered survivable in better-resourced countries—remains unacceptably high.

Behind these statistics are mothers keeping vigil at their children’s bedsides—torn between fear, exhaustion, and hope. Their stories lay bare the human toll of a health system unequipped to save its youngest patients.

One of them is Esther Mukobeko, who had just dropped her eight-year-old son at a nearby school in Lusaka West when she received a call urging her to rush home. Her two-year, five-month-old daughter had been severely burnt.

“She was playing with her younger brother when she hit a pot of hot water on a brazier used for preparing nshima,” Mukobeko recounted from the children’s ward at UTH in Lusaka, where her daughter now lies with painful burns to her abdomen and thighs.

A few beds away, another mother, Evelyn Mkwanazi Mwanza, kept vigil beside her one-year, six-month-old daughter, who also suffered burns from hot water. The accident occurred during a routine morning chore at their home in Eureka Farms, Chilanga.

“Due to loadshedding, I was using a brazier to boil water. She bumped into the pot and got burnt,” Mwanza said, her voice filled with worry. “Now, she is not only dealing with burns but has developed an infection.”

Paediatric burn injuries are becoming increasingly common, marking a silent but deadly trend sweeping through Zambian homes, particularly during the cold season. As temperatures drop during cold season, many families in peri-urban and low-income areas rely on open flames and charcoal braziers (mbaula) for warmth and cooking. In overcrowded homes, where children are often left unsupervised or huddle around fires to stay warm, the consequences can be devastating.

Children at Greatest Risk

The human toll is most visible among the youngest victims.

According to global statistics from the World Health Organisation (WHO), 43,000 people die from burns annually in Africa, with children under five being disproportionately affected. Zambia’s own UTH records confirm that most fatalities are children who sustained burns in seemingly minor domestic incidents.

“These are children who cannot advocate for themselves. We see unnecessary pain and death simply because we lack a dedicated burns unit and the resources to treat these injuries effectively,” said Professor Emmanuel Makasa, a consultant Orthopaedic at UTH.

A Healthcare System Under Pressure

While burns can be survivable with proper treatment, Zambia’s healthcare system is poorly equipped to handle them. UTH, the country’s premier referral hospital, does not have a dedicated burns unit. Children and adults with severe burns are treated in general wards, where resources are stretched thin and infections are rife.

A 2023 study titled “Factors Associated with Mortality of Patients Admitted with Burns at the University Teaching Hospitals, Lusaka, Zambia” reveals sobering statistics. The study, conducted over 12 months, found that even patients with burns covering less than 30% of their body—typically considered treatable in better-resourced settings—face alarmingly high deaths rates at UTH.

“Infection is the most common factor leading to complications and death,” the study noted. Other contributing factors include the patient’s age, body mass index, and the mechanism of the burn injury.

UTH initiated a Quality Improving project on 01 July, 2024 to improve the quality of care of patients by reducing the death rate among children below five years with burns, according to a statement from the hospital’s surgery unit.

The project was initiated following a data review on 22 May last year, which revealed a sharp rise in mortality among children under five with burns — from 20 percent to 53 percent — between December 2023 and March 2024.

“The project represents a strategic, ethical and impactful initiative to improve the quality of care for a vulnerable population. Ultimately reducing mortality and enhancing the health and wellbeing of children at UTH is the main goal of the project,” the statement read.

It’s a tragic paradox. While high-income countries report decreasing burn-related fatalities due to advanced care and preventive strategies, low- and middle-income countries like Zambia report burn-related death rates up to 11 times higher.

A Season of Suffering

“This is burn season,” warns Prof. Makasa, when he was interviewed in July. “We see a spike in burn cases during the cold season, especially among children under five. It’s preventable, but tragically, many still suffer or die.”

According to Makasa, who is also Professor of global surgery and a strong advocate of improved surgical care which includes prevention of surgical conditions like burns through health education and health promotion, the problem is from a combination of factors among them, the use of live flamed fires to cook and for warmth, and lack of supervision of young children, especially in poor homes.

“It’s preventable, but tragically, many children still suffer burns that could lead to death due to complications such as infections because bacteria can easily enter the body through the breached skin, worse when we have infection from drug resistant bacteria.

Most homes in high-density areas lack insulation, warm clothing, or alternative heating. As a result, many households rely on open flames used for both cooking and heating—a dangerous dual function.

“Inadequate warm clothing, poorly insulated households, the use of live flames to cook and warm up, lack of supervision of young children are among other factors.

Mothers are busy. Children are left alone and curious. It’s a disaster waiting to happen,” he said.

Prof Makasa suggests that limited resources, appropriate skills and lack of burn management spaces (burn units) also contribute to poor clinical outcomes in health facilities for most burnt patients.

“The public also don’t seem to fully appreciate the devastating impact of burns especially on children which includes death, otherwise they would do more to prevent the same or do the right thing for first aid at home when burns occur,” he said.

Experts warn that the danger is compounded by the immunosuppressive effect of burns, which heightens the risk of life-threatening infections — especially when treatment is delayed or inadequate.

Building on the last success of the first half of the project, the Quality Improvement project was extended for six months more. In the first six months, the unit managed to reduce the mortality below 13 percent.

“This was positive outlook for the management of burns at UTH because previous data indicated a mortality rate as high as 50 percent of the admission.

In the second phase of the project, the unit attended and admitted 103 burns patients. Out of this number, 88 patients were discharged and were being followed up in clinic IV. The unit recorded a total of 15 mortalities across the admitting wards.,” the statement read.

Among its recommendations are, prioritise burns unit in terms of medical consumables essential to burns patients; encourage exchange programs for members of the unit with institution of excellency in burns; accelerate the opening of the burns wing in the new building; and make patient monitors and oxygen available in the High Dependency Unit.

Prevention is Key

While improving hospital infrastructure and training are long-term goals, experts agree that prevention remains the most effective strategy to reduce burn-related injuries and fatalities.

Simple interventions—like ensuring children are kept away from cooking areas, educating parents about burn risks, providing adequate warm clothing for kids and promoting safer cooking methods—can have a significant impact.

“It’s not about blame,” Prof. Makasa said. “It’s about recognising a problem and solving it together. Government, communities, and individuals all have a role to play.”

Zambia Medical Association president Roy Kaumba Tolopu describes as a good initiative the intended creation of a burns unit at UTH.

“I think that is the direction UTH is taking, they want to create a burns unit. Right now, they are just working on some components to operationalise it,” Dr Tolopu said.

He said the creation of a burns unit is important because it will provide care tailored to burns and aimed at reducing infections.

Public awareness campaigns, especially during the cold season, could help mitigate the seasonal spike in burn cases. Additionally, the promotion of safer, enclosed cooking and heating technologies could drastically reduce accidents in homes.

A Shared Responsibility

Despite the grim reality, Prof. Makasa remains hopeful, noting that burn mortality at UTH has fallen from 100 percent between 2000 and 2010 to around 30 percent today.

“But 30 percent is still too high—especially when it’s our children,” he said.

Editorial Note: The image does not represent actual events or persons; it is AI-generated for illustrative purposes.