Advice Column

A Burning Issue

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The middle of winter might simply mean cold and discomfort for some but for others just keeping warm and having a hotplate of food can be life threatening. Burns and ingestions are the leading cause of accidental-injury deaths amongst infants and children under the age of five in Africa.  Known as ‘energy related incidents’, statistics include paraffin, gas, candles, electricity, matches and wood fires.  Apart–from deaths, millions of children require hospital care every year for non-fatal injuries and many are left with lifelong disabilities. It is a problem that the whole country shares as the cost is about R104 billion a year, says Sustainable Energy Africa.

Emeritus Professor Heinz Rode, Burns Unit, Red Cross War Memorial Children’s Hospital says, The greater majority of severe burns occur amongst the lower socio-economic population groups in the developing world. The high incidence is driven by haphazard urban development with little space between dwellings, overcrowding, lack of education, and inadequate electrification of homes resulting in the use of paraffin as a primary energy source, open fires for cooking and heating, and candles for lighting. In addition there is a failure of prevention and educational programs as well as a lack of knowledge of first aid procedures in the event of a burn.

Burns are among the most devastating of all injuries, ranging from physical impairments and disfigurement, to emotional and mental anguish.  Rode says burns have a devastating effect both physically and emotionally. Burns—destroy the soul’s clothing and leave the frail self in naked agony. The surgeon may be the component to graft skin, but skill alone will not avail to re-cloth the soul. Burns victims are heavily stigmatized in a society where appearance is so important and it is this rejection and stigmatisation that is so traumatic and damaging to the child’s emergent sense of ‘self and self-worth’ in the struggle to adapt to a permanently  changed physical appearance. Rejection by peers, being teased at school and the inability of teachers, parents and the community to emotional support the burned child can lead to life long suffering.

Africa carries an extraordinary burden of fire related injuries with the Medical Research Council showing that in 2012 burns were among the top 10 external causes of accidental-injury deaths in South Africa.

According to the World Health Organisation (WHO), globally burns are the 11th leading cause of child fatalities (between the ages of one and nine) and are the 5th most common cause of non-fatal childhood injuries.  Yet, the fact is that injury due to burns is largely preventable.

Did you know?

Burns are the number one cause of fatal injuries in children under the age of one in South Africa

The vast majority of burn injuries happen at home

It is estimated that over a million patients suffer burn injuries annually on the African continent

The majority of energy related incidents are fires – the majority of which are multiple fires

46% of households lose their homes and/or belongings in fires

24% of households experience an energy related incident or injury

95%  of burn injuries are caused by hot liquid regardless of the energy carrier

It costs between R30 000 and R100 000 to treat one burn victim

‘With the onset of winter it is inevitable that we will hear and read about shack fires in informal settlements bringing with it death, injury, devastation and destruction,’ says Dr Bobby Ramasia, Principal Officer of Bonitas Medical Fund.  ‘Data from the Fire Protection Association of Southern Africa (FPASA) shows that fire incidents are steadily increasing year on year with close to 16,000 fires in informal and formal settlements reported between 2010 and 2013.  It is estimated that 3.2% (1,600,000) of the country’s population will suffer burn injuries annually, the vast majority being from poorer communities.

‘How do we change these statistics?  We need to educate our families, children and communities about how to prevent fires and if or when they do happen, how to keep safe and out of harm’s way as well as the best way to treat burns.’

Professor Rode recommends safety equipment like a fire extinguisher, smoke detectors or a bucket of sand should be available and accessible at the work place, school or at home as many injuries occur in places familiar to the child. Children need to be taught to stop, drop and rollon the floor’ if clothing catches a-light and to crawl on the floor to escape thick smoke. All inflammable liquid fires should be doused with sand or an extinguisher or smother the flame with a pot lid or cloth soaked in water if a pot of oil catches alight.

Children need to be taught to respect electricity. Electrical systems should not be overloaded with multiple adapter plugs. Electrical cords should not run under carpets and those that are frayed or worn should be replaced. Children should be warned to keep away from electricity sub-stations.

Electrical burns

Professor Rode says electrical burns are extremely dangerous. Not only can they cause external burns but the electric current can harm internal organs and tissues.  If burns aren’t visible on the skin it doesn’t mean there is no internal damage.

The human body can conduct electricity so any minor contact with an electrical source can cause harm. Grasping live wires, falling into water that is electrified and touching electrical outlets are the most common causes of electrical burns.

Treating electrical burns

These can be tricky to treat especially if the patient is still in contact with the electrical current , it needs to be switched off or removed as soon as possible. Use an object that is made of wood, rubber or plastic as these materials do not conduct electricity.
The patient should be laid down to prevent injury, shock or seizures. Treat external burns in the same way as other burns.

Let’s get educated about fire prevention 


Buy a small fire extinguisher from a reputable dealer to keep handy and learn the correct way to use it

Familiarise yourself with emergency numbers in the event of a fire and medical emergency

Take note of warnings on selected appliances – never cover heaters, switch off electrical blankets while sleeping

Check electrical cables regularly for damage

Always extinguish cigarettes and candles in the appropriate manner

Turn appliances off when not in use (which will also save on the electricity bill)

Keep dangerous products out of reach of children and use special containers with a safety cap

Buy your paraffin or gas from reputable sources

Store matches in a safe place

Ensure children know who to call and what to do in an emergency.


Leave a room where a candle is burning, a heater is on, a fire in the fire place is still burning fiercely or there’s oil heating on top of a stove

Try and put an oil fire in the kitchen out with water, rather use sand or a pot  lid

Leave  appliances on with unsupervised children

Leave children unattended

Enter a room that is on fire

Stay behind to pack up personal belongings

‘Families and communities are affected by fires – it’s not always a loss of life or injury but losing your possessions and home is a major trauma – both mentally and financially.  We urge every South African to be more vigilant.’

In the case of fire:

Try and put out the fire, if it is manageable, with a fire extinguisher

Raise the alarm and phone the relevant emergency number

Close the door on the room that is on fire

Exit the building as soon as safely possible

Stay close to the ground when exiting a smoke filled room. Smoke rises so staying low minimises the potential for inhalation injuries

Cover your nose and mouth with a (moist) cloth. This also minimises the inhalation of smoke by breathing through a barrier.

What is the difference between a first, second and third degree burn?

Professor Heinz Rode warns that for any burn do not use ice.  Rather run the burn under cold tap water for 20-30 minutes. He says it is a good idea after that to cover the burn with cling wrap to ward off infection.

A first-degree burn is also called a superficial burn or wound. It’s an injury that affects the first layer of your skin. The skin will be red and slightly swollen. As the burn is superficial, it is painful to the touch, and may resemble sunburn. Simply run cold water over the affected area for five to 10 minutes and cover the burn with a sterile dressing.

Second-degree burns or partial thickness burns affect the epidermis and dermis. They cause extreme pain, redness, swelling, and blistering. Seek medical assistance.

Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues. They are extremely serious. If the burn covers a large part of the body cover it with a clean sheet soaked in cold water. Remove clothing, shoes and jewellery from the area unless it is stuck and seek medical assistance.

Treating a burn caused by a chemical

Remove any contaminated clothing and brush off any dry chemicals or residue. Wash the affected area under running water for 15 minutes then visit a doctor or hospital.

Seek medical help immediately if:

The burn area is larger than the victim’s palm

The victim has inhaled smoke

The burn is on the genitals, face, hands, feet or joints

The burn is a second- or third-degree burn

The burn is caused by a chemical or electric shock.

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