Thermal Energy Exposure Injuries: Burden of Injury in South Asia 1

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Thermal Energy Exposure Injuries: Burden of Injury in South Asia 1

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Thermal Energy Exposure Injuries: Burden of Injury in South Asia 8

Thermal Energy Exposure Injuries: Burden of Injury in South Asia

Florida State College at Jacksonville


Thermal Energy Exposure Injuries: Burden of Injury in South Asia

An inevitable part of living our day-to-day lives are injuries, whether intentional or unintentional. Injury resulting from thermal energy exposure will be analyzed in the South Asia World Bank region. Exploration of this low- to lower-middle-income region sheds insight on the burden of thermal injury, its financial impact, and how the injury varies across age and sex. The impact of South Asia’s cultural and social factors on society’s vulnerability to morbidity and mortality from thermal energy exposure concludes.


Spencer et al. (2019) estimated, “Globally, there were 8,991,468 (7,481,218 to 10,740,897) new fire, heat, and hot substance injuries in 2017”. Of the reported 1.836 billion South Asian population how many deaths are attributed to thermal energy exposure (World Bank, 2020)? Emaduddin et al. (2015) estimated, “Mortality rates from fire-related burns are the highest in the South-East Asia region (11.6 per 100,000 population) and when compared to the 1 death per 100,000 population found in high-income countries” (p. 3). The data equated to over 200,000 deaths per year in the region attributed to fire, heat, and hot substance injuries.

Morbidity and Disability

The World Health Organization (WHO) (2020) concluded, “Non-fatal burns are a leading cause of morbidity, including prolonged hospitalization, disfigurement and disability, often with resulting stigma and rejection”. Skin burns, amputations, open wounds, and cognitive and motor skills loss are examples of morbidities associated with heat. In addition, per Spencer et al. (2019), “The average disability weight globally after comorbidity adjustment was 0.032, meaning that the average person suffering from a fire, heat and hot substance injury lost 3.2% of their full health status”. Max Roser and Hannah Ritchie (2017) recorded Disability Adjusted Life Years’ (DALYs) for fire, heat, and hot substance injuries in the regions of South Asia are recorded as Afghanistan 53,339, India 1.99 million, Pakistan 281,610, Bangladesh 155,126, Maldives 202, Sri Lanka 16,798, Bhutan 971, and Nepal 33,068”.

Economic Impact

The burden of injury caused by thermal energy exposure economically impacts the individual, country, region, and overall globe. WHO (2020) described hospital burn management as direct costs and indirect costs as lost wages, prolonged care for deformities and emotional trauma, and commitment of family resources. For example, “In Sri Lanka, 10,000 injuries and 100 deaths are burn related, costing US $1 million annually” per Ashkan Golshan, Cyra Patel, and Adnan A. Hyder (2013, p. 384).

Variation Across Age and Sex

Research shows that 5 million deaths occur each year, accounting for 9 percent of the total world death. In the south Asia region, burn injuries are significant causes of mortality in children over one year. Injuries vary differently in terms of, age and especially children living in low socioeconomic status. Injuries in the south Asia region that occur due to burns account for 6.1 per 100 000 deaths. Male children account for 3.3, while their female counterparts were accounting for 9.1 of the total number. Few countries in this region have data on these childhood injuries; Bangladesh has the highest number accounting for thirty-eight percent. Examples of countries in this region are; Pakistan, Nepal, Bangladesh, and Afghanistan.


The majority of fire-related deaths in the south Asia region occur due to flames in the kitchen while preparing foods. Children of 1-4 years of age are likely to sustain these injuries since they are more aggressive and practical. More than 50 percent of fire burns in the south Asia region occur in adults aged between 25 and 64 years. Research shows that flames cause sixty-five percent of hospitalized children in Bangladesh due to burns. 5oo deaths occur each year due to fires among children aged 14 years and this region, high numbers of burns are recorded due to low social, economic status, low educational level or illiteracy, little housing spaces, and also some cultures. Others include textiles clothing, decreased parental care to children, and female activities in the kitchen also account for a higher number of female morbidity than their male counterparts (Sengoelge, 2017).


In the south Asia region, injuries from heat arise from scalds. Which account for 64.3 percent of heat burns. The male gender is more affected by these injuries, with 67.2 percent, while females have 32.8 percent of the total burn injuries. People between the ages of 20-29 years are mostly affected and account for 32.5 percent, followed by people between the age of 10-19 with a percentage of 16.9. Children under five years have the lowest percentage of 5.5, and this is because most of these burns are associated with occupation (Sengoelge, 2017).

Hot Substances

In south Asia, chemical burns are associated with gender-based violence, where acid has been used as a weapon against women. The mostly used acids include; hydrochloric acid, sulphuric acid, and nitric acid, which are easily available in this region (Makwana, 2019).

Factors of Cultural and Social Impact

Due to the high level of poverty in the region, the countries of South Asia bear a significant burden of injury due to injuries such as burns from fires, heat, and hot substances. Female mortality outnumbers male mortality, though it is to be noted that females are typically 14 years old and older, with the male mortality at younger ages of 0 to 12. It can be inferred that the stated age ranges of those with an increased risk are the women who are responsible for the household cooking, with their children, per the statistics mainly males, who stay home with the women. The majority of burns occur from within the home, particularly in the kitchen. The use of kerosene (paraffin) as a cooking fuel, which is highly explosive, causes a quarter of the burns in children as reported by Golshan et al. (2013).

In countries such as India, where traditionally loose clothing, such as a sari, is worn, it is noted by Golshan et al. that women are noted to have more flame type burns. The donning of synthetic clothing increased the likelihood of accelerating the fire, causing burns to cover more than fifty percent of the body; synthetic clothing also increases the chances of death from burns. There is an increased prevalence of injuries from fire, heat, and hot substances in rural areas compared to urban areas as well as in households that are overcrowded, such as multiple families living together. Another source of burns and fire-related injuries occur in the industrial and work-related events, though this mainly applies to males. (Golshan et al., 2013) Lack of proper safety measures in the utilization of either household or industrial settings is a risk factor for this population (WHO, 2018).

In low- and middle-income countries, many people do not seek medical attention, which makes the estimation of 11 million people worldwide seeking medical attention due to burns most likely an underestimation. (Zia et al., 1970) The reliance of traditional cooking fuels, such as coal, charcoal, biomass, firewood, crops, straw, and animal dung contributes to this population’s vulnerability to injuries from fires, heat, and hot substances. Households with female breadwinners are an important socioeconomic determinant and are more vulnerable. Female workers are affected by gender disparities and further increase the poverty gap. Families that are larger and have to rent versus own their homes increase the susceptibility to be affected by having to use cheaper and more dangerous forms of cooking and heating fuels due to the lower cost. (Abbas et al., 2020) All of the factors of poverty, rural areas, and larger families/households increase the vulnerability of young and older women and younger males to suffer and possibly have a fatality from fires, heat, or hot substances.



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