Perspectives of caregivers towards physiotherapy treatment for children with burns in Harare, Zimbabwe: A cross-sectional study

A burn is generally considered as an injury to the skin or other organic tissue primarily caused by heat, radiation, radioactivity, electricity, friction, smoke or contact with chemicals [1]. Worldwidely, more than 310,000 human beings die each year from burns [2]. This is despite significant improvements in life-support measures, antimicrobial therapy and surgical techniques [3]. Paediatrics are hardest hit, accounting for one quarter to half of all patients hospitalised with burns [4, 5]. Global statistics reveal that the highest rate of paediatric burn admissions is found on the African continent [6]. In Zimbabwe, in particular, burn injuries rank among the top ten causes of outpatient attendances at referral hospitals in all age groups [7]. A longitudinal study on the epidemiology of burns conducted by Mzezewa et al. [8] for over 6 years at two burn units in Harare, Zimbabwe, showed that burns predominantly affect children.

Death is not the only problem that burn victims face as more than a million survivors develop complications which include pain, infections, contractures, hypertrophic scarring and deformities [9]. These problems may have a major impact on their developmental, functional, psychological and aesthetic status into adulthood [10–14]. Because of this, scientific research in paediatric burns over the years has shifted focus from acute care and reducing mortality to health-related quality of life and functional recovery post – burn [10]. In this regard, physiotherapy has traditionally been one of the interventions used in burn management. Working in a multidisciplinary team, physiotherapists focus on patient and caregiver education, scar prevention, hypertrophic scar suppression, management of heterotopic ossification, leukoderma and pruritis, as well as restoration of the patient’s functional capacity, such as full range of motion, muscle strength, and independent mobility and activities of daily living [10, 15–17]. However, successful rehabilitation of paediatric burn patients depends largely on the active participation of the child and the caregiver in the prescribed exercise programmes [10, 14].

In central hospitals in Harare, paediatric burn patients are admitted along with their caregivers, who play important roles in providing explanations, persuading and motivating the burnt children, obtaining their cooperation during physiotherapy which is often uncomfortable or painful to the patient. They also play a crucial role in executing ward exercise programmes outlined by the physiotherapists in charge of the patient. Ward exercise programmes are an essential part of continued care for the burn patient executed in the absence of the physiotherapist in order to maintain therapeutic gains achieved during normal physiotherapy [10, 18]. Caregivers’ compliance with the ward exercise programmes may facilitate a better prognosis for the patient. Given the important role caregivers play in the management of paediatric patients with burns in central hospitals, we set out primarily to explore the perspectives of caregivers towards the physiotherapy care for children admitted with burns in two central hospitals in Harare, Zimbabwe. In order to fully understand this, we had to secondarily investigate the characteristics of burn injuries in children hospitalised in the burn unit in terms of mechanism of injury, diagnosis, cause and location of the burn, time of injury, and physiotherapy treatment administered. The paucity of studies on perceptions towards physiotherapy care of caregivers in Zimbabwe is a significant shortcoming. Caregivers are extended members of the burn treatment team, and their views towards care of their child, especially during physiotherapy, are important for clinicians to understand. With the advent of patient and family-centred approaches to clinical care, details about satisfaction with physiotherapy by caregivers can be used to target areas where improvement is needed [13].