Burn mortality: recent trends and sociocultural determinants in rural India

Abstract

In 1998, India was the only country in the world where fire (burns) was classified among the 15 leading causes of death. High mortality in young married women from burns has already become an alarming and contentious medical problem in rural India. The incidences of burn mortality by age, sex, residence, marital status; manner and reasons have been reported only infrequently from the rural parts of India. From a total of 4042 medicolegal deaths reported at an Apex medical centre of a rural health district, over a period of 5 years 1997–2001, 942 deaths (23.3%) were due to burns; with mortality rate of 15.1 per year per 100,000 population. Of all burn death cases, 80.8% were females, 82.4% married ones, 71.9% belonged to the young age group of 21–40 years and 75.0% came from the rural parts of the district. Out of all burn deaths, 50.7% were accidental, 47.8% suicidal and 1.5% were homicidal in manner. In all female suicides, burns was the commonest method adopted by over 60% females. Torture by in-laws (32.1%) was the commonest reason for committing suicide by burns in married women. The present study has tried to identify the high-risk group and reasons for high burn mortality in this rural area. Religious and sociocultural reasons prevalent in the area are discussed, which play the determinant role in such a high mortality rate in burns in rural India. Further studies in India into psychodynamics of sociocultural, religious and family life are advised.

Introduction

One million people die annually worldwide due to suicides and homicides alone. Another 2.5 million people die each year because of accidents, burns, drowning, poisoning, falling from heights and from disasters [1]. India was the only country in the world, where fire was classified among the 15 leading causes of death in 1998 [2]. In the list, road traffic accident (RTA) deaths stood 7th, fire (burns) 14th and self-inflicted injuries at 15th rank. Deaths due to burning in India are the problem of great concern. It has been reported [3] that in India, a dowry death (the unnatural death of a bride within 7 years of marriage directly or indirectly due to any dispute over bridal dowry, usually by burning) occurs every 1 h 42 min. In the early 1980s, in view of the increasing number of dowry deaths, guide lines had been laid down by the Government of India and the law in respect thereof had been amended. Since then, in all cases of unnatural death of a female within 7 years of marriage or if she is below the age of 30 years, an autopsy is compulsory and in case of a death due to burns, it has to be carried out by two medical officers, one of whom is a lady medical officer, whenever possible. Apart from dowry deaths, a large number of suicides by married women is associated with ‘torture’ by in-laws, which includes (1) any willful conduct which is of such a nature as is likely to drive the woman to commit suicide or to cause grave injury or danger to life, limb or mental or physical health of the woman, or (2) harassment of the woman where such harassment is with a view to coercing her or any person related to her to meet unlawful demand for any property or valuable security, or is on account of failure of her or any person related to her to meet such demand. Hence, the mortality due to burns is a public health problem in rural India by virtue of its incidence, regardless to any real or suspected trends. The incidences of burn mortality by age, sex, residence (rural or urban), marital status; manner (accidental, suicidal or homicidal) and reasons have been reported only infrequently from the rural parts of India. Also, the reasons for high percentage of the females, especially the married wives, involved in burning cases in this rural region demanded a review and analysis. Against this background, the present study was undertaken to understand the real incidence, magnitude and pattern of the burn deaths in a rural health district of India during a period of 5 years, 1997–2001 (inclusive). The study aims to provide the most recent estimates and trends in burn mortality in the rural health district of Yavatmal of the State of Maharashtra in India. The study also aims to identify, firstly, the group at a higher risk for burn mortality and secondly, the determinant factors related to sociocultural set-up, resulting in high mortality rates in burns in rural India.