Burn Mortality Trends and Access to Surgical Intervention in Resource-Limited Settings.

INTRODUCTION: Burn injuries remain a leading cause of morbidity and mortality in low- and middle-income countries, particularly in sub-Saharan Africa. Management of severe burns often requires early surgical debridement and skin grafting to reduce infection risk and promote wound healing. This study aimed to evaluate trends in burn mortality at Kamuzu Central Hospital (KCH) from 2011 to 2024 and assess the role of surgical intervention on patient outcomes. METHODS: We analyzed a database of patients admitted to the KCH burn unit in Lilongwe, Malawi. We conducted bivariate analyses to evaluate associations between surgical intervention and in-hospital mortality, followed by logistic regression to determine the independent contribution of surgical intervention on mortality after burn injury. RESULTS: There was no significant change in burn mortality rates over the study period. However, surgical intervention was independently associated with decreased odds of death (odds ratio: 0.20, 95% confidence interval [CI] 0.11-0.36, P < 0.001), whereas increasing total body surface area was strongly associated with increased mortality (odds ratio: 1.09 per 1% increase, P < 0.001). Only a small proportion of patients underwent surgical intervention despite its protective role. CONCLUSIONS: Burn mortality at KCH has remained essentially unchanged over the past decade. Surgical intervention is strongly protective but remains underutilized. Expanding access to early surgical debridement and grafting may be a critical step toward reducing burn mortality in resource-limited settings.