Prevention of burn injuries: A public health approach to reducing morbidity and mortality in low- and middle-income countries

Burn injuries represent a significant yet preventable public health challenge, with an estimated 180,000 deaths annually worldwide, 95% occurring in low- and middle-income countries (LMICs). In India specifically, approximately 6–7 million burn injuries occur annually, with 700,000 requiring hospitalization and 140,000 proving fatal. This narrative review critically synthesizes evidence-based preventive medicine strategies for reducing burn injury incidence and severity across diverse settings. We conducted a systematic literature search of PubMed, Scopus, and Web of Science databases (2019–2024) focusing on burn prevention interventions in LMICs, particularly India. Evidence quality was assessed using modified Grading of Recommendations Assessment, Development and Evaluation criteria. Primary prevention interventions, including safer cookstove programs, show variable effectiveness (0%–30% burn reduction) with significant implementation challenges related to fuel stacking behaviors. India’s Pradhan Mantri Ujjwala Yojana program, while reaching 100 million households, demonstrates limited sustained impact due to economic barriers and incomplete behavioral transition. Secondary prevention through proper first aid (20 min cool running water within 3 h) shows robust evidence for reducing burn severity (moderate to high-quality evidence), though implementation rates remain under 30% in Indian settings. Tertiary prevention strategies face severe resource constraints with limited applicability of high-income country evidence to LMIC contexts. Critical appraisal reveals substantial evidence gaps, methodological limitations, and publication bias favoring positive results. We examine evidence quality systematically, discuss implementation barriers specific to resource-constrained settings, and provide realistic recommendations acknowledging the complexities of translating evidence into practice. This review offers burn care specialists, public health practitioners, and policymakers a critical, evidence-informed analysis of burn prevention approaches applicable to India and similar LMICs.