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A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India

BACKGROUND: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause – accidental or non-accidental, suicidal or homicidal – is often unclear. Our study aimed to understand...

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Autores principales: Daruwalla, Nayreen, Belur, Jyoti, Kumar, Meena, Tiwari, Vinay, Sarabahi, Sujata, Tilley, Nick, Osrin, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260258/
https://www.ncbi.nlm.nih.gov/pubmed/25433681
http://dx.doi.org/10.1186/s12905-014-0142-5
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author Daruwalla, Nayreen
Belur, Jyoti
Kumar, Meena
Tiwari, Vinay
Sarabahi, Sujata
Tilley, Nick
Osrin, David
author_facet Daruwalla, Nayreen
Belur, Jyoti
Kumar, Meena
Tiwari, Vinay
Sarabahi, Sujata
Tilley, Nick
Osrin, David
author_sort Daruwalla, Nayreen
collection PubMed
description BACKGROUND: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause – accidental or non-accidental, suicidal or homicidal – is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement. METHODS: We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital. RESULTS: Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women’s understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism. CONCLUSIONS: The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women’s understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns.
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spelling pubmed-42602582014-12-09 A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India Daruwalla, Nayreen Belur, Jyoti Kumar, Meena Tiwari, Vinay Sarabahi, Sujata Tilley, Nick Osrin, David BMC Womens Health Research Article BACKGROUND: Most burns happen in low- and middle-income countries. In India, deaths related to burns are more common in women than in men and occur against a complex background in which the cause – accidental or non-accidental, suicidal or homicidal – is often unclear. Our study aimed to understand the antecedents to burns and the problem of ascribing cause, the sequence of medicolegal events after a woman was admitted to hospital, and potential opportunities for improvement. METHODS: We conducted semi-structured interviews with 33 women admitted to two major burns units, their families, and 26 key informant doctors, nurses, and police officers. We used framework analysis to examine the context in which burns occurred and the sequence of medicolegal action after admission to hospital. RESULTS: Interviewees described accidents, attempted suicide, and attempted homicide. Distinguishing between these was difficult because the underlying combination of poverty and cultural precedent was common to all and action was contingent on potentially conflicting narratives. Space constraint, problems with cooking equipment, and inflammable clothing increased the risk of accidental burns, but coexisted with household conflict, gender-based violence, and alcohol use. Most burns were initially ascribed to accidents. Clinicians adhered to medicolegal procedures, the police carried out their investigative requirements relatively rapidly, but both groups felt vulnerable in the face of the legal process. Women’s understandable reticence to describe burns as non-accidental, the contested nature of statements, their perceived history of changeability, the limited quality and validity of forensic evidence, and the requirement for resilience on the part of clients underlay a general pessimism. CONCLUSIONS: The similarities between accident and intention cluster so tightly as to make them challenging to distinguish, especially given women’s understandable reticence to describe burns as non-accidental. The contested status of forensic evidence and a reliance on testimony means that only a minority of cases lead to conviction. The emphasis should be on improving documentation, communication between service providers, and public understanding of the risks of burns. BioMed Central 2014-11-30 /pmc/articles/PMC4260258/ /pubmed/25433681 http://dx.doi.org/10.1186/s12905-014-0142-5 Text en © Daruwalla et al.; licensee BioMed Central Ltd. 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Daruwalla, Nayreen
Belur, Jyoti
Kumar, Meena
Tiwari, Vinay
Sarabahi, Sujata
Tilley, Nick
Osrin, David
A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title_full A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title_fullStr A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title_full_unstemmed A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title_short A qualitative study of the background and in-hospital medicolegal response to female burn injuries in India
title_sort qualitative study of the background and in-hospital medicolegal response to female burn injuries in india
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260258/
https://www.ncbi.nlm.nih.gov/pubmed/25433681
http://dx.doi.org/10.1186/s12905-014-0142-5
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