240 - "Every time I look at my granddaughter, I blame myself”: A qualitative study of the biopsychosocial impacts on caregivers of children hospitalized with burn injuries in Northern Tanzania.

Publication Number: 1227.240

Shannon Anderson, University of Utah School of Medicine, Salt Lake City, UT, United States; Happiness Duncan. Kajoka, KCMC-DUKE Collaboration, Moshi Urban, Kilimanjaro, Tanzania; Irma Fleming, University of Utah School of Medicine, Salt Lake City, UT, United States; Giavonni M. Lewis, University of Utah Health, Salt Lake City, UT, United States; Nancy Stewart. Mmary, Mwenge Catholic university, Kilimanjaro, Kilimanjaro, Tanzania; Deusdedith Evarist. Marandu, Hai Hospital, Moshi, Kilimanjaro, Tanzania; Catherine Staton, Duke University School of Medicine, Durham, NC, United States; Melissa H. Watt, University of Utah, School of Medicine, Population Health Sciences, Salt Lake City, UT, United States; Elizabeth M. Keating, University of Utah, Salt Lake City, UT, United States; Kajsa Vlasic, University of Utah School of Medicine, Salt Lake City, UT, United States; Getrude M. Nkini, KCMC-Duke Collaboration, Moshi mjini, Kilimanjaro, Tanzania; Theresia Mwakyembe, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Francis Sakita, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Blandina Mmbaga, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania

Background: Burn injuries are among the leading causes of pediatric morbidity and mortality in low- and middle-income countries (LMIC), especially in Sub-Saharan Africa. Caregivers of children with severe burn injuries often experience significant stressors that can affect their well-being and caregiving capacity. Literature from high-income countries (HIC) has documented these challenges, but little is known about caregiver experiences in LMIC settings, where limited resources and strong family dependence may exacerbate caregiver strain.

Objective: To explore the biological, psychological, and social challenges experienced by caregivers of children hospitalized with burn injuries in Northern Tanzania.

Design/Methods: This was a qualitative study using in-depth interviews (IDIs) with principal caregivers of pediatric burn patients admitted to Kilimanjaro Christian Medical Centre (KCMC), which houses a burn referral center for Northern Tanzania, between March 2024 and March 2025. Interviews were conducted in Kiswahili, audio recorded, and translated verbatim into English by bilingual research assistants. A codebook was developed a priori and refined through iterative memoing. Transcripts were double-coded by two analysts and thematic analysis was conducted using a team-based approach. Identified themes were organized according to the Biopsychosocial (BPS) Model (Figure 1).

Results: Twenty caregivers were enrolled. Two children of interviewed caregivers died during hospitalization; one of these caregivers elected not to complete the interview. Biological themes included disrupted caregiver health routines and challenges related to hospital transport. Psychological themes included emotional distress from vicarious trauma, parental guilt over the burn event, the mental toll of advocating for higher care, and fear of their child dying. Social themes encompassed financial strain, scarring and community stigma concerns, and social stressors in family dynamic change. In contrast to many HIC settings, caregivers described stress from limited hospital support services, like food access and bedside care expectations. Table 1 describes these emerging themes.

Conclusion(s): Caregivers of children hospitalized with burns in Northern Tanzania face challenges across the three BPS Model domains. While similar to patterns seen in HICs, these stressors are exacerbated by limited hospital support services. Interventions to support patients and their families after burn injuries in Northern Tanzania should attend to all three BPS Model areas to strengthen resilience and promote recovery for both the patient and their family.

Table 1.
Emerging qualitative themes using the Biopsychosocial (BPS) Model framework.