Determinants of Prolonged Length of Stay and Financial Burden After Burn Injury in Addis Ababa, Ethiopia

Background: Burn injuries impose substantial burdens in low- and middle-income countries, where prolonged hospitalization occurs due to limited specialized centers, resources, and surgical delays. This study examines factors associated with prolonged length of stay (LOS) and treatment costs relative to catastrophic health expenditure (CHE) thresholds among burn patients treated at a tertiary center in Ethiopia. Methods: Burn patients treated at the Addis Ababa Burn, Emergency, and Trauma Center from January 2023 to 2025 were prospectively enrolled in this observational cohort study. Univariable and multivariable analyses were performed to evaluate factors associated with LOS for the overall cohort and by age subgroup and treatment costs were compared with CHE thresholds. Results: Among 196 patients (55.6% men; mean age 17.6 y), the mean LOS was 33.5 ± 28.8 days. Electrical (36.4%) and flame (35.2%) injuries predominated in adults versus scalds in children (73.1%). Total body surface area and sex distribution were similar across groups, but pediatric burns were more superficial and required fewer surgical procedures (0.6 versus 1.4). The number of procedures and systemic infections remained independently associated with log-transformed LOS in adjusted analyses for all groups (all P < 0.05). LOS independently predicted cost. Facility and out-of-pocket costs averaged 24,428 and 7283 Ethiopian birr, respectively, with out-of-pocket spending by subgroup approaching or exceeding CHE thresholds. Conclusions: Prolonged LOS after burn injury in Addis Ababa is driven by clinical severity and complications, escalating costs toward catastrophic levels. Prevention strategies and age-tailored clinical pathways may shorten LOS, reduce costs, and strengthen financial risk protection in low-resource settings.