PK-NTN-1433899-8-BURNS-203082 Ishrat Husain Pakistan Institute of Living and Learning (PILL) This research aims to co-adapt, implement, and evaluate an improved healthcare and rehabilitation program for people with burn injuries in Pakistan, with the intention that the program can be scaled and applied across other low- and middle-income countries (LMICs). By working closely with patients, families, healthcare professionals, and policy stakeholders, the project seeks to address gaps in burn prevention, acute care, rehabilitation, and long-term social reintegration. Burn injuries are described by the World Health Organization (WHO) as a forgotten global public health crisis. Globally, an estimated 11 million people sustain burn injuries each year, resulting in approximately 265,000 burn-related deaths annually. Alarmingly, nine out of ten burn injuries and deaths occur in LMICs, including Pakistan. Despite this high burden, there are currently no comprehensive prevention strategies or consistently high-quality healthcare and rehabilitation services for burn injuries in many LMIC settings. In Pakistan, one in three patients admitted to hospital with burn injuries dies within three weeks of admission. Those who survive often experience lifelong physical disability, psychological distress, social exclusion, and stigma associated with burn scars. To address these challenges, the study adopts a multi-component, theory-driven approach structured across six interconnected work packages (WPs). WP1 focuses on understanding the lived experiences of burn survivors and their families, as well as the perspectives of key stakeholders. Through in-depth interviews and group discussions, the study will explore experiences of burn injury, barriers to care, prevention opportunities, and stigma. Findings from this work will inform the co-adaptation of a culturally appropriate and feasible program of burn care and rehabilitation. The program will begin at the point of hospital presentation and will support patients and families throughout the care pathway, including post-discharge and community-based rehabilitation. WP2 will establish the first national burn registry in Pakistan. This registry will systematically capture data on burn injuries, treatment, and outcomes, providing essential evidence to inform clinical practice, planning, and policy development. WP3 involves a large-scale research study in which over 1,000 patients admitted to burn units across Pakistan will be randomly assigned to receive either the new burn care and rehabilitation program or usual care. The study will evaluate whether the new program improves survival over a 12-month period and assess its affordability. Patients will complete questionnaires assessing physical, mental, and social well-being, and a sub-sample will participate in interviews before and after receiving the intervention. WP4 will work in partnership with patients and stakeholders to design and launch national social media campaigns. These campaigns will focus on burn prevention, first-aid practices, and reducing stigma experienced by people living with burn scars. WP5 will ensure continuous engagement with policymakers throughout the project. This engagement will support the translation of research findings into routine practice and inform future national strategies for burn prevention and care. WP6 will strengthen capacity in burn care and research in Pakistan by offering training courses in burn management and research methods, and by funding three PhD studentships. Patient and public involvement is central to the research. The Proposal and Partnership Development Award (PPDA) has enabled meaningful participation of vulnerable and marginalised groups through theory of change and patient and public involvement and engagement (PPIE) workshops. This involvement will continue throughout the project to ensure that the research remains relevant, inclusive, and responsive to patient needs. Dissemination of findings will target both academic and non-academic audiences. Lay summaries will be shared through radio broadcasts, webinars, the project website, newsletters, and social media platforms. Research findings will also be presented at local, national, and international conferences and published in academic journals. Ongoing engagement with media and policymakers will support the long-term impact and sustainability of the research outcomes. We seek to: a. Co-adapt (with patients, caregivers, clinicians, and service users) a culturally appropriate burns care quality and rehabilitation program for burn survivors b. Evaluate the acceptability, clinical effectiveness, and cost-effectiveness of its implementation across Pakistan, and to determine its scalability and sustainability c. Improve burn prevention and risk assessment, and reduce stigma d. Build capacity and capability in burn care, prevention and research in Pakistan. UK-Department of Health and Social Care Ishrat Husain Pakistan Institute of Living and Learning (PILL),Pakistan The University of Manchester, Manchester ,United Kingdom University of Glasgow, Glasgow, United Kingdom University College London, London ,United Kingdom The Interburns, Wales, United Kingdom Manchester Global Foundation, Manchester, United Kingdom Liverpool School of Tropical Medicine, Liverpool ,United Kingdom Khyber Medical University, Peshawar, Pakistan Iqra University, Karachi ,Pakistan King Edward University, Lahore ,Pakistan Sindh Institute of Physical Medicine and Rehabilitation, Karachi,Pakistan Ishrat Husain Pakistan Institute of Learning and Learning (PILL) https://www.pill.org.pk/ Suite # 201, 2nd Floor, The Plaza, Do-Talwar, Khayaban-e-Iqbal Clifton, Karachi Health, General 933263 849222 835325 729860 662077 Sixth Tranche of NIHR203082 UK-Department of Health and Social Care Ishrat Husain Pakistan Institute of Living and Learning (PILL) 332842 Seventh Tranche of 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