184472 Results of a hospital-based trauma registry in Lilongwe, Malawi

Monday, October 27, 2008: 12:30 PM

Jonathan C. Samuel, MD, MPH , Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
Clara N. Lee, MD, MPP , Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
Anthony G. Charles, MD , Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
Andres Villaveces, MD PhD , Injury Prevention Research Center, University of North Carolina, Chapel Hill, Chapel Hill, NC
Lillian B. Brown, MPH , Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Simeon Lijenje, MD , Casualty Department, Kamuzu Central Hospital, Lilongwe, Malawi
Paul Baloyi , Casualty Department, Kamuzu Central Hospital, Lilongwe, Malawi
Irving Hoffman, PA, MPH , Dept. of Medicine, University of North Carolina, Chapell Hill, NC
Arturo P. Muyco, MD , Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
Background/Purpose: Individuals in developing countries continue to adopt behaviors more traditionally seen in developed countries. Concurrently, developing countries are experiencing a shift in disease burden. Though infectious diseases remain challenging, traumatic injuries are becoming more common. In the year 2000, the WHO estimated that 450,000 deaths in Africa were due to traumatic injury. However, the patterns of injury are unique in each country, and there is almost no data from the country of Malawi. To address this, we sought to better define the burden of traumatic injuries within Malawi.

Methods: Beginning July 2007, data was prospectively collected data on injured patients treated in the casualty department at Kamuzu Central Hospital (KCH), in Lilongwe, Malawi. Elements included demographic s; mechanism; and health-related factors including diagnosis, treatment, and outcome. Throughout the process, interaction between Malawian stakeholders and University of North Carolina faculty ensured efforts were clinically relevant and methodologically sound.

Results/Outcomes: During the initial 8 weeks, 330 injured patients were seen: 70% male, 17% under five, 4.2% 55 or older; 22% admitted; 28% road traffic related, 25% falls, 24% assaults, and 6% burns. 30% of injuries were contusions, 25% fractures, 16% lacerations, and 6% burns. Fractures were most commonly of the tibia/fibula, radius/ulna, or femur. Lacerations were most commonly of the face, scalp, or hand. Updated data will be presented at the conference.

Conclusions: The data confirms the disease burden due to traumatic injury is high. The most common mechanism was road traffic related, similar to other urban settings within Africa. However, the incidence of assault was considerably higher than previous reports from other African nations, warranting further investigation. Furthermore, continued monitoring will be useful for training and allocating scarce resources, especially as Malawi's population, now 85% rural, continues to urbanize.

Learning Objectives:
1. Describe the key components and importance of a trauma registry to prevention, health care delivery, and policy development. 2. Understand the importance of longitudinal injury data collection, related to training efforts and resource allocation. 3. Appreciate the strengths and limitations of injury data sources.

Keywords: Surveillance, Injury

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have contributed to the conceptualization, implementation, and management of this project. This involvement includes data analysis and on-site dissemination efforts.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.