Adesola C Akinkuotu1, Laura N Purcell2, Linda Kayange2, Michael R Phillips2, Andrea Hayes-Jordan2, Anthony G Charles2. 1. Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Houpt Physicians' Office Building, Campus Box 7223, 170 Manning Drive, Chapel Hill, NC, 27599-7223, USA. adesola_akinkuotu@med.unc.edu. 2. Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Houpt Physicians' Office Building, Campus Box 7223, 170 Manning Drive, Chapel Hill, NC, 27599-7223, USA.
Abstract
INTRODUCTION: Intentional injuries pose a significant, yet underreported threat to children in sub-Saharan Africa. We sought to evaluate intentional injuries trends and compare outcomes between unintentional and intentional injuries in pediatric patients presenting to a tertiary care facility in Malawi. METHODS: We performed a review of pediatric (≤15 years old) trauma patients presenting to Kamuzu Central Hospital, Lilongwe, Malawi, from 2009 to 2018. Patient characteristics and outcomes were compared based on the injury intent, using bivariate and multivariate regression analysis. RESULTS: We included 42,600 pediatric trauma patients in the study. Intentional injuries accounted for 5.9% of all injuries. Children with intentional injuries were older (median, 10 vs. 6 years, p < 0.001), more likely to be male (68.4% vs. 63.9%, p < 0.001), and had significantly lower mortality (0.8% vs. 1.4%, p = 0.02) than those with unintentional injuries There was no significant change in the incidence of or mortality associated with intentional injuries. On multivariable regression, increasing age, head and cervical spine injury, night-time presentation, penetrating injury, and alcohol use were associated with increased risk of intentional harm. CONCLUSION: Intentional injury remains a significant cause of pediatric trauma in Malawi without decreasing hospital presentation incidence or mortality. In sub-Saharan Africa, there is a need to develop comprehensive plans and policies to protect children. LEVEL OF EVIDENCE: II.
INTRODUCTION: Intentional injuries pose a significant, yet underreported threat to children in sub-Saharan Africa. We sought to evaluate intentional injuries trends and compare outcomes between unintentional and intentional injuries in pediatric patients presenting to a tertiary care facility in Malawi. METHODS: We performed a review of pediatric (≤15 years old) traumapatients presenting to Kamuzu Central Hospital, Lilongwe, Malawi, from 2009 to 2018. Patient characteristics and outcomes were compared based on the injury intent, using bivariate and multivariate regression analysis. RESULTS: We included 42,600 pediatric traumapatients in the study. Intentional injuries accounted for 5.9% of all injuries. Children with intentional injuries were older (median, 10 vs. 6 years, p < 0.001), more likely to be male (68.4% vs. 63.9%, p < 0.001), and had significantly lower mortality (0.8% vs. 1.4%, p = 0.02) than those with unintentional injuries There was no significant change in the incidence of or mortality associated with intentional injuries. On multivariable regression, increasing age, head and cervical spine injury, night-time presentation, penetrating injury, and alcohol use were associated with increased risk of intentional harm. CONCLUSION: Intentional injury remains a significant cause of pediatric trauma in Malawi without decreasing hospital presentation incidence or mortality. In sub-Saharan Africa, there is a need to develop comprehensive plans and policies to protect children. LEVEL OF EVIDENCE: II.
Entities:
Keywords:
Child abuse; Global surgery; Injury; Intentional injury; Trauma; Violence
Authors: Claire E Kendig; Jonathan C Samuel; Carlos Varela; Nelson Msiska; Michelle M Kiser; Sean E McLean; Bruce A Cairns; Anthony G Charles Journal: J Trop Pediatr Date: 2014-04-25 Impact factor: 1.165
Authors: Laura Purcell; Charles E Mabedi; Jared Gallaher; Steven Mjuweni; Sean McLean; Bruce Cairns; Anthony Charles Journal: Malawi Med J Date: 2017-06 Impact factor: 0.875