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Malawi Medical Journal
College of Medicine, University of Malawi and Medical Association of Malawi
ISSN: 1995-7262
Vol. 29, No. 2, 2017, pp. 146-150
Bioline Code: mm17032
Full paper language: English
Document type: Research Article
Document available free of charge

Malawi Medical Journal, Vol. 29, No. 2, 2017, pp. 146-150

 en Variations in injury characteristics among paediatric patients following trauma: A retrospective descriptive analysis comparing pre-hospital and in-hospital deaths at Kamuzu Central Hospital, Lilongwe, Malawi
Purcell, Laura; Mabedi, Charles E.; Gallaher, Jared; Mjuweni, Steven; McLean, Sean; Cairns, Bruce & Charles, Anthony


Trauma is a major cause of paediatric mortality in sub-Saharan Africa. In the absence of pre-hospital care, injury mechanisms and causes of death are difficult to characterise. Injury characteristics of pre-hospital deaths (PHD) and in-hospital deaths (IHD) were compared.
Using our trauma surveillance database, a retrospective, descriptive analysis of children (< 18 years) presenting to Kmuzu Central Hospital in Lilongwe, Malawi, from 2008 to 2013 was performed. Patient and injury characteristics of pre-hospital and in-hospital deaths were compared with univariate and bivariate analysis.
Of 30,462 paediatric trauma patients, presenting between 2008 and 2013, 170 and 173 resulted in PHD and IHD, respectively. In PHD and IHD patients, mean age was 7.3 ± 4.9 vs 5.2 ± 4.3 (P < 0.001), respectively. IHD patients were more likely transported by ambulance than PHD patients (51.2% vs 8.3%, respectively; P < 0.001). The primary mechanisms of injury for PHD were road traffic injuries (RTI) (45.8%) and drowning (22.0%), with head injury (46.7%) being the predominant cause of death. Burns were the leading mechanism of injury (61.8%) and cause of death (61.9%) in IHD, with a mean total body surface area involvement of 24.7% ± 16.0%.
RTI remains Malawi’s major driver of paediatric mortality. Most of these deaths attributed to head injury occur prior to hospitalisation; therefore the mortality burden is underestimated if accounting for IHD alone. Death among burn patients is likely due to under-resuscitation or sepsis. Improving pre-hospital care and head injury and burn management can improve injury-related paediatric mortality.

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