Epidemiology of Pediatric Injury in Malawi: Burden of Disease and Implications for Prevention.
ABSTRACT PURPOSE: Pediatric injuries pose a significant health burden in sub-Saharan Africa, though historic data are too scarce to appreciate the extent of the problem. The purpose of this study is to utilize a comprehensive database to describe the epidemiology of pediatric injuries at a tertiary hospital in Malawi. METHODS: Data were prospectively collected on patients presenting to the emergency department for treatment of injuries from 2008-2010 (N=23,625). The subset of pediatric patients (N=7,233) underwent cross-sectional analysis to examine demographics, injury environment, timing and mechanisms. RESULTS: Pediatric patients, (0-16 years) comprised 30.6% of all trauma patients. Mean age was 7.2 years. Falls were the most common injury (43%), followed by burns (11.1%), pedestrian road traffic injuries (9.7%), foreign bodies (7.5%), and assaults (7.2%). Statistically significant differences in injury pattern were observed between gender, age groups and season. After logistic regression, predictors of fall included male gender, home setting, and rainy season, whereas predictors of burn included female gender, age 0-5yrs, home setting, and cold season. Predictors of pedestrian injury included age 6-10yrs, female, and roadside setting. Predictors of foreign body ingestion included age 0-5yrs, female gender, home setting, and daytime, and predictors of assault include male gender, age 11-16yrs, nighttime hours. All predictors were statistically significant (p<0.05). CONCLUSIONS: This study revealed patterns of injury based upon age, gender, location, and season. Our results may prove useful to stakeholders in injury prevention for designing, evaluating, and implementing programs to improve public safety in children in Malawi and similar resource poor nations.
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ABSTRACT: The aim of this study was to assess both burn prevention knowledge and the effectiveness of educational intervention in alleviating the current knowledge deficit in Zambian youth. In one rural Zambian district, a burn prevention program was implemented in June 2011. Children at two elementary schools completed a 10-question survey that aimed to assess knowledge regarding burn injuries. After completing the survey, children received a burn and fire safety presentation and a burn prevention coloring book. Children were reassessed in May 2012 using the same survey to determine program efficacy and knowledge retention. Burn knowledge assessments were also completed for children at other schools who did not receive the burn prevention program in 2011. Logistic regression analysis was used for statistical adjustment for confounding variables. Between June 2011 and May 2012, 2747 children from six schools were assessed for their burn knowledge, with 312 of them resurveyed after educational intervention since initial survey. Reassessed children performed significantly better on three questions after controlling for confounders. They did better on five questions but their performance on these failed to achieve statistical significance. Children performed significantly worse on one concept about first aid treatment of a burn. A majority of the children demonstrated knowledge deficit in three concepts, even after educational intervention. There is a large variation in first burn knowledge survey performance of children from different schools, with inconsistency between concepts. With half the questions, knowledge deficit did not improve with advancement in school grade. Low- and moderate-income countries (LMICs) face the largest burns burden. With the lack of adequate burn care facing LMICs, burn injury prevention is of particular importance in those countries. This study shows that burn educational intervention could be effective in reducing burn knowledge deficit; however, the residual deficit posteducation could still be large and potentially contributing to heightened burn injury incidence. Customized and integrated educational programs may be proposed regarding the epidemiological profile of burn knowledge deficit from various schools. This study represents one of the few reports on the effectiveness of a burn prevention program in an LMIC. Future epidemiological data will be needed from nearby healthcare facilities to determine whether this program decreased burn morbidity and mortality at the hospital level.Journal of burn care & research: official publication of the American Burn Association 09/2013; · 1.55 Impact Factor
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ABSTRACT: BACKGROUND: Burns are among the most devastating of all injuries and a major global public health crisis, particularly in sub-Saharan Africa. In developed countries, aggressive management of burns continues to lower overall mortality and increase lethal total body surface area (TBSA) at which 50% of patients die (LA50). However, lack of resources and inadequate infrastructure significantly impede such improvements in developing countries. METHODS: This study is a retrospective analysis of patients admitted to the burn center at Kamuzu Central Hospital in Lilongwe, Malawi between June 2011 and December 2012. We collected information including patient age, gender, date of admission, mechanism of injury, time to presentation to hospital, total body surface area (TBSA) burn, comorbidities, date and type of operative procedures, date of discharge, length of hospital stay, and survival. We then performed bivariate analysis and logistic regression to identify characteristics associated with increased mortality. RESULTS: A total of 454 patients were admitted during the study period with a median age of 4 years (range 0.5 months to 79 years). Of these patients, 53% were male. The overall mean TBSA was 18.5%, and average TBSA increased with age-17% for 0-18 year olds, 24% for 19-60 year olds, and 41% for patients over 60 years old. Scald and flame burns were the commonest mechanisms, 52% and 41% respectively, and flame burns were associated with higher mortality. Overall survival in this population was 82%; however survival reduced with increasing age categories (84% in patients 0-18 years old, 79% in patients 19-60 years old, and 36% in patients older than 60 years). TBSA remained the strongest predictor of mortality after adjusting for age and mechanism of burn. The LA50 for this population was 39% TBSA. DISCUSSION: Our data reiterate that burn in Malawi is largely a pediatric disease and that the high burn mortality and relatively low LA50 have modestly improved over the past two decades. The lack of financial resources, health care personnel, and necessary infrastructure will continue to pose a significant challenge in this developing nation. Efforts to increase burn education and prevention in addition to improvement of burn care delivery are imperative.Burns: journal of the International Society for Burn Injuries 06/2013; · 1.95 Impact Factor