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Intentional injury against children in Sub-Saharan Africa: A tertiary trauma centre experience
Jared R Gallaher1, Benjamin Wildfire2, Charles Mabedi3
1Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC CB# 7228, USA.
Insights
Intentional injuries in children are a significant public health concern in sub-Saharan Africa. This study highlights key characteristics of intentional versus unintentional injuries in Malawian children, emphasizing the need for targeted interventions.
Area of Science:
- Public Health
- Trauma Surgery
- Pediatrics
Background:
- Intentional injuries, a result of violence, represent a critical public health issue, especially among children in sub-Saharan Africa.
- This study addresses the under-recognized problem of intentional injuries in children within this region.
Purpose of the Study:
- To describe the characteristics of intentional injuries, specifically physical abuse, in children presenting to a tertiary trauma center in Malawi.
- To compare these characteristics with those of children experiencing unintentional injuries.
Main Methods:
- A retrospective analysis of pediatric trauma patients (<18 years) at Kamuzu Central Hospital, Malawi (2009-2013).
- Comparison of intentional and unintentional injury groups using bivariate analysis and multivariate logistic regression.
Main Results:
- Intentional injury patients were older, more likely male, and more often injured at night or with alcohol involvement.
- Soft tissue injuries were more prevalent in intentional injury cases, with fists being the most common weapon.
- While most patients were discharged, head injury remained the leading cause of death in both groups.
Conclusions:
- Tertiary hospitals in sub-Saharan Africa are crucial for identifying, managing, and preventing intentional injuries in children.
- Facilitating access to social services and implementing prevention strategies are key roles for these institutions.
Background:
Intentional injuries are the result of violence. This is an important public health issue, particularly in children, and is an unaddressed problem in sub-Saharan Africa. This study sought to describe the characteristics of intentional injury, particularly physical abuse, in children presenting to our tertiary trauma centre in Lilongwe, Malawi and how they compare to children with unintentional injuries.
Methods:
A retrospective analysis of children (<18 years old) with traumatic injuries presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2009 to 2013 was performed. Children with intentional and unintentional injuries were compared with bivariate analysis and multivariate logistic regression modelling.
Results:
67,672 patients with traumatic injuries presented to KCH of which 24,365 were children. 1976 (8.1%) patients presented with intentional injury. Intentional injury patients had a higher mean age (11.1 ± 5.0 vs. 7.1 ± 4.6, p<0.001), a greater male preponderance (72.5 vs. 63.6%, p<0.001), were more often injured at night (38.3 vs. 20.7%, p<0.001), and alcohol was more often involved (7.8 vs. 1.0%, p<0.001). Multivariate logistic regression modelling showed that increasing age, male gender, and nighttime or urban setting for injury were associated with increased odds of intentional injury. Soft tissue injuries were more common in intentional injury patients (80.5 vs. 45.4%, p<0.001) and fist punches were the most common weapon (25.6%). Most patients were discharged in both groups (89.2 vs 80.9%, p<0.001) and overall mortality was lower for intentional injury patients (0.9 vs. 1.2%, p=0.001). Head injury was the most common cause of death (43.8 vs. 32.2%, p<0.001) in both groups.
Conclusions:
Sub-Saharan African tertiary hospitals are uniquely positioned to play a pivotal role in the identification, clinical management, and alleviation of intentional injuries to children by facilitating access to social services and through prevention efforts.
