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Trends and outcomes following intentional injuries in pediatric patients in a resource-limited setting
Adesola C Akinkuotu1, Laura N Purcell2, Linda Kayange2
1Division 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.
Insights
Intentional injuries are a significant threat to children in Malawi. Despite lower mortality, these injuries remain a concern without decreasing incidence, highlighting the need for child protection policies.
Area of Science:
- Pediatric Trauma Care
- Injury Epidemiology
- Public Health in Sub-Saharan Africa
Background:
- Intentional injuries represent an underreported threat to children in sub-Saharan Africa.
- This study addresses the need to evaluate trends and outcomes of intentional injuries in pediatric patients.
Purpose of the Study:
- To evaluate trends in intentional pediatric injuries.
- To compare outcomes between intentional and unintentional injuries in children.
Main Methods:
- A review of pediatric trauma patients (≤15 years) at Kamuzu Central Hospital, Malawi (2009-2018).
- Comparison of patient characteristics and outcomes based on injury intent using regression analysis.
Main Results:
- Intentional injuries comprised 5.9% of pediatric trauma cases.
- Children with intentional injuries were older, more likely male, and had lower mortality than those with unintentional injuries.
- Risk factors for intentional harm included older age, head/cervical spine injury, night-time presentation, penetrating trauma, and alcohol use.
Conclusions:
- Intentional injury is a significant cause of pediatric trauma in Malawi, with no decrease in incidence or mortality.
- There is an urgent need for comprehensive child protection plans and policies in sub-Saharan Africa.
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.
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