Association Between Gender, Surgery and Mortality for Patients Treated at Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan

Abstract

Introduction There is paucity of literature describing type of injury and care for females in conflicts. This study aimed to describe the injury pattern and outcome in terms of surgery and mortality for female patients presenting to Médecins Sans Frontières Trauma Centre in Kunduz, Afghanistan, and compare them with males. Materials and Methods This study retrospectively analysed patient data from 17,916 patients treated at the emergency department in Kunduz between January and September 2015, before its destruction by aerial bombing in October the same year. Routinely collected data on patient characteristics, injury patterns, triage category, time to arrival and outcome were retrieved and analysed. Comparative analyses were conducted using logistic regression. Results Females constituted 23.6% of patients. Burns and back injuries were more common among females (1.4% and 3.3%) than among males (0.6% and 2.0%). In contrast, open wounds and thoracic injuries were more common among males (10.1% and 0.6%) than among females (5.2% and 0.2%). Females were less likely to undergo surgery (OR 0.60, CI 0.528-0.688), and this remained significant after adjustment for age, nature of injury, triage category, multiple injuries and delay to arrival (OR 0.80, CI 0.690-0.926). Females also had lower unadjusted odds of mortality (OR 0.49, CI 0.277-0.874), but this was not significant in the adjusted analysis (OR 0.81, CI 0.446-1.453). Conclusion Our main findings suggest that females seeking care at Kunduz Trauma Centre arrived later, had different injury patterns and were less likely to undergo surgery as compared to males.

Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi

“…Divergence of findings between community- and facility-based methods in our study included the barriers “ cultural norms ” with weak evidence from community qualitative methods in contrast to strong facility-based evidence. Community social and cultural perceptions and gender-based factors are known barriers to women seeking care [ 4 , 22 , 30 , 65 , 66 ]. Male household heads can have higher disease severity thresholds for financing health-seeking, more readily financing healthcare for male household members [ 67 ].…”

Surgery in Armed Conflicts : Predicting surgical treatment needs and improving resource use in resource-constrained settings

“…This contrasts sharply with reports from other armed conflicts where females have constituted up to 43% of the treated patients. 153,154 The observed difference may be explained by the fact that ICRC facilities are devoted to only treating patients with weapon-related injuries, whereas other health care facilities in conflict areas may also treat patients with conditions that are not weapon-related. This notion is supported by a report, published in 2016, from the Médicines sans Frontières (MSF) trauma center in Kunduz, Afghanistan, that operated in a similar context as the ICRC hospital in Peshawar.…”

“…This is more or less the opposite of what Tounsi et al reported in 2019, from the MSF Trauma Centre in Kunduz, Afghanistan. 154 They found that females arrived later and were less likely to undergo surgery compared to males. However, less than 10% of the females treated at MSF's Trauma Center in Kunduz had weapon-related injuries, whereas ICRC facilities, as mentioned earlier, only treated weapon-related injuries.…”

“…However, less than 10% of the females treated at MSF's Trauma Center in Kunduz had weapon-related injuries, whereas ICRC facilities, as mentioned earlier, only treated weapon-related injuries. 154 Comparisons between surgical treatment needs for females in these facilities are therefore difficult to do. Furthermore, the difference in surgical treatment needs for females and males observed in both Tounsi's and our study could be attributed to survivorship bias.…”

Impact of injury mechanism on early wound closure in patients with acute conflict‐related extremity wounds: A prospective cohort analysis from two civilian hospitals in Iraq and Jordan

“…6 In recent years, the number of civilian targets in armed conflict areas has increased as have the challenges associated with managing their injuries. 7,8 Still, research conducted on conflict-related injuries continues to focus on military rather than civilian populations. 9,10 Few studies have focused on gunshot and bomb blast wounds in civilians.…”