“Life is at a standstill” Quality of life after lower extremity trauma in Malawi

Abstract

Purpose Low- and middle-income countries face a disproportionate burden of death and disability from injuries, many of which are due to road traffic accidents or falls. Lower extremity injuries in particular have implications not only for physical disabilities affecting work and school performance, but also for quality of life (QOL) of the individual. This qualitative study explores the psychosocial impact and QOL changes due to lower extremity injuries among trauma patients in central Malawi. Methods We transcribed and translated interviews with 20 patients who received care for a trauma to the lower extremity at a tertiary hospital in Lilongwe. We used NVivo to organize and thematically analyze the data. Results Participants reported limitations in physical functioning, activities of daily living, social roles, and vocational and social activities. Limited mobility led to unplanned long term disruptions in work, personal financial loss, and household economic hardship. As a result psychological distress, fears and worries about recovery, and poor perceptions of health and QOL were common. Several contextual factors influenced patient outcomes including socioeconomic status, religious beliefs, social networks, local landscape, housing structures, and transportation accessibility. Conclusions Lower extremity trauma led to physical suffering and ongoing social and economic costs among Malawians. Injuries affecting mobility have broad QOL and economic consequences for patients and affected family members. Interventions are needed to improve post-injury recovery and QOL. Better access to trauma surgery and social and welfare support services for people living with disabling conditions are needed to alleviate the consequences of injuries.

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

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“…This study demonstrated that Ugandans who suffered RTIs as well as those who presented for other emergency complaints suffered significant morbidity and mortality Similar disabilities and financial impacts to those described above were seen in a study of patients in Malawi who suffered traumatic lower extremity injury. [16] Patients described difficulty with activities of daily living leading to food insecurity, the sale of assets, and missed school-and work-days by family members. Our study expands on these findings by also quantifying the drops in household income as well as the total household impact in terms of weeks of labor needed to cover the sudden, unexpected costs.…”

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“…Kohler et al reported that trauma to the lower extremities led to physical distress and ongoing social and economic costs, while injuries affecting mobility have widespread levels of injuries and economic consequences for the patient and affected family. [29] One year post injury in patients with lower extremity injury reported limitations in walking (46%), inability to return to work (22%), depression (39%), and post-traumatic stress disorder (18%). Long-lasting physical and psychological burdens may impede recovery and alter the lifestyle of patients with lower extremity injury.…”