Paediatric road traffic injuries in Lilongwe, Malawi: an analysis of 4776 consecutive cases

Sundet, Mads; Grudziak, Joanna; Charles, Anthony; Banza, Leonard; Varela, Carlos; Young, Sven

doi:10.1177/0049475518790893

Cited by 8 publications

(13 citation statements)

References 23 publications

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“…Road traffic accidents are a common cause of injury for both children and adults in sub-Saharan Africa [ 29 ]. Similar to other studies in the region, we found that most injured children were pedestrians [ 30 31 32 ]. We suspect that children are vulnerable to traffic accidents while playing or going to and returning from school, a hypothesis supported by a study in Tanzania [ 29 ].…”

Section: Discussionsupporting

confidence: 90%

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study

Bagahirwa

Mukeshimana

Cherian

et al. 2020

Annals of Global Health

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Background: Injuries are a leading cause of mortality among children globally, with children in low-and middle-income countries more likely to die if injured compared to children in high-income countries. Timely and high-quality care are essential to reduce injury-related morbidity and mortality. Objectives: This study describes patterns, management, and outcomes of children 0-15 years presenting with unintentional injuries at three district hospitals in rural Rwanda between January 1 and December 31, 2017. Methods: Using a retrospective cross-sectional study design, we assessed the demographic and clinical characteristics, care provided, and outcomes of the children using data extracted from patient medical charts. We describe the patient population using frequencies and proportions as well as median and interquartile ranges. Findings: Of the 449 injured children who sought care at the three rural district hospitals, 66.2% (n = 297) were boys. The main causes of injury were falls (n = 261, 58.1%), burns (n = 101, 22.5%), and road traffic injuries (n = 67, 14.9%). Burns were the most common injury among children aged 0-5 years while falls were the leading injury type among the 5-15 years age group. Vital signs were inconsistently completed ranging between 23.8-89.1% of vital sign items. Of the injured children, 37.0% (n = 166) received surgery at the district hospital, general practitioners performed 80.9% (n = 114) of surgeries, 87.4% (n = 145) of operated patients received no anesthesia, and 69.3% (n = 311) were admitted to the district hospital, while 2.7% (n = 12) were transferred to tertiary facilities for higher-level care. Conclusions: The presentation of child injuries-namely falls, burns, and road traffic accidents-is similar to what has been reported in other sub-Saharan African countries. However, more needs to be done to improve the completion and documentation of vital signs and increase availability of surgical specialists. Finally, targeted strategies to prevent burns and motorcycle-related injuries are recommended prevention interventions for this rural population.

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Section: Discussionsupporting

confidence: 90%

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study

Bagahirwa

Mukeshimana

Cherian

et al. 2020

Annals of Global Health

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“…To determine the number of injuries assigned to each injured person, we developed a negative exponential distribution and calibrated our resulting average number of injuries reported in a paediatric study from Malawi’s Kamuzu Central Hospital (Sundet et al 2018 ). Our process of developing the distribution is given in ‘ Appendix ’.…”

Section: Methodsmentioning

confidence: 99%

Estimating the health burden of road traffic injuries in Malawi using an individual-based model

et al. 2022

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Background Road traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to determine. A limited number of models predict the incidence of mortality due to road traffic injury in Malawi. These estimates vary greatly, owing to differences in assumptions, and so the health burden caused on the population by road traffic injuries remains unclear. Methods We use an individual-based model and combine an epidemiological model of road traffic injuries with a health seeking behaviour and health system model. We provide a detailed representation of road traffic injuries in Malawi, from the onset of the injury through to the final health outcome. We also investigate the effects of an assumption made by other models that multiple injuries do not contribute to health burden caused by road accidents. Results Our model estimates an overall average incidence of mortality between 23.5 and 29.8 per 100,000 person years due to road traffic injuries and an average of 180,000 to 225,000 disability-adjusted life years (DALYs) per year between 2010 and 2020 in an estimated average population size of 1,364,000 over the 10-year period. Our estimated incidence of mortality falls within the range of other estimates currently available for Malawi, whereas our estimated number of DALYs is greater than the only other estimate available for Malawi, the GBD estimate predicting and average of 126,200 DALYs per year over the same time period. Our estimates, which account for multiple injuries, predict a 22–58% increase in overall health burden compared to the model ran as a single injury model. Conclusions Road traffic injuries are difficult to model with conventional modelling methods, owing to the numerous types of injuries that occur. Using an individual-based model framework, we can provide a detailed representation of road traffic injuries. Our results indicate a higher health burden caused by road traffic injuries than previously estimated.

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“…We tried to account for this uncertainty by running the model for varying parameter values which produced an overall percentage of HSB falling within the range reported by Zafar et al (2018). In each of these runs the number of injuries and probability of death in-hospital was adjusted to still match the results of studies from KCH (Tyson et al 2015;Sundet et al 2018), a consequence of this calibration effort was in different model runs, a person with the same injuries would have a slightly different likelihood of mortality. This run-speci c calibration was necessary as there wasn't a Malawi-speci c estimate for HSB, but without a set point to calibrate to, we were limited in our investigation of the interaction between road tra c injury epidemiology, HSB and health system usage.…”

Section: Discussionmentioning

confidence: 99%

“…The GBD estimates were the only population wide estimate for the incidence of RTIs in Malawi that also provided an estimate for the incidence of death, as such, the results of our model are dependent on the validity of the GBD estimates. We also based our model's predicted number of injuries on results from a study focusing on paediatric patients (Sundet et al 2018).…”

Section: Modelling Discussionmentioning

confidence: 99%

“…shows the model's resulting percentage of RTIs that involve alcohol consumption compared to output from Kamuzu Central Hospital(Sundet et al 2020), Figure2eshows the calibration of the overall incidence of on-scene mortality RTIs in the population to the estimate from Malawi police data(Schlottmann et al 2017), Figure2fshows the calibration number of injuries of those in the health system, to an estimate from Kamuzu Central Hospital(Sundet et al 2018), Figure2gshows the calibration of the overall percentage of HSB, compared to the bounds reported in other SSA countries(Zafar et al 2018), and Figure2hshows the calibration percentage of overall in-hospital mortality to the Tanzanian national average in-hospital mortality for RTIs(Sawe et al 2021). Based on the range of parameters which produced HSB that t within the ranges reported by Zafar et al (2018) (Figure2g), we recalibrated several model parameters to produce the above calibration targets for each value of rt_emergency_care_ISS_score_cut_off to ensure full calibration in each model run (TableA 4).…”

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confidence: 99%

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Estimating the health burden of road traffic injuries in Malawi using an individual based model

Smith

Cambiano

Colbourn

et al. 2022

Preprint

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BackgroundRoad traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to determine. A limited number of models predict the incidence of death due to road traffic injury in Malawi. These estimates vary greatly, owing to differences in assumptions and so the health burden caused on the population by road traffic injuries remains unclear.MethodsWe use an individual based model and combine an epidemiological model of road traffic injuries with a health seeking behaviour and health system model. We provide a detailed representation of road traffic injuries in Malawi, from the onset of the injury through to the final health outcome. We also investigate the effects of an assumption made by other models, that multiple injuries do not contribute to health burden caused by road accidents.Results Our model estimates an overall average incidence of death between 23.5 to 29.8 deaths per 100,000 person years due to road traffic injuries and an average of 180,000 to 225,000 disability-adjusted life years (DALYs) per year between 2010 and 2020 in an estimated average population size of 1,364,000 over the 10-year period. Our estimated incidence of death falls within the range of other estimates currently available for Malawi, whereas our estimated number of DALYs is greater than the only other estimate available for Malawi, the GBD estimate predicting and average of 126,200 DALYs per year over the same time period. Our estimates, which account for multiple injuries, predict a 22-58% increase in overall health burden compared to the model ran as a single injury model.ConclusionsRoad traffic injuries are difficult to model with conventional modelling methods, owing to the numerous types of injuries that occur. Using an individual based model framework, we can provide a detailed representation of road traffic injuries. Our results indicate a higher health burden caused by road traffic injuries than previously estimated.

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Paediatric road traffic injuries in Lilongwe, Malawi: an analysis of 4776 consecutive cases

Cited by 8 publications

References 23 publications

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study

Estimating the health burden of road traffic injuries in Malawi using an individual-based model

Estimating the health burden of road traffic injuries in Malawi using an individual based model

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