The burden of trauma in four rural district hospitals in Malawi: A retrospective review of medical records Linda Chokotho a , Wakisa Mulwafu b , Kathryn H. Jacobsen c, *, Hemant Pandit d , Chris Lavy d a Beit Cure Hospital, Blantyre, Malawi b Department of Surgery, College of Medicine, Malawi c Department of Global & Community Health, George Mason University, Fairfax, VA, USA d Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Introduction Trauma is a major public health problem worldwide. Every year injuries are responsible for more than 5 million deaths, accounting for 9.6% of all mortality [1]. The burden of injuries disproportion- ately affects low- and middle-income countries (LMICs), where almost 90% of unintentional injury deaths occur [2]. Injuries are also the cause of about 11% of all disability-adjusted life years lost and 6% of all years lived with disability worldwide [3,4]. Despite the very high burden of injury-related disability and deaths in LMICs, limited data are available about the trauma burden in these areas, especially in sub-Saharan Africa. This lack of data has been recognised as a barrier to increased funding and support for injury prevention policies and interventions [5,6]. Trauma registries can be an integral component of studies of injury burden in populations, and they are also valuable to trauma care providers who conduct patient outcome evaluations as part of the process of improving patient care. However, there are few trauma registries in low-income countries. A recent review found that less than 1% of registries mentioned online or in a published abstract or article were located in countries designated as ‘‘least developed’’ [7]. There is a need for improved trauma data collection in LMICs, and it is important to ensure that any such injury surveillance systems provide essential information to health practitioners working in these areas while minimizing the additional workload associated with reporting [8,9]. In resource- limited settings, one quick and efficient method of obtaining trauma data is a review of medical records (such as casualty, admission wards, theatre, and mortuary records) for a specified period of time. When these data are accurate, relevant, and as Injury, Int. J. Care Injured 45 (2014) 2065–2070 A R T I C L E I N F O Article history: Accepted 5 October 2014 Keywords: Emergency wards Hospital surgery departments Injuries Malawi Medical records Registries Sub-Saharan Africa Traffic accidents A B S T R A C T Background: Few injury surveillance systems collect data in sub-Saharan Africa. This medical record review of four rural hospitals provides baseline data on the burden of trauma in Malawi. Methods: We reviewed all outpatient, inpatient, and mortuary records for one full year at four of the 28 district hospitals in Malawi: Dedza in central Malawi, Mangochi in the east, Nkhata Bay in the north, and Thyolo in the south. We used descriptive and comparative statistics to examine characteristics of patients and the data file. Results: During 2012, 18,735 trauma patients were treated at the four district hospitals. Trauma cases accounted for 3.5% of the 541,170 patient visits. In total, 60.8% of trauma patients were male; 39.1% were 0–14 years old and 50.4% were 15–49 years old. The logbooks were missing information about the primary type of injury for 44.9% of patients and about injury cause for 82.7%. Of the recorded trauma diagnoses, the most common injuries were soft tissue injuries, fractures, and sprains. The most commonly reported causes of injuries were animal bites (mostly dog bites), road traffic injuries, assaults, burns, and falls. Conclusions: The development and implementation of improved methods for acquiring more complete, accurate, and useful trauma data in Malawi and other low-income countries requires addressing difficulties that might result in missing data. Increased injury surveillance is critical for improving trauma care and meeting the emerging global demand for burden of disease data. ß 2014 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Global & Community Health, George Mason University, 4400 University Drive 5B7, Fairfax, VA 22030, USA. Tel.: +1 703 993 9168; fax: +1 703 993 1908. E-mail address: kjacobse@gmu.edu (K.H. Jacobsen). Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2014.10.001 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.