J. S. Qureshi1, G. Mulima2, S. Zadrozny1, B. Cairns1, A. G. Charles1 1University Of North Carolina At Chapel Hill,Chapel Hill, NC, USA 2Kamuzu Central Hospital,Lilongwe, , Malawi
Introduction:
Trauma, particularly Road Traffic Injury (RTI), is a leading cause of global death and disability. Africa has one of the highest RTI related mortality in the world, at 28.3 deaths per 100 000 population, however, this may be underestimated as only 7% of cause of death information is obtained from population based vital registration systems. We herein compare pre-hospital to in-hospital trauma-mortality burden using a validated verbal autopsy tool in an urban sub-Saharan African setting.
Methods:
A modified World Health Organization (WHO) VA tool was administered at the Kamuzu Central Hospital (KCH) morgue in Lilongwe, Malawi to family members of deceased from outside the hospital (referred to as ‘brought in dead’; BID) over three months. These results were compared to validated VA assessment of inpatient deaths to compare differences in disease burden in these two settings.
Results:
The top five categories of mortality were the same for both the inpatient population studied in the validation phase and the BID population. According to Physician Coded Verbal Autopsy (PCVA), infectious diseases remained the highest cause of mortality in BID patients followed by injury, gastrointestinal disease, cancer and cardiovascular disease. However, injury constituted a higher percentage of deaths in the BID population than in the inpatient population, particularly road traffic injury. (Table: Burden of Traumatic Injury in Brought-In-Dead Patients)
Conclusion:
Global burden of trauma-mortality is underestimated in resource poor settings if only hospital registries are used. Verbal autopsy provides a novel adjunct to traditional hospital-based trauma registries to assess community trauma burden, particularly road traffic injuries. Our study reveals that road traffic injury constitutes the majority of prehospital trauma death in a resource poor urban setting. Efforts to improve prehospital care are imperative to reduce the burden of trauma mortality.
