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      Trauma care in Malawi: A call to action

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          Abstract

          Injuries are a global public health concern because most are preventable yet they continue to be a major cause of death and disability, especially among children, adolescents, and young adults. This enormous loss of human potential has numerous negative social and economic consequences. Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury surveillance database compiling the data needed in order to develop and implement evidence-based prevention initiatives and guidelines to improve the quality of clinical care. Studies in other low- and middle-income countries (LMICs) have demonstrated cost-effective methods for enhancing prehospital, in-hospital, and post-discharge care of trauma patients. We encourage health sectors leaders from across Malawi to take action to improve trauma care and reduce the burden from injury in this country.

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          Most cited references35

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          A statewide system of trauma care in Victoria: effect on patient survival.

          To determine whether the statewide system of trauma care introduced in 2000 has resulted in improved survival for all major trauma patients in Victoria. Population-based cohort study using data from the Victorian State Trauma Registry (VSTR), a registry of all hospitalised major trauma patients in Victoria. The study included major trauma patients with an Injury Severity Score > 15 captured by the VSTR between July 2001 and June 2006. In-hospital mortality. The number of major trauma cases captured by the registry rose from 1153 in 2001-02 to 1737 in 2005-06. Adjusting for key predictors of mortality, there was a significant overall reduction between 2001-02 and 2005-06 in the risk of death for patients treated in the trauma system (adjusted odds ratio [AOR], 0.62 [95% CI, 0.48-0.80]). The reduced risk of death was also significant when road trauma cases (AOR, 0.56 [95% CI, 0.39-0.80]) and serious head injury cases (AOR, 0.62 [95% CI, 0.46-0.83]) were analysed separately. The proportion of road trauma patients definitively treated at one of the three major trauma service (MTS) hospitals in Victoria rose by 7% over the 5-year period. Direct transfers from the scene of injury to MTS hospitals rose by 8% for all cases and 13% for road trauma cases over the same period. Introduction of a statewide trauma system was associated with a significant reduction in risk-adjusted mortality. Such inclusive systems of trauma care should be regarded as a minimum standard for health jurisdictions.
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            Road Traffic Injury Is an Escalating Burden in Africa and Deserves Proportionate Research Efforts

            Changing the mindset of road users in Africa will be a challenge, says the author, but many lives are at stake.
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              Trauma system development.

              The word 'trauma' describes the disease entity resulting from physical injury. Trauma is one of the leading causes of death worldwide and deaths due to injury look set to increase. As early as the 1970s, it became evident that centralisation of resources and expertise could reduce the mortality rate from serious injury and that organisation of trauma care delivery into formal systems could improve outcome further. Internationally, trauma systems have evolved in various forms, with widespread reports of mortality and functional outcome benefits when major trauma management is delivered in this way. The management of major trauma in England is currently undergoing significant change. The London Trauma System began operating in April 2010 and others throughout England became operational this year. Similar systems exist internationally and continue to be developed. Anaesthetists have been and continue to be involved with all levels of trauma care delivery, from the provision of pre-hospital trauma and retrieval teams, through to chronic pain management and rehabilitation of patients back into society. This review examines the international development of major trauma care delivery and the components of a modern trauma system.
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                Author and article information

                Journal
                Malawi Med J
                Malawi Med J
                Malawi Medical Journal
                The Medical Association Of Malawi (Malawi )
                1995-7262
                1995-7270
                June 2017
                : 29
                : 2
                : 198-202
                Affiliations
                [1 ] Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi
                [2 ] Beit CURE International Hospital, Blantyre, Malawi
                [3 ] Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
                [4 ] Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
                [5 ] Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Oxford, United Kindgom
                [6 ] Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
                Author notes
                Correspondence: Dr Wakisa Mulwafu ( wmulwafu2@ 123456gmail.com )
                Article
                jMMJ.v29.i2.pg198
                10.4314/mmj.v29i2.23
                5610296
                28955433
                b36e1bd2-1292-4922-aa31-e45c2aaef236
                Copyright © 2017, Malawi Medical Journal

                © 2017 The College of Medicine and the Medical Association of Malawi. This work is licensed under the Creative Commons Attribution 4.0 International License. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/)

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