ArticleThe Journal of bone and joint surgery. American volume2019
Risk Factors for Delayed Presentation Among Patients with Musculoskeletal Injuries in Malawi.
Article in The Journal of bone and joint surgery. American volume, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Clinical outcomes of ankle fractures in sub-Saharan Africa: a systematic review.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Pooled it
- Article
- Epidemiology and Management of Pediatric Fractures in Malawi.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Epidemiology and Treatment of Distal Radius Fractures at Four Public Hospitals in Malawi.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.PLoS medicine · 2024Article
- Policy and practice review consensus statements and clinical guidelines on managing pediatric trauma and orthopedics during the COVID-19 pandemic: a systematic review on the global response for future pandemics and public health crises.Frontiers in pediatrics · 2024Review
- The Socioeconomic consequences of femoral shaft fracture for patients in Malawi.Malawi medical journal : the journal of Medical Association of Malawi · 2023Article
- Fall-Related Injuries in Malawi: Outcomes and Trends Over Time.World journal of surgery · 2023Article
- Article
- Limb Injuries and Disability in the Southwest Region of Cameroon.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2023Article
- Article
- Clinical and functional outcomes of Paediatric femoral shaft fractures managed non-operatively at Nkhotakota District Hospital, Malawi.Malawi medical journal : the journal of Medical Association of Malawi · 2021Article
- Assessing the capacity of Malawi's district and central hospitals to manage traumatic diaphyseal femoral fractures in adults.PloS one · 2019Article
- Outcomes of Nonoperatively Treated Pediatric Supracondylar Humeral Fractures at the Nkhotakota District Hospital, Malawi.JB & JS open accessArticle
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Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundThe burden of injuries is high in low-income and middle-income countries such as Malawi, where access to musculoskeletal trauma care is limited. Delayed treatment can worsen trauma-related disability. Understanding risk factors for delayed hospital presentation will assist in guiding trauma system development.
methodsWe examined the records of 1,380 pediatric and adult patients with fractures who presented to the orthopaedic clinics of 2 urban referral hospitals and 2 rural district hospitals in Malawi. We used multivariate Poisson regression to evaluate the association between presentation to a hospital ≥2 days after the injury (delayed presentation) and 11 covariates: age, sex, education level, occupation, season of injury, day of injury, injury mechanism, injury type or extremity of injury, referral status, hospital of presentation, and estimated travel time.
resultsTwenty-eight percent of pediatric patients and 34% of adult patients presented late. In the pediatric cohort, fall (relative risk [RR], 1.40 [95% confidence interval (CI), 1.02 to 1.93]), sports injuries (RR, 1.65 [95% CI, 1.09 to 2.49]), tibial or fibular injuries (RR, 1.36 [95% CI, 1.05 to 1.77]), injury over the weekend (RR, 2.30 [95% CI, 1.88 to 2.80]), estimated travel time of ≥20 minutes (RR, 1.45 [95% CI, 1.16 to 1.81]), referral from another facility (RR, 1.46 [95% CI, 1.05 to 2.02]), and presentation to Kamuzu Central Hospital, Mangochi District Hospital, or Nkhata Bay District Hospital (RR, 1.34 [95% CI, 1.07 to 1.69]) independently increased the risk of delayed presentation. In the adult cohort, fall (RR, 1.85 [95% CI, 1.38 to 2.46]), injury over the weekend (RR, 1.80 [95% CI, 1.38 to 2.36]), estimated travel time ≥20 minutes (RR, 1.36 [95% CI, 1.03 to 1.80]), and presentation to Kamuzu Central Hospital (RR, 1.74 [95% CI, 1.30 to 2.33]) independently increased the risk of delayed presentation.
conclusionsDelayed presentation to the hospital after a musculoskeletal injury is common in Malawi. Interventions are needed to improve access to musculoskeletal trauma care, especially for pediatric patients with tibial or fibular injuries, all patients after falls, patients injured over the weekend, and patients living far from health facilities.
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