Sex differences in interpersonal violence in Malawi: analysis of a hospital-based trauma registry.
BACKGROUND
Although interpersonal violence ("assault") exists in every society, the World Health Organization (WHO) estimated that 90 % of the exposure burden occurs in low- and middle-income countries. The objectives of this study were to define the incidence of assault-related injuries among subjects presenting for emergency room care secondary to sustained trauma in Lilongwe, Malawi; to measure the impact of sex on incidence, injury type, and care received; and to measure the effect of both sex and geographic location of the injury on time to presentation for medical care.


METHODS
This is a retrospective cohort analysis of data prospectively collected in the Kamuzu Central Hospital Trauma Surveillance Registry from July 2008 to December 2010 (n = 23,625). We used univariate, bivariate, and logistic regression analyses to measure association of sex with variables of interest, and geospatial mapping to evaluate the association of location of assault on time to presentation for care.


RESULTS
The mean age of our trauma cohort was 27.7 years. Assaults accounted for 26.8 % of all injuries. Of those assaulted, 21.0 % (1299) were female, who were younger (26.2 vs. 28.1 years, p < 0.001), more likely to arrive to the hospital by minibus (p < 0.001), and less likely to arrive by police (p < 0.001). Altogether 62 % of the females were assaulted in their homes-much more often than their male counterparts (p < 0.001). Females were more likely to sustain contusions (p < 0.001) and males more likely to have lacerations and penetrating stab wounds (p < 0.001) or head injury (p < 0.001). Females had delayed hospital presentation following assault (p = 0.001) and were more likely to be treated as outpatients after adjusting for age, injury type, and injury location (adjusted odds ratio 1.74, 95 % CI 1.3-2.3, p < 0.001). Assaults clustered geographically in the Lilongwe district. Delayed presentation of females occurred irrespective of proximity to the hospital.


CONCLUSIONS
This study brings attention to sex differences in assault victims. A prevention strategy focusing on sex roles and domestic abuse of women is paramount. Efforts are needed to stop dischargin female assault victims back into a potentially unsafe, abusive environment.
Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Michelle
M
Kiser
Veronica
V
Escamilla
Jonathan
J
Samuel
Kacey
K
Eichelberger
Judith
J
Mkwaila
Bruce
B
Cairns
Anthony
A
Charles
D000328:Adult; D015331:Cohort Studies; D003906:Developing Countries; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*