title: Intentional injury against children in Sub-Saharan Africa: A tertiary trauma centre experience.
abstract: BACKGROUND
  Intentional injuries are the result of violence. This is an important public health issue, particularly in children, and is an unaddressed problem in sub-Saharan Africa. This study sought to describe the characteristics of intentional injury, particularly physical abuse, in children presenting to our tertiary trauma centre in Lilongwe, Malawi and how they compare to children with unintentional injuries.
  
  
  METHODS
  A retrospective analysis of children (<18 years old) with traumatic injuries presenting to Kamuzu Central Hospital (KCH) in Lilongwe, Malawi from 2009 to 2013 was performed. Children with intentional and unintentional injuries were compared with bivariate analysis and multivariate logistic regression modelling.
  
  
  RESULTS
  67,672 patients with traumatic injuries presented to KCH of which 24,365 were children. 1976 (8.1%) patients presented with intentional injury. Intentional injury patients had a higher mean age (11.1 ± 5.0 vs. 7.1 ± 4.6, p<0.001), a greater male preponderance (72.5 vs. 63.6%, p<0.001), were more often injured at night (38.3 vs. 20.7%, p<0.001), and alcohol was more often involved (7.8 vs. 1.0%, p<0.001). Multivariate logistic regression modelling showed that increasing age, male gender, and nighttime or urban setting for injury were associated with increased odds of intentional injury. Soft tissue injuries were more common in intentional injury patients (80.5 vs. 45.4%, p<0.001) and fist punches were the most common weapon (25.6%). Most patients were discharged in both groups (89.2 vs 80.9%, p<0.001) and overall mortality was lower for intentional injury patients (0.9 vs. 1.2%, p=0.001). Head injury was the most common cause of death (43.8 vs. 32.2%, p<0.001) in both groups.
  
  
  CONCLUSIONS
  Sub-Saharan African tertiary hospitals are uniquely positioned to play a pivotal role in the identification, clinical management, and alleviation of intentional injuries to children by facilitating access to social services and through prevention efforts.
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC CB# 7228, USA.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Gallaher
authors.affiliation: UNICEF Malawi, PO Box 30375, Lilongwe 3, Malawi.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wildfire
authors.affiliation: Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Mabedi
authors.affiliation: North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC CB# 7600, USA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.affiliation: Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC CB# 7228, USA; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; North Carolina Jaycee Burn Center, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC CB# 7600, USA. Electronic address: anthony_charles@med.unc.edu.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Charles
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011634:Public Health; D012042:Registries; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014754:Violence; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology
keywords: Child abuse; Childhood injury; Intentional injury in children; Malawi; Sub Saharan Africa