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Sex Differences in Interpersonal Violence in Malawi: Analysis of a Hospital-Based Trauma Registry

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Abstract

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.

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References

  1. Krug E, Mercy J, Dahlberg L et al (2002) The world report on violence and health. Lancet 360:1083–1088

    Article  PubMed  Google Scholar 

  2. Mercy J, Butchart A, Rosenberg M et al (2008) Preventing violence in developing countries: a framework for action. Int J Inj Contr Saf Promot 15:197–208

    Article  PubMed  Google Scholar 

  3. WHO (2012) WHO Cooperation Strategy 2008–2013. Available at http://www.who.int/countryfocus/cooperation_strategy/ccs_mwi_en.pdf. Accessed June 2012

  4. Dahlberg L, Butchart A (2005) State of the science: violence prevention efforts in developing and developed countries. Int J Inj Contr Saf Promot 12:93–104

    Article  PubMed  Google Scholar 

  5. Matzopoulos R, Bowman B, Butchart A et al (2008) Background on violence and its prevention in low- and middle-income countries. Intl J Inj Contr Saf Promot 15:177–187

    Article  Google Scholar 

  6. Bowman R, Matzopoulos R, Butchart A et al (2008) The impact of violence on development in low- to middle-income countries. Int J Inj Contr Saf Promot 15:209–219

    Article  PubMed  Google Scholar 

  7. Julliard C, Mballa G, Ndongo C et al (2011) Patterns of injury and violence in Yaounde Camaroon: an analysis of hospital data. World J Surg 35:1–8. doi:10.1007/s00268-010-0825-5

    Article  Google Scholar 

  8. Ogendi J, Ayisi J (2011) Causes of injuries resulting in a visit to the emergency department of a Provincial General Hospital, Nyanza, Western Kenya. Afr Health Sci 11:255–261

    PubMed  CAS  Google Scholar 

  9. Ranney M, Odero W, Mello M et al (2009) Injuries from interpersonal violence presenting to a rural health center in Western Kenya: characteristics and correlates. Inj Prev 15:36–40

    Article  PubMed  CAS  Google Scholar 

  10. Norman R, Schneider M, Bradshaw D et al (2010) Interpersonal violence: an important risk factor for disease and injury in South Africa. Popul Health Metr 8:32

    Article  PubMed  Google Scholar 

  11. Bazargan-Hejazi S, Medeiros S, Mohammadi R et al (2013) Patterns of intimate partner violence: a study of female victims in Malawi. J Inj Violence Res 5:38–50

    Article  PubMed  Google Scholar 

  12. Samuel J, Akinkuotu A, Baloyi P et al (2010) Hospital-based injury data in Malawi: strategies for data collection and feasibility of trauma scoring tools. Trop Doct 40:98–99

    Article  PubMed  Google Scholar 

  13. Masiira N, Ombito B (2002) Surgical admissions to the Rift Valley Provincial General Hospital, Kenya. E Afr Med J 79:373–378

    Google Scholar 

  14. Hulme P (2010) Mechanisms of trauma at a rural hospital in Uganda. Pan Afr Med Jl 7:5

    Google Scholar 

  15. McCloskey L, Williams C, Larson U (2005) Gender inequality and intimate partner violence among women in Moshi, Tanzania. Int Fam Plann Perspect 31:124–130

    Article  Google Scholar 

  16. Ludermir A, Lewis G, Valongueiro S et al (2010) Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 376:903–910

    Article  PubMed  Google Scholar 

  17. Silva E, Ludermir A, Barreto de Arujo T et al (2011) Frequency and pattern of intimate partner violence before, during and after pregnancy. Rev Saude Publica 45:1–9

    Article  Google Scholar 

  18. Anonymous (2012) Organization for Economic Co-operation and Development. Social Institutions and Gender Index, Malawi. Available at http://genderindex.org/country/malawi. Accessed June 2012

  19. Uthman O, Lawoko S, Moradi T (2009) Factors associated with attitudes towards intimate partner violence against women: a comparative analysis of 17 sub-Saharan countries. BMC Health Hum Rights 9:1–15

    Article  Google Scholar 

  20. Jewkes R (2010) Emotional abuse: a neglected dimension of partner violence. Lancet 376:851–852

    Article  PubMed  Google Scholar 

  21. Ortiz-Barreda G, Vives-Cases C (2012) Violence against women: the role of the health sector in international legislation. Gac Sanit. doi:10.1016/j.gaceta.2011.09.027

    Google Scholar 

  22. Howe A, Crilly M (2002) Identification and characteristics of victims of violence identified by emergency physicians, triage, nurses, and the police. Inj Prev 8:321–323

    Article  PubMed  CAS  Google Scholar 

  23. Barancik J, Chatterjee B, Greene Y et al (1983) Northeastern Ohio trauma study. I. Magnitude of the problem. Am J Public Health 73:746–751

    Article  PubMed  CAS  Google Scholar 

  24. Sutherland I, Sivarajasingam V, Shepherd J (2002) Recording of community violence by medical and police services. Inj Prev 8:246–247

    Article  PubMed  CAS  Google Scholar 

  25. Jewkes R (2002) Preventing sexual violence: a rights-based approach. Lancet 360:1092–1093

    Article  PubMed  Google Scholar 

  26. Gottleib A (2008) Intimate partner violence: a clinical review of screening and intervention. Womens Health 4:529–539

    Google Scholar 

  27. Joyner K, Mash R (2012) Recognizing intimate partner violence in primary care: Western Cape, South Africa. PLoS One 7:e29540

    Article  PubMed  CAS  Google Scholar 

  28. Uthman O (2008) Geographical variations and contextual effects on age of initiation of sexual intercourse among women in Nigeria: a multilevel and spatial analysis. Int J Health Geogr 7:27

    Article  PubMed  Google Scholar 

  29. Anonymous (2012) UN Habitat. Malawi: Lilongwe Urban Profile. Available at http://www.unhabitat.org/pmss/listItemDetails.aspx?publicationID=3173. Accessed June 2012

  30. Karimi F, Basu M (2012) Longtime women’s activist Banda sworn in as Malawi president. CNN news, April 7, 2012. Available at http://articles.cnn.com/2012-04-07/africa/world_africa_malawi-president_1_malawi-president-malawian-patricia-kaliati?_s=PM:AFRICA. Accessed June 2012

  31. Joyce Banda Foundation International (2012) Available at http://www.jbfoi.org/. Accessed June 2012

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina, Chapel Hill, NC, USA

    Michelle Kiser, Jonathan Samuel & Bruce Cairns

  2. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA

    Kacey Eichelberger

  3. Department of Geography, University of North Carolina, Chapel Hill, NC, USA

    Veronica Escamilla

  4. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi

    Judith Mkwaila

  5. Department of Surgery, UNC School of Medicine, and Gillings School of Global Public Health, University of North Carolina, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA

    Anthony Charles

Authors
  1. Michelle Kiser
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  2. Veronica Escamilla
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  3. Jonathan Samuel
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  4. Kacey Eichelberger
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  5. Judith Mkwaila
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  6. Bruce Cairns
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  7. Anthony Charles
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Corresponding author

Correspondence to Anthony Charles.

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Kiser, M., Escamilla, V., Samuel, J. et al. Sex Differences in Interpersonal Violence in Malawi: Analysis of a Hospital-Based Trauma Registry. World J Surg 37, 2972–2978 (2013). https://doi.org/10.1007/s00268-013-2204-5

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  • DOI: https://doi.org/10.1007/s00268-013-2204-5

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