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“Life is at a standstill” Quality of life after lower extremity trauma in Malawi

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Low- and middle-income countries face a disproportionate burden of death and disability from injuries, many of which are due to road traffic accidents or falls. Lower extremity injuries in particular have implications not only for physical disabilities affecting work and school performance, but also for quality of life (QOL) of the individual. This qualitative study explores the psychosocial impact and QOL changes due to lower extremity injuries among trauma patients in central Malawi.


We transcribed and translated interviews with 20 patients who received care for a trauma to the lower extremity at a tertiary hospital in Lilongwe. We used NVivo to organize and thematically analyze the data.


Participants reported limitations in physical functioning, activities of daily living, social roles, and vocational and social activities. Limited mobility led to unplanned long-term disruptions in work, personal financial loss, and household economic hardship. As a result, psychological distress, fears and worries about recovery, and poor perceptions of health and QOL were common. Several contextual factors influenced patient outcomes including socioeconomic status, religious beliefs, social networks, local landscape, housing structures, and transportation accessibility.


Lower extremity trauma led to physical suffering and ongoing social and economic costs among Malawians. Injuries affecting mobility have broad QOL and economic consequences for patients and affected family members. Interventions are needed to improve post-injury recovery and QOL. Better access to trauma surgery and social and welfare support services for people living with disabling conditions are needed to alleviate the consequences of injuries.

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The authors would like to thank the surgery and orthopedic departments at Kamuzu Central Hospital and UNC Project Malawi for their assistance with this study. REK was supported by UNC Cancer Care Quality Training Program (R25 CA116339) and the Dana-Farber/Harvard Cancer Prevention Fellowship (3R25 CA057711). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Correspondence to Racquel E. Kohler.

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The authors have no potential conflicts to disclose.

Ethical approval

This study was approved by the Malawi National Health Sciences Review Committee and the UNC Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Kohler, R.E., Tomlinson, J., Chilunjika, T.E. et al. “Life is at a standstill” Quality of life after lower extremity trauma in Malawi. Qual Life Res 26, 1027–1035 (2017).

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