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District hospital based injury data—are they an option in a developing country?
  1. J Razzak,
  2. D Marsh,
  3. S Stansfield
  1. Yale University School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA; junaid.razzak{at}yale.edu

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    Lack of epidemiological data on injuries is one of the main impediments to injury prevention activities.1 Setting up a costly surveillance system is not an option in many developing countries. Utilizing existing sources of data like the hospital logs has been suggested.2 We present our findings on the quality of injury data available in existing logs in a district hospital in a developing country.

    Mangochi District (total population about 660 000) in southern Malawi is served by a 250 bed district hospital. We reviewed the discharge logs from pediatric, male, and female wards for a period of six months (1 August 1995 to 31 January 1996). A total of 3188 patients were admitted during the study period (998 children, 2190 adults). There were 386 patients with injuries, 64 (17%) among children under age 5 years. Children were more likely to be admitted for injury than adults (17% v 9.7% p<0.001). Discharge diagnosis showed that “fractures, sprains, and dislocations” accounted for over half (196; 51%) of all injuries. Motor vehicle crashes (62; 16%), burns (41; 11%), assaults (24; 6%), bites (10; 3%), and poisoning (8; 2%) accounted for most of the remainder. There were a total of 22 deaths after admission to the hospital (case fatality rate 6%). Children had higher case fatality rate compared with adults (7.8 v 5.3%), though the difference failed to reach statistical significance (odds ratio 1.52, 95% confidence interval 0.47 to 4.61).

    The epidemiological data in the logs were limited. No information describing the circumstances, mechanism, nature, severity, or intentionality of injury was available. Outcome information was limited to dead versus alive. Discharge diagnosis varied between type of injury (for example, fracture) and cause of injury (for example, motor vehicle crashes, falls, etc). Routine information from district hospitals in developing countries, therefore, may be insufficient to identify risk groups and inform data driven interventions.

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