Young Sven, Banza Leonard, Munthali Boston S, Manda Kumbukani G, Gallaher Jared, Charles Anthony
a Department of Surgery , Kamuzu Central Hospital , Lilongwe.
b Department of Surgery, College of Medicine , University of Malawi , Blantyre , Malawi.
Acta Orthop. 2016 Dec;87(6):632-636. doi: 10.1080/17453674.2016.1228413. Epub 2016 Sep 2.
Background and purpose - The burden of road traffic injuries globally is rising rapidly, and has a huge effect on health systems and development in low- and middle-income countries. Malawi is a small low-income country in southeastern Africa with a population of 16.7 million and a gross national income per capita of only 250 USD. The impact of the rising burden of trauma is very apparent to healthcare workers on the ground, but there are very few data showing this development. Patients and methods - The annual number of femoral fracture patients admitted to Kamuzu Central Hospital (KCH) in the Capital of Malawi, Lilongwe, from 2009 to 2014 was retrieved from the KCH trauma database. Linear regression curve estimation was used to project the growth in the burden of femoral fractures and the number of operations performed for femoral fractures over the same time period. Results - 992 patients with femoral fractures (26% of all admissions for fractures) presented at KCH from 2009 through 2014. In this period, there was a 132% increase in the annual number of femoral fractures admitted to KCH. In the same time period, the total number of operations more than doubled, but there was no increase in the number of operations performed for femoral fractures. Overall, there was a 7% mortality rate for patients with femoral fractures. Interpretation - The burden of femoral fractures in Malawi is rising rapidly, and the surgical resources available cannot keep up with this development. Limited funds for orthopedic trauma care in Malawi should be invested in central training hospitals, to develop a sustainable number of orthopedic surgeons and improve current infrastructure and equipment. The centralization of orthopedic surgical care delivery at the central training hospitals will lead to better access to surgical care and early return of patients to local district hospitals for rehabilitation, thus increasing surgical throughput and efficiency in a more cost-effective manner, with the goal of expanding the future orthopedic surgical workforce to meet the national need.
背景与目的——全球道路交通伤害负担正在迅速上升，对低收入和中等收入国家的卫生系统及发展产生巨大影响。马拉维是非洲东南部的一个低收入小国，人口1670万，人均国民收入仅250美元。创伤负担上升的影响在一线医护人员中非常明显，但很少有数据显示这一发展情况。
患者与方法——从卡穆祖中央医院（KCH）创伤数据库中检索2009年至2014年期间在马拉维首都利隆圭的KCH住院的股骨骨折患者的年度数量。使用线性回归曲线估计法来预测同一时期股骨骨折负担的增长以及针对股骨骨折进行的手术数量。
结果——2009年至2014年期间，有992例股骨骨折患者（占所有骨折入院患者的26%）在KCH就诊。在此期间，KCH收治的股骨骨折年度数量增加了132%。同一时期，手术总数增加了一倍多，但股骨骨折手术数量没有增加。总体而言，股骨骨折患者的死亡率为7%。
解读——马拉维的股骨骨折负担正在迅速上升，现有的外科资源无法跟上这一发展。马拉维用于骨科创伤护理的有限资金应投入到中央培训医院，以培养可持续数量的骨科医生，并改善现有基础设施和设备。将骨科手术护理集中在中央培训医院将使患者能更好地获得手术护理，并早日返回当地地区医院进行康复，从而以更具成本效益的方式提高手术量和效率，目标是扩大未来的骨科手术人员队伍以满足国家需求。
