Access to quality care after injury in Northern Malawi: results of a household survey

Background Most injury care research in low-income contexts such as Malawi is facility centric. Community-derived data is needed to better understand actual injury incidence, health system utilisation and barriers to seeking care following injury.We administered a household survey to 2200 households in Karonga, Malawi. The primary outcome was injury incidence, with non-fatal injuries classified as major or minor (> 30 or 1–29 disability days respectively). Those seeking medical treatment were asked about time delays to seeking, reaching and receiving care at a facility, where they sought care, and whether they attended a second facility. We performed analysis for associations between injury severity and whether the patient sought care, stayed overnight in a facility, attended a second facility, or received care within 1 or 2 h. The reason for those not seeking care was asked.Most households (82.7%) completed the survey, with 29.2% reporting an injury. Overall, 611 non-fatal and four fatal injuries were reported from 531 households: an incidence of 6900 per 100,000. Major injuries accounted for 26.6%. Three quarters, 76.1% (465/611), sought medical attention. Almost all, 96.3% (448/465), seeking care attended a primary facility first. Only 29.7% (138/465), attended a second place of care. Only 32.0% (142/444), received care within one hour. A further 19.1% (85/444) received care within 2 h. Major injury was associated with being more likely to have; sought care (94.4% vs 69.8% p < 0.001), stayed overnight at a facility (22.9% vs 15.4% P = 0.047), attended a second place of care (50.3% vs 19.9%, P < 0.001). For those not seeking care the most important reason was the injury not being serious enough for 52.1% (74/142), followed by transport difficulties 13.4% (19/142) and financial costs 5.6% (8/142).Injuries in Northern Malawi are substantial. Community-derived details are necessary to fully understand injury burden and barriers to seeking and reaching care.

背景：在低收入环境，如马拉维等地的伤害护理研究大多以医疗机构为中心。为了更好地理解实际伤害发生率、卫生系统利用情况以及寻求护理的障碍，迫切需要来自社区的数据。我们在马拉维的卡龙加地区对2200户家庭进行了家庭调查。主要研究结果是伤害发生率，其中非致命性伤害被划分为重伤（>30天或1-29天的残疾天数）和轻伤。寻求医疗治疗者被询问了寻求、到达和接受护理的时间延迟、他们寻求护理的地点以及是否访问了第二个医疗机构。我们对伤害严重程度与患者是否寻求护理、是否在医疗机构过夜、是否访问第二个医疗机构或是否在1至2小时内接受护理之间的关联进行了分析。询问了未寻求护理的原因。大多数家庭（82.7%）完成了调查，其中29.2%报告了受伤。总体而言，531户家庭报告了611起非致命性和4起致命性伤害，发生率为每10万人6900起：重伤占26.6%。四分之三，即76.1%（465/611）的人寻求了医疗关注。几乎所有寻求护理的人（96.3%，448/465）首先访问了初级医疗机构。只有29.7%（138/465）的人访问了第二个护理地点。只有32.0%（142/444）的人在一小时内接受了护理。另外19.1%（85/444）的人在接受护理时花费了2小时。重伤与寻求护理的可能性更高（94.4% vs 69.8%，p < 0.001）、在医疗机构过夜（22.9% vs 15.4%，P = 0.047）、访问第二个医疗机构（50.3% vs 19.9%，P < 0.001）相关。对于未寻求护理的人，最重要的原因是伤势不够严重，占52.1%（74/142），其次是交通困难（13.4%，19/142）和财务成本（5.6%，8/142）。北部马拉维的伤害情况严重。来自社区的具体细节对于全面理解伤害负担以及寻求和到达护理的障碍至关重要。