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Interpersonal violence in peacetime Malawi
  1. Rebecca G Maine1,
  2. Brittney Williams1,
  3. Jennifer A Kincaid2,
  4. Gift Mulima3,
  5. Carlos Varela3,
  6. Jared R Gallaher1,
  7. Trista D Reid1,
  8. Anthony G Charles1
  1. 1 Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2 Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  3. 3 Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
  1. Correspondence to Dr Rebecca G Maine, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; rebecca_maine{at}


Background The contribution of interpersonal violence (IPV) to trauma burden varies greatly by region. The high rates of IPV in sub-Saharan Africa are thought to relate in part to the high rates of collective violence. Malawi, a country with no history of internal collective violence, provides an excellent setting to evaluate whether collective violence drives the high rates of IPV in this region.

Methods This is a retrospective review of a prospective trauma registry from 2009 through 2016 at Kamuzu Central Hospital in Lilongwe, Malawi. Adult (>16 years) victims of IPV were compared with non-intentional trauma victims. Log binomial regression determined factors associated with increased risk of mortality for victims of IPV.

Results Of 72 488 trauma patients, 25 008 (34.5%) suffered IPV. Victims of IPV were more often male (80.2% vs. 74.8%; p<0.001), younger (median age: 28 years (IQR: 23–34) vs. 30 years (IQR: 24–39); p<0.001), and were more often admitted at night (47.4% vs. 31.9%; p<0.001). Of the IPV victims, 16.5% admitted alcohol use, compared with only 4.4% in other trauma victims (p<0.001). In regression modeling, compared with extremity injuries, head injuries (3.14, 2.24–4.39; p<0.001) and torso injuries (4.32, 2.98–6.27; p<0.001) had increased risk of mortality. Compared with other or unknown mechanisms, penetrating injuries also had increased risk of mortality (1.46, 95% CI 1.17 to 1.81, p=0.001). Alcohol use was associated with a lower risk of mortality (0.54, 95% CI 0.39 to 0.75; p<0.001).

Discussion Even in a sub-Saharan country that never experienced internal collective violence, IPV injury rates are high. Public health efforts to measure and address alcohol use, and studies to determine the role of “mob justice,” poverty, and intimate partner violence in IPV, in Malawi are needed.

Level of evidence Level III.

  • global surgery
  • interpersonal violence
  • Malawi

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  • Presented at This article was presented as an oral presentation at the 2018 World Trauma Congress in San Diego, California.

  • Contributors RGM: study design, data analysis, data interpretation, article draft and revision. BW: study design, data interpretation, article revision. JAK: data interpretation, article draft and revision. GM: study design, data interpretation, article revision. CV: study design, data interpretation, article revision. JG: data interpretation, article revision. TR: study design, data interpretation, article revision. AGC: study design, data interpretation, article revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Institutional Review Board of the University of North Carolina at Chapel Hill and the National Health Science and Research Council of Malawi approved this study.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Study data were collected from the Kamuzu Central Hospital trauma registry. These data are maintained at the hospital and available with permission from the Malawi Ministry of Health.

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