Transfusion and Mortality in Acute Care Surgical Patients in Malawi: A Propensity-Matched Analysis

INTRODUCTION

Information on transfusion-associated outcomes is limited in sub-Saharan Africa. We sought to characterize predictors of mortality in transfused patients with acute care surgical conditions in Malawi.

METHODS

We performed a retrospective propensity-matched analysis of patients with acute care surgical conditions at Kamuzu Central Hospital in Malawi from 2013 to 2021. We compared outcomes between patients who did and did not receive transfusions.

RESULTS

A total of 7395 patients were included. Transfused patients (n = 1086) were older (median 43 y with interquartile range 30-59, versus 39 y [interquartile range 27-53] in the nontransfused group, P < 0.01), had a higher proportion of females (41% versus 27%, P < 0.01), presented earlier to the hospital (median 2.9 versus 3.7 d, P = 0.02), and with lower hemoglobin levels (27% versus 1% < 7 g/dL, P < 0.01). They had a lower rate of surgical intervention (48% versus 59%, P < 0.01) but a higher rate of complications (62% versus 33%, P < 0.01). Crude in-hospital mortality was 25.5% for the transfused group and 12.8% for the nontransfused group (P < 0.01). After propensity matching, transfused patients had three times the odds of mortality compared to nontransfused patients (odds ratio 3.3, 95% confidence interval 2.3, 4.8).

CONCLUSIONS

In this propensity-matched study, transfused surgical patients were more likely to experience in-hospital mortality. These results suggest that the transfusion requirement reflects critical illness and warrants further investigation in this low-resource setting.

Fall-Related Injuries in Malawi: Outcomes and Trends Over Time

BACKGROUND

Fall-related injury (FRI) is a leading cause of injuries worldwide. Data on injury patterns and trends over time are lacking in resource-limited settings.

METHODS

We performed a retrospective analysis of FRI at Kamuzu Central Hospital in Malawi from 2009 to 2021. Outcomes were compared between patients presenting with FRI and those with other injury mechanisms. Bivariate and multivariate regressions were used to determine predictors of presentation following falls and mortality. We also analyzed time trends.

RESULTS

A total of 166,047 patients were included, of which 41,695 were patients presenting after falls (25.7%). Most FRI patients were between 5 and 45 (67.2%) and male (66.9%). Most falls occurred at home (67.3%) and resulted in extremity injuries (51.6%). The predicted probability of hospital presentation after falling is highest for children ≤  5 years and adults >  60 years and decreases over time. On multivariate analysis, patients between 5 and 15 [adjusted odds ratio (AOR) 1.70, 95% confidence interval (CI) 1.63-1.77] and > 60 (AOR 1.14, 95% CI 1.07-1.22) and women (AOR 1.13, 95% CI 1.10-1.16) are more likely to present with FRI. Compared to patients with non-FRI, those with FRI were more likely to have been injured at school (AOR 2.16, 95% CI 2.01-2.32) and during sports and recreation (AOR 4.53, 95% CI 4.24-4.85).

CONCLUSION

FRI is the most common injury presentation after motor vehicle injury in this low-resource setting. This study provides essential information about FRI in Malawi over time. Our findings can help inform resource allocation and injury prevention initiatives.

Characteristics and outcomes in paediatric patients presenting with congenital colorectal diseases in sub-Saharan Africa

In sub-Saharan Africa, there is a high burden of paediatric surgical conditions and a paucity of data regarding outcomes of congenital colorectal anomalies. A retrospective, descriptive analysis utilizing the Kamuzu Central Hospital (Lilongwe, Malawi) paediatric acute care surgery database (age ≤ 18 years) over 44 months was performed. Of the 133 children presenting, 82 had Hirschsprung disease (HD) (2.4 ± 2.7 years) and 51 had anorectal malformations (ARM) (1.8 ± 2.4 years). Of the latter, 51.0% underwent surgery, mainly exploratory laparotomy (n = 15, 57.7%) and posterior sagittal anorectoplasty (n = 7, 26.9%). Of those with HD, 50.0% underwent operative intervention (77.3% boys), including exploratory laparotomy (n = 17, 41.5%) and definitive pull-through (n = 8, 19.5%). A dearth of expert paediatric surgeons and limited exposure to paediatric conditions in general surgeons limits definitive surgery. An emphasis on paediatric surgical training and improvement of referral networks for definitive therapy will improve patient outcomes.