• Adesola C Akinkuotu, Laura N Purcell, Linda Kayange, Michael R Phillips, Andrea Hayes-Jordan, and Anthony G Charles.
• Division of Pediatric Surgery, University of North Carolina at Chapel Hill, Houpt Physicians' Office Building, Campus Box 7223, 170 Manning Drive, Chapel Hill, NC, 27599-7223, USA. adesola_akinkuotu@med.unc.edu.
• Pediatr. Surg. Int. 2021 May 1; 37 (5): 649-657.

IntroductionIntentional injuries pose a significant, yet underreported threat to children in sub-Saharan Africa. We sought to evaluate intentional injuries trends and compare outcomes between unintentional and intentional injuries in pediatric patients presenting to a tertiary care facility in Malawi.MethodsWe performed a review of pediatric (≤15 years old) trauma patients presenting to Kamuzu Central Hospital, Lilongwe, Malawi, from 2009 to 2018. Patient characteristics and outcomes were compared based on the injury intent, using bivariate and multivariate regression analysis.ResultsWe included 42,600 pediatric trauma patients in the study. Intentional injuries accounted for 5.9% of all injuries. Children with intentional injuries were older (median, 10 vs. 6 years, p < 0.001), more likely to be male (68.4% vs. 63.9%, p < 0.001), and had significantly lower mortality (0.8% vs. 1.4%, p = 0.02) than those with unintentional injuries There was no significant change in the incidence of or mortality associated with intentional injuries. On multivariable regression, increasing age, head and cervical spine injury, night-time presentation, penetrating injury, and alcohol use were associated with increased risk of intentional harm.ConclusionIntentional injury remains a significant cause of pediatric trauma in Malawi without decreasing hospital presentation incidence or mortality. In sub-Saharan Africa, there is a need to develop comprehensive plans and policies to protect children.Level Of EvidenceII.

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