Validating and Applying a Novel Method of Assessing Trauma Burden in a Resource Poor Setting

Introduction: Trauma, particularly Road Traffic Injury (RTI), is a leading cause of global death. African RTI mortality is among the highest in the world, at 28.3 deaths per 100,000 population. However, this burden of injury may be underestimated for the African region as only 7% of cause of death information is obtained from population based vital registration systems. The Verbal Autopsy (VA) method has been extensively used to assess maternal and child deaths in resource poor settings by analyzing the deceased's symptoms and circumstances as reported by family members. Here we present the validation and application of a VA tool to assess trauma burden in Lilongwe, Malawi, an urban sub Saharan African setting. Methods: A modified World Health Organization (WHO) VA tool was administered at the Kamuzu Central Hospital (KCH) morgue in Lilongwe, Malawi to family members of inpatient deceased. Two physicians assigned cause of death as 'trauma' or 'non-trauma' as well as a simplified ICD-10 code based on the Verbal Autopsy questionnaire. These assignments were compared to the 'gold standard' of physician review of hospital records using a kappa statistic. The validated tool was then applied to deceased from the community who were "brought in dead" (BID) to the morgue. Results: The VA method had near perfect agreement with the hospital record in determining "trauma" versus "non-trauma" while there was moderate agreement when comparing types of death e.g cardiovascular disease versus infectious disease. When applied to the BID population, it showed a significantly higher percentage of RTI deaths in BID versus in-hospital deceased while the total trauma burden was similar in BID versus in-hospital deaths. Conclusion: This VA tool can accurately ascertain trauma-related mortality with almost perfect agreement. It provides information on the high burden of road traffic injury death that is not captured by hospital based trauma registries and reaffirms the great need for primary prevention and early care for the injured. To allocate resources for secondary trauma mortality prevention, VA of BID community deaths illustrates that pre-hospital care must be improved in addition to continuing efforts at improving in-hospital care.Master of Public Healt