Kush S. Mody1,2,* Hao-Hua Wu2,3*, Linda C. Chokotho4, Nyengo C. Mkandawire5,6, Sven Young7,8, Brian C. Lau3,9, David Shearer3, Kiran J. Agarwal-Harding2,10
1.Rutgers New Jersey Medical School, NJ, USA
2.Harvard Global Orthopaedics Collaborative, Boston, MA, USA
3.Orthopaedic Trauma Institute, Institute for Global Orthopaedics and Traumatology, Department of Orthopaedic Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA
4.Malawi University of Science and Technology, Limbe, Malawi
5.Department of Orthopaedics, Queen Elizabeth Central Hospital, Blantyre, Malawi
6.Kamuzu University of Health Sciences, Blantyre, Malawi
7.Lilongwe Institute of Orthopaedics and Neurosurgery, Kamuzu Central Hospital, Lilongwe, Malawi
8.Department of Orthopedics, Haukeland University Hospital, Bergen, Norway
9.Duke University Department of Orthopaedic Surgery, Durham, NC, USA
10.Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
*Co-first authors
*Corresponding Authors: Kiran Jay Agarwal-Harding; E-mail: kiran.agarwalharding@gmail.com
Abstract
Background
Femoral shaft fractures are common in Malawi, with an annual incidence of 44 per 100,000 people. Inadequate treatment and delayed presentation often result in functional, biopsychosocial, and financial challenges for patients. The purpose of this study was to examine the socioeconomic consequences of femoral shaft fractures for patients in Malawi.
Methods
This study of 42 patients was part of a larger study that prospectively examined quality of life. Questionnaires were distributed to patients at 1-year follow-up following femoral shaft fracture treatment. Patients reported pre- and post-injury standard of living and financial well-being.
Results
Patients reported relatively high transportation costs to and from the hospital. One year after injury, 17 patients (40%) had not returned to work. Of the 25 (60%) who had returned, 5 (20%) changed jobs due to their injury, all reported decreased productivity. Household income decreased for 29% of patients. 20 (49%) of 41 patients reported food insecurity in the week prior to questionnaire completion. Many patients reported changing their residence, borrowing money, selling personal property, and unenrolling children from school due to financial hardship caused by their injury.
Conclusion
While the Malawian public healthcare system is free at the point of care, it lacks the financial risk protection that is essential to universal health coverage (UHC). In this study, we found that the indirect costs of care due to femoral shaft fractures had substantial socioeconomic consequences on the majority of patients and their families. Increased investment of financial and human capital should be made into capacity building and preventative measures to decrease the burden of injury, increase access to care, improve care delivery, and provide financial risk protection for patients with traumatic injuries in Malawi.
Key words: Socioeconomic; Femoral Shaft Fractures; Malawi