A nationwide survey investigating the prevalence and incidence of adults with femoral shaft fractures receiving care in Malawian district and central hospitals

  • Kiran J. Agarwal-Harding
  • Linda Chokotho
  • Sven Young
  • Nyengo Mkandawire
  • Elena Losina
  • Jeffrey N. Katz
Keywords: trauma, incidence, prevalence, femur fracture, femoral shaft fracture, musculoskeletal trauma, orthopaedic surgery, trauma care, Malawi


Background: Diaphyseal femoral fractures are a common musculoskeletal injury in Malawi, often due to road traffic collisions. Most adults are treated non-operatively as inpatients, occupying limited beds for up to 2 months. We sought to document current prevalence and incidence of adult patients with femoral shaft fractures admitted to Malawian public hospitals.

Methods: Between May 29th and June 15th 2018, we performed in-person surveys of all 25 district and 4 central hospitals in Malawi. At each hospital, we asked a single orthopaedic provider to report the number of adults with femoral shaft fractures currently being treated on the inpatient wards, and the number who were admitted in the last 7 days. To assess accuracy of reporting by orthopaedic providers, we performed independent counts in a randomly selected 25% of hospitals. We calculated prevalence (per 100,000 persons) and incidence (per 100,000 person-weeks) by dividing the number of observed cases by the adult population. We compared our observed incidence to estimates derived from a previously published model.

Results: We identified 120 adults currently being treated in Malawian public hospitals at the time of survey completion, with a median of three cases at district hospitals and 10 at central hospitals. Nationwide prevalence among adults was 1.38 per 100,000 persons. We identified 44 patients nationwide who were admitted in the 7 days prior to survey completion, with a median of one patient per week at district hospitals, and 4 patients per week at central hospitals. We estimated a national incidence of 0.51 per 100,000 person-weeks.

Conclusions: Our estimation of femoral shaft fracture prevalence and incidence at public hospitals may be useful for planning the resources required to treat femoral fractures in Malawi. The capacity of Malawian hospitals to treat musculoskeletal injuries should be assessed nationwide to develop strategies for effective trauma system development.

Original Research