The Inter-Relationship Between Employment Status and Interpersonal Violence in Malawi: A Trauma Center Experience
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ORIGINAL SCIENTIFIC REPORT
The Inter-Relationship Between Employment Status and Interpersonal Violence in Malawi: A Trauma Center Experience Laura N. Purcell1 • Linda Kayange2 • Jared Gallaher1 • Carlos Varela2 Anthony Charles1,2
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Introduction As a proportion of the overall population, sub-Saharan Africa (SSA) has the highest youth demographic, composing 60% of Africa’s unemployed. With the worsening economic crisis in low- and middle-income countries, unengaged youth are susceptible to gang violence and anti-government demonstrations, resulting in political instability. Methods We performed a retrospective review of the Kamuzu Central Hospital Trauma Registry from 2008–2018. All adult patients ([14 years) injured by interpersonal violence (IPV) were included. Age was categorized as 15–24 (youth), 25–45, and [45 years. A bivariate analysis (IPV versus unintentional injury), and Poisson multivariable analysis were performed to identify factors increasing the risk of IPV. Results During the study, 87,338 trauma patients presented; 30,532 (35.0%) were injured following IPV. Patients injured following IPV (28 years, IQR 23–34) were younger than those unintentionally injured (30 years, IQR 23–39, p \ 0.001). More patients injured following IPV were unemployed (n = 7,178, 23.6% vs. n = 10,148, 17.9%, p \ 0.001), injured at night (n = 19,346, 63.7% vs. n = 10,148, 17.9%, p \ 0.001), and reported alcohol use (n = 4.973, 16.4% vs n = 2,461, 4.4%, p \ 0.001). Being unemployed (RR 1.25, 95% CI 1.22–1.27), youth compared to age [45 years (RR 1.72, 1.66–1.79), and those injured at night (RR 2.18, 95% CI 2.14–2.23) had increased the risk of being victims of IPV. Conclusion In Malawi, there is an interrelationship between unemployment and IPV, particularly in the youth population. Given impending demographic realities, government and non-government organizations should prioritize youth employment to help defer political instability in vulnerable nation-states.
Introduction
& Anthony Charles [email protected] 1
Department of Surgery, UNC School of Medicine, University of North Carolina At Chapel Hill, 4008 Burnett Womack Building, Chapel Hill CB 7228, USA
2
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
Interpersonal violence is common in all societies. The World Health Organization (WHO) and the World Health Assembly have proclaimed it as a global health priority, as well as a leading human rights and social issue [1, 2]. According to the WHO, approximately 1.6 million people die yearly as a result of violence. Of these deaths, an astonishing 91% are attributed to low- to middle-income countries (LMIC), with the remaining occurring in highincome countries (HIC) [3]. Interpersonal violence (IPV) is defined by the WHO as ‘‘the intentional use of physical
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World J Surg
force or power, threatened or actual, against a person or group that results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or
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