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Beit CURE International Hospital, Malawi, one of our main research partners © CURE International
Beit CURE International Hospital, Malawi, one of our main research partners

A key component of COOL is epidemiological research into trauma and musculoskeletal treatment needs in the COSECSA region, with the aim of developing an evidence base to support improved service provision and strengthening research capacity in the region for trauma and musculoskeletal impairment.


We have reviewed the impact of the trauma training courses run in the COOL programme by assessing participants' knowledge and confidence in trauma management before and after attending training, and after six months.

Our publications on this are listed here.

Key Informant Methodology (KIM) study into disability in children

In 2013, the International Centre for Evidence in Disability at the London School of Hygiene and Tropical Medicine (LSHTM) led a Key Informant Methodology epidemiology study co-funded by COOL to assess the prevalence of childhood disabilities in Malawi, one of the COSECSA countries. The study successfully identified more than 2,500 children with different types of disability in two districts in Malawi.

The KIM Malawi study trained around 500 existing community leaders to identify children with disabilities. These children were then referred to medical screening camps where impairments were assessed and the children (and caregivers) were referred to available clinical and social services. The results of this study has provided useful information that governmental and non-governmental service providers can use to improve the provision of health care and other services for children with disabilities, such as physiotherapy and occupational therapy for children with physical impairments, development of basic primary level ear and hearing care and provision of medication for children with epilepsy.

The study was co-funded by COOL through the Health Partnership Scheme, together with CBM, CURE International UK, Liliane Foundation Fight for Sight. The Collaborating Research Institutions were Beit CURE International Hospital, LSHTM and the Malawi College of Medicine, who worked together with an Expert Advisory Committee and many local partners in and around Blantyre.

The resulting study report (1.8MB PDF) and summary report (611KB PDF) from KIM Malawi were published in August 2014 and are available here for free download.

The final results paper was published in BMC Pediatrics in 2017: Childhood disability in Malawi: a population based assessment using the key informant method.

Survey of TMSI capacity in the COSECSA countries

Trauma and Musculoskeletal Impairment (TMSI) is the most common cause of long-term pain and disability worldwide, affecting millions of people. Low-income countries are expected to experience a rise in the TMSI burden over the next decades due to longer life expectancies and increasing numbers of road traffic accidents.

COOL undertook a survey 2013-4 of over 260 hospitals across the COSECSA region to examine existing surgical capacity and to identify current and future resource needs. This study used a web-based data collection form to assess the capacity for TMSI care in secondary-level (district) and tertiary-level hospitals in the COSECSA countries. It used a modified WHO Tool to Assess Emergency and Essential Surgical Care to gather baseline data about the facility, infrastructure, personnel and types of surgical operations performed.

An abstract of the results has been published in The LancetTrauma and orthopaedic capacity of 267 hospitals in east central and southern Africa and and as a paper in Injury journal.

Review of trauma cases in district hospitals

The actual burden of trauma in low-and middle-income countries (LMICs) is not known as there are no injury surveillance systems to provide relevant statistics. The objective of this study was to assess the annual burden of trauma seen in four district hospitals in Malawi. A retrospective study was conducted reviewing outpatient, inpatient and mortuary records of four district hospitals to identify trauma cases and deaths seen in 2012.

The results have been published in Injury in The burden of trauma in four rural district hospitals in Malawi: A retrospective review of medical records.

Establishing a trauma registry

A new trauma registry is being established at Queen Elizabeth Central Hospital, Blantyre, Malawi, which will generate relevant and timely data on the causes, severity, and mortality of injuries. The data will help to determine the annual burden of trauma seen at QECH, to inform injury prevention, and to improve resources for and care of injured persons at the hospital. Preliminary results have been shared at the COSECSA Scientific Conference, and we will soon share these results more widely.


Fourteen COSECSA trainees have received grants from COOL for short studies into trauma and musculoskeletal impairment care, including studies on major limb dislocations, the burden of musculoskeletal trauma, reduction of road traffic incidents, major lower limb amputations, clubfoot treatment, post-injury rehabilitation, management of supracondylar fractures and open tibial fractures.

Reports and results of these will be published here in due course.

Featured article

A Review of Existing Trauma and Musculoskeletal Impairment (TMSI) Care Capacity in East, Central, and Southern Africa

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Selected Publications