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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 was 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.

Full list of COOL publications

Sheikh S, Chokotho L, Mulwafu W, et al. Characteristics of interpersonal violence in adult victims at the Adult Emergency Trauma Centre (AETC) of Queen Elizabeth Central Hospital. Malawi Med J. 2020;32(1):24-30. doi:10.4314/mmj.v32i1.6


Zerfu T T, Etsub M, Nunn T, Gardner R. Impact of musculoskeletal impairment on the lives of school-aged children in Ethiopia: A prospective mixed methods study, East and Central African Journal of Surgery,  24 No 3 (2019)

Chokotho LC, Mulwafu W, Nyirenda M, Mbomuwa FJ, Pandit HG, Le G, Lavy C. Establishment of trauma registry at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi and mapping of high risk geographic areas for trauma. World J Emerg Med. 2019;10(1):33-41. doi: 10.5847/wjem.j.1920-8642.2019.01.005. PubMed PMID: 30598716; PubMed Central PMCID: PMC6264976.


Tataryn M, Polack S, Chokotho L, Mulwafu W, Kayange P, Banks LM, Noe C, Lavy C, Kuper H. Childhood disability in Malawi: a population based assessment using the key informant method. BMC Pediatr. 2017 Nov 28;17(1):198. doi: 10.1186/s12887-017-0948-z. Erratum in: BMC Pediatr. 2018 Feb 28;18(1):92. PubMed PMID: 29179740; PubMed Central PMCID: PMC5704595.


Yeomans D, Le G, Pandit H, Lavy C. Is overseas volunteering beneficial to the NHS? The analysis of volunteers' responses to a feedback questionnaire following experiences in low-income and middle-income countries. BMJ Open. 2017 Oct 16;7(10):e017517. doi: 10.1136/bmjopen-2017-017517. PubMed PMID: 29042388; PubMed Central PMCID: PMC5652529.


Ologunde R, Le G, Turner J, Pandit H, Peter N, Maurer D, Hodgson S, Larvin J, Lavy C. Do trauma courses change practice? A qualitative review of 20 courses in East, Central and Southern Africa. Injury. 2017 Sep;48(9):2010- 2016. doi: 10.1016/j.injury.2017.06.007. Epub 2017 Jun 13. PubMed PMID: 28625562.


Peter NA, Pandit H, Le G, Nduhiu M, Moro E, Lavy C. Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model. Injury. 2016 May;47(5):1128-34. doi: 10.1016/j.injury.2015.11.042. Epub 2015 Dec 7. PubMed PMID: 26725708.


Chokotho L, Jacobsen KH, Burgess D, Labib M, Le G, Peter N, Lavy CB, Pandit H. A review of existing trauma and musculoskeletal impairment (TMSI) care capacity in East, Central, and Southern Africa. Injury. 2016 Sep;47(9):1990-5. doi: 10.1016/j.injury.2015.10.036. Epub 2015 Oct 26. PubMed PMID: 27178767.


Peter NA, Pandit H, Le G, Muguti G, Lavy C. Delivering trauma training to multiple health-worker cadres in nine sub-Saharan African countries: lessons learnt from the COOL programme. Lancet. 2015 Apr 27;385 Suppl 2:S45. doi: 10.1016/S0140-6736(15)60840-6. Epub 2015 Apr 26. PubMed PMID: 26313094.


Peter NA, Pandit H, Le G, Nduhiu M, Moro E, Lavy C. A multicountry health partnership programme to establish sustainable trauma training in east, central, and southern African countries using a cascading trauma management course model. Lancet. 2015 Apr 27;385 Suppl 2:S43. doi: 10.1016/S0140-6736(15)60838-8. Epub 2015 Apr 26. PubMed PMID: 26313092.


Chokotho L, Jacobsen KH, Burgess D, Labib M, Le G, Lavy CB, Pandit H. Trauma and orthopaedic capacity of 267 hospitals in east central and southern Africa. Lancet. 2015 Apr 27;385 Suppl 2:S17. doi: 10.1016/S0140-6736(15)60812-1. Epub 2015 Apr 26. PubMed PMID: 26313063.


Nogaro MC, Pandit H, Peter N, Le G, Oloruntoba D, Muguti G, Lavy C. How useful are Primary Trauma Care courses in sub-Saharan Africa? Injury. 2015 Jul;46(7):1293-8. doi: 10.1016/j.injury.2015.04.010. Epub 2015 Apr 15. PubMed PMID: 25907403.


Chokotho L, Mulwafu W, Jacobsen KH, Pandit H, Lavy C. The burden of trauma in four rural district hospitals in Malawi: a retrospective review of medical records. Injury. 2014 Dec;45(12):2065-70. PubMed PMID: 25458068.

 cool research overview:

Trauma Training Outcomes

We 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 were 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 in Malawi

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 were 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 in Malawi

A new trauma registry was piloted at Queen Elizabeth Central Hospital, Blantyre, Malawi, to generate relevant and timely data on the causes, severity, and mortality of injuries. The data helped 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. 


COSECSA Trainee Research Studies in Trauma

Fourteen COSECSA trainees 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.


Featured article

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

Selected Publications