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.