Original communicationSuicide in Blantyre, Malawi (2000–2003)
Introduction
Suicide is a complex phenomenon, associated with psychological, biological and social factors. The World Health Organisation (WHO) estimates that approximately one million people commit suicide per year.1 In countries collecting and reporting data, suicide is among the top ten causes of death, with higher rates in young people (15–35 years) and the very elderly; additionally, incidence is higher in males than females, although the latter have more suicide attempts.1 The range of data from Africa regarding suicide, attempted suicide, and parasuicide from both the clinical and forensic arenas includes many excellent studies; yet, there remains a great need for centralized collection and processing of mortality statistics, including suicide, across the continent.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16
Published forensic data (i.e., mortality studies) from the late 1970s for the African continent indicate suicides constitute 6.3–7.4% of autopsies.5, 17 Studies from the Centers for Disease Control and Prevention as recent as 1990 found the suicide rate to be lowest in Sub-Saharan Africa (3.4 per 100,000) compared to the rest of the world.18
Several studies in Africa have address the specific reasons for committing suicide on the continent which do not differ greatly from other populations around the world; they can include acute marital and family conflicts, sexual conflicts and unwanted pregnancies, incrimination, mental or emotional disorders (i.e., depression, schizophrenia), age issues, gender issues, chronic medical conditions (i.e., HIV), and substance abuse (i.e., alcohol).2, 6, 7, 8, 9, 10, 12, 15, 19 Statistics on the religious practices of people committing and/or attempting suicide show variable associations with no particular sect or denomination at risk.9, 10 Reported methods of committing suicide vary by popularity for different countries in Africa influenced by socio-cultural factors but tend to include some proportion of self-poisoning (i.e., organophosphates, prescription medications), self-immolation, hanging, and gunshot wounds.7, 9, 10, 11, 16, 19, 20, 21 There is some evidence from Africa that seasonal variation may play a role in rates of suicides (e.g., the dry seasons, following major annual economic shortages) while other studies have shown no seasonal predilection.5, 6, 11, 22, 23, 24
There have been no published reports of suicide data from Malawi. The magnitude of the problem is not known although the law provides for all such cases to be reported to the police. Risk factors, populations at highest risk, and means employed have not been studied. This study is an attempt to analyse the burden of suicide cases reported to the Malawi police within the jurisdiction of the Queen Elizabeth Central Hospital, Blantyre.
Section snippets
Materials and methods
The Queen Elizabeth Central Hospital (QECH) is the largest referral hospital in Malawi, a country of just under 12,000,000 citizens.25 It also functions as the district hospital for Blantyre district, population of 800,000, and a teaching hospital for the College of Medicine of the University of Malawi. QECH is also the only hospital in Malawi where pathologists because of its proximity to the College of Medicine perform medico-legal autopsies. A few post-mortems are also carried out in the
Results
Four hundred seventy-nine autopsies were performed during the four-year period of which 84 cases (17%) were due to suicide. There were 65 males (77%) and 19 females (23%). The age range was 9–70 years with a mean age of 33.4 years. Although the age was stated in only 7 of the 19 female cases and 31 of the 69 males, female suicide cases tended to be younger than their male counterparts. In men whose age was recorded, 48% of the suicide cases occurred in the 30–39 years age group. For women 43%
Discussion
This is the first reported analysis of suicide cases in Malawi. As in other African countries culturally discouraging suicide, these 84 cases of completed suicide may represent only a small percentage of the total – those actually reported to the police as required by the law. Despite this fact, 17% represents twice the percent of cases seen in older mortality studies.5, 17 In this group of suicide cases, males outnumbered females by a ratio of 3.4:1. This predominance of men over women and
Acknowledgements
We thank the government of Malawi and the Department of Histopathology for funding the anatomic pathologists of the University of Malawi College of Medicine. We also like to thank the College of American Pathologists Foundation for supporting Dr. Milner’s continued work in Malawi within the Department of Histopathology at the University of Malawi College of Medicine.
References (26)
- et al.
A prospective study of suicidal burns admitted to the Harare burns unit
Burns
(2000) - et al.
The share of suicide in injury deaths in the South African context: sociodemographic distribution
Public Health
(2003) - et al.
Seasonal variation of suicide in South Africa
Psychiat Res
(1997) - et al.
Spectrum of unnatural fatalities in the Chandigarh zone of north-west India – a 25 year autopsy study from a tertiary care hospital
J Clin Forensic Med
(2003) Preventing suicide: a resource for general physicians
World Health Org
(2000)Attempted suicide in Durban: a general hospital study
S Afr Med J
(1966)- et al.
Suicides in Rhodesia
Cent Afr J Med
(1972) The present state of suicide prevention – an African survey
Int J Soc Psychiat
(1972)Suicide rates in Lusaka, Zambia: preliminary observations
Psychol Med
(1978)- et al.
A current study of parasuicide in Durban
S Afr Med J
(1980)
Suicide attempts in Ethiopian adolescents in Addis Abeba high schools
Ethiop Med J
Suicidal ideation in Sudanese women
Crisis
Suicide attempts among adults in Butajira
Ethiopia Act Psychiat Scand Suppl
Cited by (28)
Acute poisoning at two hospitals in Kampala-Uganda
2008, Journal of Forensic and Legal MedicineCitation Excerpt :This finding is inconsistent with those reported in the literature since the case fatality rate is usually higher in case of deliberate poisoning.10,14 However the case fatality rate reported in this study is lower when compared to reports by other investigators.15 Although this study did not assess the factors associated with the low fatality, it is known that in case of acute poisoning, factors such as the intrinsic toxicity of the poisoning agent, and the dose consumed play an important role.16,8
Suicide in the Dar es Salaam region, Tanzania, 2005
2008, Journal of Forensic and Legal MedicineCitation Excerpt :The age group with the highest suicide rate was 45–59 years. However, the rate of suicide was consistently higher among males than females for all age groups between 15 and 59 years, a phenomenon that has been reported elsewhere.16–18,20 Factors that contribute to female suicide in this age group are mainly family related problems including unwanted pregnancy, prostitution, and family conflicts.
Acute pesticide poisoning related deaths in Tehran during the period 2003-2004
2007, Journal of Forensic and Legal MedicineSuicidal and homicidal deaths: A comparative and circumstantial approach
2007, Journal of Forensic and Legal MedicineCitation Excerpt :In Caribbean Inland of West Indies, hanging is the commonest method used for suicide in Jamaica in contrast to poisoning in Trinidad and Tobago.15 However, in agriculture-based country like Srilanka16 and African country like Balantyre, Malawi,17 poisoning is the commonest method of suicide followed by hanging. In homicidal deaths, blunt trauma is the commonest method of homicide in Germany18 and Japan.19
The role of effective factors on suicidal tendency of women in Turkey
2023, Frontiers in Public Health