Original communication
Suicide in Blantyre, Malawi (2000–2003)

https://doi.org/10.1016/j.jcfm.2005.08.006Get rights and content

Abstract

In an attempt to identify at risk individuals, we analysed available information for individuals who committed suicide in Blantyre, Malawi. A retrospective audit of suicides autopsied at the Queen Elizabeth Central Hospital and the University of Malawi College of Medicine mortuaries between January 2000 and December 2003 was analysed by age, sex, residential location, and mode of suicide. Eighty-four suicide cases (65 males, 19 females) represented 17% of all autopsies. The major mode of suicide in Blantyre was chemical poisoning using an agricultural pesticide, accounting for 66 cases (79%)–49 males (76%), 17 females (89%). There were no cases of poisoning by therapeutic medicines, self-immolation or incised wounds. The majority of cases were from one major urban area, Limbe, and one peri-urban area, Chileka. The demographics of suicide in Malawi differ from those reported for other African countries (e.g., lower proportion of females, no use of therapeutic medicine in poisoning, few gunshots). This audit highlights a need for investigations into the sale and use of agricultural pesticides. A prospective study of social and demographic factors around suicide should be undertaken to target groups at highest risk.

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)

  • D. Kebede et al.

    Suicide attempts in Ethiopian adolescents in Addis Abeba high schools

    Ethiop Med J

    (1993)
  • R.D. Goldney et al.

    Suicidal ideation in Sudanese women

    Crisis

    (1998)
  • A. Alem et al.

    Suicide attempts among adults in Butajira

    Ethiopia Act Psychiat Scand Suppl

    (1999)
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