The Epidemiology of District Surgery in Malawi: a Two Year Study of Surgical Rates and Indices in Rural Africa

Abstract

Background: The true surgical requirement of a rural African population is also not precisely known. Methods: Data gathered over a 2-year period from 1993 to 1995 on surgical and anaesthetic activities in 18 District Hospitals in Malawi are presented. Results: Theatre records showed that 45,032 operations were carried out at District Hospitals in the study area which had a catchment population of 6,100,000 giving an average annual rate of 369 operations per 100,000 population (range 151-1337). Of the total, 11,466 operations were classed as major, giving an average annual rate of 94 per 100,000 population (range 31-242 / 100,000). Comparable rates for total and major operations carried out in the central referral hospital were 865 and 269 per 100,000, respectively, allowing  for referrals. A total of 7,288 caesarean sections (CS) were carried out, constituting 65.6% of all major operations. The rural CS rate was 60 per 100,000 compared to the central hospital rate of 151 per 100,000. In the district hospitals, 75% of all surgery, including most major operations, was carried out by paramedical cadres (Clinical Officers or Medical Assistants), 8.2% by the resident District Health Officer and 0.8% by visiting specialists. All general and regional anaesthesia was given by paramedical cadres. The ratios of CS to all major operations and laparotomy to all major operations showed a different pattern of surgery between district hospitals and between district and central hospitals. The value of these indices in identifying deficiencies in the surgical services is discussed.

East and Central African Journal of Surgery. 2011 Nov/ December;16 (3)