Surgery in Malawi - a national survey of activity in rural and urban hospitals

Abstract

Introduction: Malawi is a poor country with few doctors. It has 21 district hospitals all of which have operating theatres but none of which has a permanent surgeon. It also has 4 central hospitals, each with one or more surgeons. Most district hospitals are manned by a single doctor and two or more paramedical clinical officers.

Patients and methods: All district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded.

Results: In 2003, a total of 48,696 surgical operations were recorded, of which 25,053 were performed in 21 district hospitals and 23,643 in 4 central hospitals. Caesarean section is the commonest major surgical procedure in district hospitals and is performed in approximately 2.8% of all births, compared to 22% in the UK. Very few major general surgical or orthopaedic procedures are carried out in district hospitals.

Conclusion: This study underlines Malawi's need for more surgeons to be trained and retained.

Figure 1

Operations in district and central hospitals in Malawi in 2003. Total number of operations 48,696 of which 25,053 in district hospitals and 23,643 in central hospitals.