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

*This article originally appeared in 1997 and is being republished as the original version is not available online.*
Background: The true surgical requirement of a rural African population is 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 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.