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


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.


CONCLUSIONS
This study underlines Malawi's need for more surgeons to be trained and retained.
Lavy
Chris
C
Beit Cure Orthopaedic Hospital, Blantyre, Malawi. christopher.lavy@ndos.ox.ac.uk
Tindall
Alistair
A
Steinlechner
Colin
C
Mkandawire
Nyengo
N
Chimangeni
Sandy
S
D006306:Health Surveys; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008295:Malawi; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*