title: Surgical conditions account for the majority of admissions to three primary referral hospitals in rural Mozambique.
abstract: BACKGROUND
  The World Health Organization has identified the primary referral hospital as its priority site for improving surgical care in low- and middle-income countries. Little is known about the relative burden surgical patients place on health care facilities at this level. This research estimates the fraction of admissions due to surgical conditions at three hospitals in rural Mozambique.
  
  
  METHODS
  Prospective data were collected on all inpatients at three primary referral hospitals in Mozambique during a 12-day period. We compared the number of surgical patients and their length of stay (LOS) to the patients admitted to the medicine, pediatric, and maternity wards. These findings were validated using retrospective data collected from one hospital from January to May 2012.
  
  
  RESULTS
  Patients with surgical conditions (i.e., patients admitted to the surgical or maternity ward) accounted for 57.5 % of admissions and 48.0 % of patient-days. The majority of patients were admitted to the maternity ward (32.3 %). The other admissions were evenly distributed to the pediatric (22.5 %), medical (20.0 %), and surgical (25.2 %) wards. Compared to patients from the three other wards, surgical patients had longer average LOS (8.7 vs. 1.9-7.7 days) and a higher number of total patient-days (891 vs. 252-703 days). The most prevalent procedures were cesarean section (33.3 %) and laceration repair/wound care (11.8 %).
  
  
  CONCLUSIONS
  Surgical conditions are the most common reason for admissions at three primary referral hospitals in rural Mozambique. These data suggest that surgical care is a major component of health care delivered at primary referral hospitals in Mozambique and likely other sub-Saharan African countries.
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, San Diego, CA, 92103, USA, jaa002@ucsd.edu.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Anderson
authors.forename: Anne
authors.initials: A
authors.lastname: Erickson
authors.forename: Carlos
authors.initials: C
authors.lastname: Funzamo
authors.forename: Peter
authors.initials: P
authors.lastname: Bendix
authors.forename: Americo
authors.initials: A
authors.lastname: Assane
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Fernando
authors.initials: F
authors.lastname: Vaz
authors.forename: Emilia Virginia
authors.initials: EV
authors.lastname: Noormahomed
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bickler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D055815:Young Adult