Pediatric surgical care in Lilongwe, Malawi: outcomes and opportunities for improvement.
BACKGROUND
One of the objectives of the Millennium Development Goals is to improve child health. We describe the burden of pediatric surgical disease at a tertiary hospital in Malawi.


METHODS
We conducted a retrospective analysis of a pediatric surgery database at Kamuzu Central Hospital in Malawi for the calendar year 2012. Variables included patient demographics, admission diagnosis, primary surgery and outcome.


RESULTS
A total of 1170 pediatric patients aged 0-17 years were admitted to the surgical service during the study period. The mean age was 6.9 years, and 62% were male. Trauma was the most common indication for admission (51%, n = 596), and 67% (n = 779) of all patients were managed non-operatively. Neonates and patients managed non-operatively had a significantly increased risk of mortality.


CONCLUSIONS
Only a third of patients admitted to the pediatric surgery service underwent surgery. More than half of patients with congenital anomalies did not undergo surgical intervention. Importantly, patients who underwent surgery had a survival advantage.
Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA UNC Project, Lilongwe, Malawi.
Claire E
CE
Kendig
Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA UNC Project, Lilongwe, Malawi.
Jonathan C
JC
Samuel
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Carlos
C
Varela
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Nelson
N
Msiska
Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA.
Michelle M
MM
Kiser
Department of Surgery, Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA.
Sean E
SE
McLean
Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA.
Bruce A
BA
Cairns
Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA UNC Project, Lilongwe, Malawi anthchar@med.unc.edu.
Anthony G
AG
Charles
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers
low- and middle-income country; neonatal surgery; sub-Saharan Africa; training