title: Surgery in district hospitals in rural Uganda-indications, interventions, and outcomes.
abstract: BACKGROUND
  There is a vast unmet need for surgical interventions in resource scarce settings. The poorest 2 billion people share 3·5% of the world's operations. The highest burden of surgical disease is seen in Africa where surgery could avert many deaths. Prospective studies investigating interventions, indications, and outcomes including perioperative mortality rates (POMR) after surgery are scant. The aim of the study was to describe the situation of surgery in a low-income setting in sub-Saharan Africa.
  
  
  METHODS
  In this descriptive, facility-based study, data were prospectively collected in questionnaires by 41 staff employed at two hospitals (Iganga General Hospital and Buluba Mission Hospital) in eastern Uganda during 4 months (major surgeries) and 3 months (minor surgeries) in 2011. Data included patient characteristics, interventions, indications for surgery, and in-hospital mortality after surgery. Descriptive statistical methods were used to analyse the data.
  
  
  RESULTS
  2701 patients underwent 2790 surgical interventions. Of these, 1051 patients underwent major surgery, which corresponds to a major surgery rate of 224·8 per 100 000 population. Most patients undergoing major surgery were women (n=923, 88%). Pregnancy related complications (n=747, 66%) leading to caesarean section (n=496, 47%) and evacuation (n=244, 22%) or gynaecological conditions (n=114, 10%) were common indications for surgery. General surgery interventions registered were herniorrhaphy (n=103, 9%), explorative laparotomy (n=60, 5%), and appendicectomy (n=31, 3%). Overall, the POMR was 0·6% (16 deaths); for major surgery it was 1·3% (14 deaths) and for minor surgeries it was 0·1% (two of 1650 patients). High POMR were seen following explorative laparotomy (13·3%, eight deaths) and caesarean section (0·8%, four deaths). Of the 510 babies delivered through caesarean section, 59 (12%) were still born or died before discharge.
  
  
  CONCLUSIONS
  Rates of surgery are low in the study setting compared with in high-income settings where surgical rates exceed 11 000 per 100 000 population. POMR are high after exploratory laparotomy and caesarean section. Although very detailed, a larger study could be undertaken to investigate the situation in other settings. Underlying reasons leading to death and quality of surgical care should be investigated further so that POMR can be reduced in this setting.
  
  
  BACKGROUND
  The Swedish Society of Medicine and the Golje Foundation.
authors: Department of Surgery and Perioperative Sciences, Umeå University, Sweden. Electronic address: jenny.loefgren@gmail.com.
authors: Jenny
authors: J
authors: Löfgren
authors: School of Public Health, Iganga/Mayuge Health and Demographic Surveillance Site, Makerere University, Kampala, Uganda.
authors: Daniel
authors: D
authors: Kadobera
authors: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
authors: Birger C
authors: BC
authors: Forsberg
authors: Iganga General Hospital, Iganga, Uganda.
authors: Jude
authors: J
authors: Mulowooza
authors: Department of Clinical Science and Education (KI SÖS), Karolinska Institute, Stockholm, Sweden.
authors: Andreas
authors: A
authors: Wladis
authors: Department of Surgery and Perioperative Sciences, Umeå University, Sweden.
authors: Pär
authors: P
authors: Nordin