title: The demographics of patients affected by surgical disease in district hospitals in two sub-Saharan African countries: a retrospective descriptive analysis.
abstract: BACKGROUND
  There is a growing awareness of the importance of surgical disease within global health. We hypothesised that surgical disease in low income countries predominantly affects young adults and may therefore have a significant economic impact.
  
  
  METHODS
  We retrospectively reviewed all surgical admission data from two rural government district hospitals in two different sub-Saharan African countries over a 6-month period. We analysed all surgical admissions with respect to patient demographics (age and gender), diagnosis, and procedure performed.
  
  
  RESULTS
  Surgical admissions accounted for 12.9 and 19.8 % of all hospital admissions in Malawi and Sierra Leone respectively. 18.5 and 6.2 % of all hospital patients required a surgical procedure in Malawi and Sierra Leone respectively, with the low number in Sierra Leone accounted for in that many of the obstetric admissions were referred to a nearby Medicins Sans Frontiers (MSF) hospital for treatment. 17.9 and 10.5 % of surgical admissions were under the age of 16 in Malawi and Sierra Leone respectively, with 16-35 year olds accounting for 57.3 % of surgical admissions in Sierra Leone and 53.5 % in Malawi. Men accounted for 53.7 and 46.0 % of surgical admissions in Sierra Leone and Malawi respectively. An unexpected finding was the high level of patients who absconded from hospital in Sierra Leone after diagnosis but before treatment. This involved 11.8 % of all surgical patients, including 38 % with a bowel obstruction, 39 % with peritonitis and 20 % with ectopic pregnancy.
  
  
  CONCLUSIONS
  Most people affected by disease requiring surgery are young adults and this may have significant economic implications.
authors.affiliation: King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK.
authors.forename: Caris E
authors.initials: CE
authors.lastname: Grimes
authors.affiliation: St George's Hospital Medical School, University of London, London, UK.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Billingsley
authors.affiliation: King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Dare
authors.affiliation: Oxford University Hospitals Trust, Oxford, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Day
authors.affiliation: Bo Hospital, Bo, Sierra Leone ; Port Loko Government Hospital, Port Loko, Sierra Leone ; School of Community Health and Clinical Sciences, Njala University, Freetown, Sierra Leone.
authors.forename: Peter M
authors.initials: PM
authors.lastname: George
authors.affiliation: Connaught Hospital, Freetown, Sierra Leone ; Department of Surgery, College of Medicine and Allied Health Sciences, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: College of Medicine, University of Malawi, Mahatma Gandhi Road, Blantyre, Malawi ; School of Medicine, Flinders University, Adelaide, Australia.
authors.forename: Nyengo C
authors.initials: NC
authors.lastname: Mkandawire
authors.affiliation: King's Centre for Global Health, Weston Education Centre, King's College London and King's Health Partners, Cutcombe Road, London, SE5 9RJ UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Leather
authors.affiliation: University of Oxford, Oxford, UK.
authors.forename: Christopher B D
authors.initials: CB
authors.lastname: Lavy
keywords: Demographics; District hospitals; Low and middle income countries; Surgery