title: Tonsillectomy rates in the South African private healthcare sector.
abstract: BACKGROUND
  Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this, there exists considerable international (190 - 850/100 000 people ≤19 years of age) and regional variation in rates. This cannot be accounted for by differences in clinical need or regional morbidity.
  
  
  OBJECTIVE
  To describe the adeno-/tonsillectomy rate in the South African (SA) private healthcare sector and regional variations thereof. To compare local rates with international rates and assess trends in adeno-/tonsillectomy practice.
  
  
  METHODS
  Analysis of 2012 and 2013 adeno-/tonsillectomy data provided by the largest SA private healthcare funder, accounting for 30% of the medical scheme market. Rates are expressed per 100 000 people ≤19 years of age.
  
  
  RESULTS
  The tonsillectomy rate in the SA private healthcare sector was 1 888/100 000 people ≤19 years of age in 2012. In 2013, the rate dropped significantly (p&lt;0.001) to 1 755/100 000. This is more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in this rate within SA.
  
  
  CONCLUSIONS
  The SA tonsillectomy rate is very high when compared with international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather, it is differences in training and clinical practice of clinicians, as well as social and family factors, that have been implicated.
  
  
  CONCLUSIONS
  The adeno-/tonsillectomy rate in the SA private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration.
authors.affiliation: Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, South Africa. pdouglasjones@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Douglas-Jones
authors.forename: J J
authors.initials: JJ
authors.lastname: Fagan