Surgery in Malawi—a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl

Beit Cure Orthopaedic Hospital, Blantyre, Malawi.
Annals of The Royal College of Surgeons of England (Impact Factor: 1.27). 11/2007; 89(7):722-4. DOI: 10.1308/003588407X209329
Source: PubMed


Malawi is a poor country with few doctors. It has 21 district hospitals all of which have operating theatres but none of which has a permanent surgeon. It also has 4 central hospitals, each with one or more surgeons. Most district hospitals are manned by a single doctor and two or more paramedical clinical officers.
All district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded.
In 2003, a total of 48,696 surgical operations were recorded, of which 25,053 were performed in 21 district hospitals and 23,643 in 4 central hospitals. Caesarean section is the commonest major surgical procedure in district hospitals and is performed in approximately 2.8% of all births, compared to 22% in the UK. Very few major general surgical or orthopaedic procedures are carried out in district hospitals.
This study underlines Malawi's need for more surgeons to be trained and retained.

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Available from: Chris Lavy, Dec 14, 2013
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    • "Table 2 gives the sense of the scope and frequencies of procedures encountered in these study sites. There is recognition that other countries in the region, including Malawi, Mozambique and Tanzania, have had success with the practice [12-16]. "
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    • "In other sub-Saharan African countries, midlevel (nonphysician) cadres have been successfully trained in surgery. Although concerns include the narrow scope of surgical procedures and difficulty in monitoring quality, reports of outcomes between physicians and nonphysicians have been comparable [18–21]. From these experiences it is clear that midlevel clinicians posted in rural areas require training, effective supervision, and mentoring to maintain quality of service. "
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    ABSTRACT: Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services.
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    • ") Given the context of an extreme surgical workforce shortage and the substantial impact of surgical care on population health, we also feel that a 'recasting' of the traditional role of the surgeon is necessary to improve access to surgery in Uganda, and that this may be applicable to similar resource-constrained environments in sub- Saharan Africa (Ozgediz et al. 2008b). Already in some countries such as Tanzania, Malawi, Mozambique and the Democratic Republic of Congo, scarce specialists train nonphysicians and nurses in surgical and perioperative skills (Longombe 1997; Kruk et al. 2007; Lavy et al. 2007). This commentary draws on the experiences of the authors in Uganda, including a full career of surgical practice and education (SL), as well as the published and 'grey' literature, to describe how and why this 'recasting' could occur. "
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