Abstract
BackgroundRelatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility.MethodsThe study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey.ResultsThe survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care.ConclusionIn Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.
Highlights
Little is known about deaths from surgical conditions in low- and middle- income African countries
Of the people that died from assumed surgical conditions 32 (21.3%) received surgical care (11.3% major, 10% minor surgical intervention.) Household heads reported that, out of the 459 persons who sought health care, 284 (62.1%) of the total deaths went to a local health facility, while 59 (12.9% of all death) went to a traditional herbal medicine provider for consultation and traditional medicine treatment, and the rest visited other distant health care facilities
This study has shown that 55.3% of deaths due to surgical conditions in Malawi occurred outside a health facility
Summary
Little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. It is estimated that 11–15% of the global burden of disease, measured as disabilityadjusted life years (DALYs), could be treated and corrected surgically [1, 2]. Shrime et al estimated that of the total deaths globally, 31.3% are related to surgical conditions, and 25.1% of DALYs were lost due to surgical conditions in LMICs [4]. Studies from several sub-Saharan African countries have found a prevalence of 6 to 35% for conditions needing surgical consultation or treatment [5,6,7,8]
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