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INTRODUCTION: 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. PATIENTS AND METHODS: All district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded. RESULTS: 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. CONCLUSION: This study underlines Malawi's need for more surgeons to be trained and retained.

Original publication




Journal article


Ann r coll surg engl

Publication Date





722 - 724


Health Surveys, Hospitals, District, Hospitals, Rural, Hospitals, Urban, Humans, Malawi, Surgery Department, Hospital, Surgical Procedures, Operative