Pediatric surgical care in Lilongwe, Malawi: outcomes and opportunities for improvement

J Trop Pediatr. 2014 Oct;60(5):352-7. doi: 10.1093/tropej/fmu026. Epub 2014 Apr 25.


Background: One of the objectives of the Millennium Development Goals is to improve child health. We describe the burden of pediatric surgical disease at a tertiary hospital in Malawi.

Methods: We conducted a retrospective analysis of a pediatric surgery database at Kamuzu Central Hospital in Malawi for the calendar year 2012. Variables included patient demographics, admission diagnosis, primary surgery and outcome.

Results: A total of 1170 pediatric patients aged 0-17 years were admitted to the surgical service during the study period. The mean age was 6.9 years, and 62% were male. Trauma was the most common indication for admission (51%, n = 596), and 67% (n = 779) of all patients were managed non-operatively. Neonates and patients managed non-operatively had a significantly increased risk of mortality.

Conclusion: Only a third of patients admitted to the pediatric surgery service underwent surgery. More than half of patients with congenital anomalies did not undergo surgical intervention. Importantly, patients who underwent surgery had a survival advantage.

Keywords: low- and middle-income country; neonatal surgery; sub-Saharan Africa; training.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Malawi
  • Male
  • Outcome Assessment, Health Care*
  • Pediatrics*
  • Retrospective Studies
  • Surgical Procedures, Operative / statistics & numerical data*
  • Tertiary Care Centers