A national survey of surgical activity in hospitals in Malawi.

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 surgeon. Most district hospitals are manned by a single doctor and two or more paramedic clinical officers. In 2003, a total of 28,594 operations were performed in district hospitals. In all, 12,506 (44%) of these were obstetric or gynaecological procedures, but only 821 (3%) were general surgical cases. It appears that district clinicians are happy to attempt emergency obstetric and gynaecological cases but tend to refer emergency general surgical cases.