Surgical operations in eastern Africa: a review with conclusions regarding the need for further research

This review of surgical ouput in eastern Africa and other developing countries, is based mainly on published, and to a small extent, on unpublished sources, such as hospital annual reports. It is noted that poorly standardized classification of surgical operations is a problem in recording and reporting, and that one internationally agreed classification would be useful in comparative studies. Rates of major surgical operations in sub-Saharan Africa are 70-500 per 100,000 population per year with inguinal hernia repair, caesarean section, hydrocele operation and surgical management of injuries as the most common major operations. There are large variations between hospitals. Corresponding figures in high-income industrialized countries are 5,000-9,000. Data on minor surgery at hospitals are scarce, but figures from a few African hospitals are presented. Almost nothing is known about minor surgery performed at health centres and dispensaries or about surgical cases referred to hospital, and population-based rates of minor surgery cannot therefore be calculated. Resources are scarce, but can be more effectively utilized. Further research should include: (a) population-based output of major and minor operations in different countries and regions; (b) outcome after a few selected operations, preferably selected in consultation with researchers studying medical care outcome in other countries; (c) availability and use of surgery-related resources such as manpower, equipment and supplies; and (d) assessment of needs for surgery using household health survey methods.