Pediatric surgical care in Lilongwe, Malawi: outcomes and opportunities for improvement
Claire E Kendig1, Jonathan C Samuel1, Carlos Varela2
1Department of Surgery, Division of Trauma and Critical Care Surgery, University of North Carolina, Chapel Hill, NC, USA UNC Project, Lilongwe, Malawi.
Insights
Pediatric surgical care in Malawi is limited, with many children not receiving necessary operations. However, surgery significantly improves survival rates for pediatric patients, highlighting a critical need for improved access to surgical interventions.
Area of Science:
- Global Health
- Pediatric Surgery
- Public Health
Background:
- Improving child health is a key Millennium Development Goal.
- This study examines the burden of pediatric surgical disease in Malawi.
- Data was collected from a tertiary hospital setting.
Purpose of the Study:
- To describe the scope of pediatric surgical disease.
- To analyze surgical intervention rates and outcomes.
- To identify factors influencing mortality in pediatric surgical patients.
Main Methods:
- Retrospective analysis of a pediatric surgery database.
- Data collected from Kamuzu Central Hospital, Malawi, in 2012.
- Included patient demographics, diagnoses, surgeries, and outcomes.
Main Results:
- 1170 pediatric patients (0-17 years) were admitted.
- Trauma was the most common reason for admission (51%).
- Two-thirds of patients were managed non-operatively; these and neonates had higher mortality.
Conclusions:
- Only one-third of admitted pediatric patients received surgery.
- Over half of patients with congenital anomalies were not operated on.
- Surgical intervention was associated with a survival advantage.
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.
