Abstract:
Background: Surgical conditions contribute significantly to the disease burden in sub-Saharan Africa. Yet there is an
apparent neglect of surgical care as a public health intervention to counter this burden. There is increasing enthusiasm to
reverse this trend, by promoting essential surgical services at the district hospital, the first point of contact for critical
conditions for rural populations. This study investigated the scope of surgery conducted at district hospitals in three sub-
Saharan African countries.
Methods and Findings: In a retrospective descriptive study, field data were collected from eight district hospitals in
Uganda, Tanzania, and Mozambique using a standardized form and interviews with key informants. Overall, the scope of
surgical procedures performed was narrow and included mainly essential and life-saving emergency procedures. Surgical
output varied across hospitals from five to 45 major procedures/10,000 people. Obstetric operations were most common
and included cesarean sections and uterine evacuations. Hernia repair and wound care accounted for 65% of general
surgical procedures. The number of beds in the studied hospitals ranged from 0.2 to 1.0 per 1,000 population.
Conclusion: The findings of this study clearly indicate low levels of surgical care provision at the district level for the
hospitals studied. The extent to which this translates into unmet need remains unknown although the very low proportions
of live births in the catchment areas of these eight hospitals that are born by cesarean section suggest that there is a
substantial unmet need for surgical services. The district hospital in the current health system in sub-Saharan Africa lends
itself to feasible integration of essential surgery into the spectrum of comprehensive primary care services. It is therefore
critical that the surgical capacity of the district hospital is significantly expanded; this will result in sustainable preventable
morbidity and mortality.
