Deaths from surgical conditions in malawi A randomised cross-sectional nationwide household survey

Abstract

Back ground The prevalence of untreated surgical conditions in Malawi has been estimated at 35% with 24% of the deaths associated with untreated surgical conditions. In SSA, the primary emphasis for health research has been on communicable diseases, and relatively little is known about deaths from surgical conditions in most middle- to low-, income African countries, including Malawi. This study aimed to address this knowledge gap by quantifying and describing the deaths from surgical conditions in Malawi. Methods To access the deaths associated with surgical conditions in Malawi, a randomised multi-stage cross-sectional national household survey was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48 233 settlements, using 50 villages from each district as data collection sites. Two to four household were randomly selected from each village. Two members of each selected household were interviewed. 1487 households were involved in the survey. Data collection was done using an electronic questionnaire. Results The total number of reported deaths from all causes was 616 in the 1479 households, ranging from 0 to 9 dead household members. Further data related to the deaths were available for 558 persons, with 294 (52.7%) males and 259 (46.4%) females. A total of 13 women died during pregnancy (5% of deceased women). Non-surgical conditions accounted for 408 (73.5%) of all the total deaths. Symptoms such as body swelling, abdominal distension and injuries were among the common associations of deaths: (6.0%, 5.3% and 4.6%). Almost half of the deaths occurred at home (234 persons - 41.9%) while 288 (51.6%) died at a health facility. Thirty persons died on their way to a health facility. Seventy-two persons (12.9%) who died had sought care from a traditional herbalist prior to attending a health facility. Conclusion In Malawi, body swelling, abdominal distension and injuries were the main conditions reported to be related to surgical causes of death. These occurred while the patients were either waiting at home or at health centre. Some patients initially consult a traditional herbalist prior to seeking modern health care. This delayed the possibility of timely surgical intervention.