ArticleWorld journal of surgery2018
The Cost of Providing District-Level Surgery in Malawi.
Article in World journal of surgery, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Costs of surgeries in low- and middle-income countries: a systematic literature review.BMJ global health · 2026Pooled it
- Safe Healthcare Facilities: A Systematic Review on the Costs of Establishing and Maintaining Environmental Health in Facilities in Low- and Middle-Income Countries.International journal of environmental research and public health · 2021Pooled it
- Household costs, catastrophic out-of-pocket payments and impoverishment related to accessing surgical care in rural Ethiopia.PloS one · 2026Article
- Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi.BMJ open quality · 2023Article
- Article
- Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia.BMC health services research · 2021Article
- Long-Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study.World journal of surgery · 2021Article
- Challenges in healthcare financing for surgery in sub-Saharan Africa.The Pan African medical journal · 2021Review
- Patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa: a systematic review.Health economics review · 2020Review
- Out-of-pocket payments and catastrophic household expenditure to access essential surgery in Malawi - A cross-sectional patient survey.Annals of medicine and surgery (2012) · 2019Article
- Predicted effect of regionalised delivery care on neonatal mortality, utilisation, financial risk, and patient utility in Malawi: an agent-based modelling analysis.The Lancet. Global health · 2019Article
- Barriers to Timely Presentation of Patients with Surgical Conditions at Tamale Teaching Hospital in Northern Ghana.World journal of surgery · 2019Article
- Evaluation of a surgical supervision model in three African countries-protocol for a prospective mixed-methods controlled pilot trial.Pilot and feasibility studies · 2019Article
- Assessing the capacity of Malawi's district and central hospitals to manage traumatic diaphyseal femoral fractures in adults.PloS one · 2019Article
- Surgical referral systems in low- and middle-income countries: A review of the evidence.PloS one · 2019Review
- Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa.International journal of health policy and management · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThree district hospitals in Malawi that provide essential surgery, which for many patients can be lifesaving or prevent disability, formed the setting of this costing study.
methodsAll resources used at district hospitals for the delivery of surgery were identified and quantified. The hospital departments were divided into three categories of cost centres-the final cost centre, intermediate and ancillary cost centres. All costs of human resources, buildings, equipment, medical and non-medical supplies and utilities were quantified and allocated to surgery through step-down accounting.
resultsThe total cost of surgery, including post-operative care, ranged from US$ 329,000 per year to more than twice that amount at one of the hospitals. At two hospitals, it represented 16-17% of the total cost of running the hospital. The main cost drivers of surgery were transport and inpatient services, including catering. The cost of a C-section ranged from $ 164 to 638 that of a hernia repair from $ 137 to 598. Evacuations from uterus were cheapest mainly because of the shorter duration of patient stay.
conclusionLow bed occupancy rates and utilisation rates of the operating theatres suggest overcapacity but may also indicate a potential to scale up surgery. This may be achieved by adding surgical staff, although there may be rate-limiting steps, such as demand for surgery in the community or capacity to provide anaesthesia. If a scale-up of surgery cannot be realised, hospital managers may be forced to reduce the number of beds, reorganise wards and/or reallocate staff to achieve better economies of scale.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.