World Journal of Surgery

, Volume 43, Issue 1, pp 60–66 | Cite as

Sex Disparities in Access to Surgical Care at a Single Institution in Malawi

  • Trista D. ReidEmail author
  • Sherry M. Wren
  • Joanna Grudziak
  • Rebecca Maine
  • Chifundo Kajombo
  • Anthony G. Charles
Original Scientific Report



There is a paucity of data regarding sex-based disparities in surgical care delivery, particularly in low- and middle-income countries. This study sought to determine whether sex disparities are present among patients presenting with surgical conditions in Malawi. Hypothesis compared to men, fewer women present to Kamuzu Central Hospital (KCH) with peritonitis and have longer delays in presentation for definitive care.


This study performs a retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to KCH in Lilongwe, Malawi, from September 2013 to April 2016. Multivariable linear and logistic regressions were used to assess the effect of sex on mortality, length of stay, operative intervention, complications, and time to presentation.


Of 462 patients presenting with general surgery conditions and peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had significantly higher odds of non-operative management when compared to men (OR 2.17, 95%CI 1.30–3.62, P = 0.003), delays in presentation (adjusted mean difference 136 h, 95%CI 100–641, P = 0.05), delays to operation (adjusted mean difference 1.91 days, 95%CI 1.12–3.27, P = 0.02), and longer lengths of stay (adjusted mean difference 1.67 days, 95%CI 1.00–2.80, P = 0.05). There were no differences in complications or in-hospital or Emergency Department mortality.


Sex disparities exist within the general surgery population at KCH in Lilongwe, Malawi. Fewer women present with surgical problems, and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Future studies to determine mortality in the community and driving factors of sex disparities will provide more insight.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Trista D. Reid
    • 1
    • 2
    • 4
    Email author
  • Sherry M. Wren
    • 3
  • Joanna Grudziak
    • 1
    • 2
  • Rebecca Maine
    • 1
    • 2
    • 4
  • Chifundo Kajombo
    • 2
  • Anthony G. Charles
    • 1
    • 2
    • 4
  1. 1.Department of SurgeryUniversity of North Carolina- Chapel HillChapel HillUSA
  2. 2.Department of SurgeryKamuzu Central HospitalLilongweMalawi
  3. 3.Department of SurgeryStanford UniversityStanfordUSA
  4. 4.UNC School of Medicine, University of North CarolinaChapel HillUSA

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