The epidemiology and spectrum of surgical care in district hospitals of Pakistan

On-site surveys of 19 district-level hospitals in Pakistan revealed that, in 1983, 23,839 procedures were performed. There were 98 different types of operations. Thirty-eight per cent were classified as General Surgery, 30 per cent Gynecology and Operative Obstetrics, 19 per cent Urology, and 13 per cent Orthopedics. In three regions, population-based data were obtained from the 12 hospitals which provided all surgical care to discrete populations. The overall rate of surgical operations per 100,000 population was 124, 1.5 per cent to 9 per cent of the rate in western countries. The ratio of surgeons per 100,000 population was 0.36, 1/80 the ratio in the United States. There were almost twice as many operations per surgeon as in the USA. These data indicate a severe shortage of surgeons in Pakistan's district hospitals. They also provide the spectrum and relative numbers of different operations performed at the district level. This information has been useful along with other factors in designing a surgical curriculum at the Aga Khan University in Karachi, Pakistan.