RATES OF MAJOR SURGERY BY AGE AND SEX IN A RURAL DISTRICT IN KENYA

All major surgical operations performed during 1 year in Meru district , Kenya, were recorded. The district, with a population of 1.3 million , had five hospitals and two nursing homes where major surgery was per formed. Over 3400 major operations were recorded: Caesarean section (1 29.0 operations/100000 population), tubal ligation (39.4), laparotomy (14.0), hysterectomy (5.0), open reduction of fracture (4.3) and herni a repair (6.3). The total major surgery rate was 263/100000.year: 88/1 00000 males and 434/100000 females. Of all major operations, 83.5% wer e performed on females, the most common being Caesarean section, tubal ligation, laparotomy, eye or lens removal and hysterectomy. Most freq uent major operations on males were laparotomy, eye or lens removal, h ernia repair, gastro-intestinal surgery and prostatectomy. Most major surgery (68.1%) was on young and middle-aged adults; only 7.7% was per formed on children aged <15 years even though these made up half of th e population. Rates increased with age, and there were modest male/fem ale differences except for very high rates of obstetrical surgery on y oung women. There is need to expand the district's capacity for major surgery and also to prevent more conditions requiring surgery, for exa mple by improving sexual- and reproductive-health education, making fa mily planning services more easily available among sexually active ado lescents, and by initiating more aggressive prevention programmes agai nst injuries. Although population-based operation rates, totally and b y sex and age-group, are useful indicators for monitoring service outp ut, current reporting is inadequate. One step towards improvement woul d be to require that every hospital reports, annually to the district level, all major operations by kind and by age and sex of the patient.