Referral Patterns And Transportation Of Surgery Patients Presenting To A Tertiary Hospital In Malawi

Background We aimed to describe the referrals and modes of transportation among surgery patients referred to Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Methods A cross-sectional descriptive study of non-trauma patients aged 18 years and above admitted to general surgery wards at KCH between June 2024 and March 2025. Results A total of 216 patients were recruited in the study (females, n=69, 31.9%). The median age was 43 years (IQR: 30.5-58.5). The patients came from district hospitals (n=128, 60.7%), mission or private hospitals (n=37, 17.5%), health centres or private clinics (n=21, 10%), and 11.9% self-referrals. Common referral diagnoses included acute abdomen (n=82, 38%) and gastrointestinal bleeding (n=27, 12.5%). Most patients were referred to KCH without prior communication (82.9%) and during weekdays (80.6%) compared to weekends. The use of hospital ambulances was more prevalent during weekdays (64.4%) than on weekends (59.5%) when compared to public or private transportation (35.6% vs 40.5%), p = 0.559. The median duration from the date of referral to arrival at KCH was less than a day for both ambulances (IQR: 0-1) and public/private transport (IQR: 0-1). Conclusion To improve and sustain the referral of patients with surgical conditions to tertiary health facilities in Malawi, referral procedures should be developed focusing on district hospitals, with particular attention to providing and maintaining sufficient numbers of ambulances. The public/private transport system is vital in transporting surgery patients to referral centres and should not be ignored.