Surgical conditions disproportionately affect the world's poor, but have been neglected as priority health interventions by governments and donors, write Doruk Ozgediz and Robert Riviello in PLoS Medicine.
Injuries, such as road accidents, account for the highest proportion of surgical disease burden in Africa, followed by obstetric complications, malignancies, congenital anomalies and perinatal conditions.
These conditions can be cheaply addressed, and basic surgical care can be a cost-effective prevention strategy, for example the use of male circumcision can reduce the impact of HIV/AIDS.
But costs greatly increase if surgical problems are left untreated.
"Over two million women in Africa are living with an untreated obstetric fistula. This consequence of poor access to basic emergency surgery subsequently requires more resource-intensive surgery," say the authors.
Despite carrying almost 25 per cent of the global disease burden, Africa has only two per cent of the global health workforce. This shortage is even more pronounced in the surgical sector.
Postgraduate students are being drawn away from surgery by research and income opportunities in infectious disease, as well as by the lure of jobs in rich countries.
Additionally, there has been a failure to develop 'blockbuster' devices and technologies for surgical conditions in low-income countries.