CONCLUSIONS: Patients with head injuries from falls are at higher risk of mortality compared to patients with other anatomic injury locations. This knowledge can be used to identify fall pa- tients who may benefit from triage to a higher level of care in resource-poor settings. Sex Disparities in Access to Surgical Care in Sub-Saharan Africa Joanna Grudziak, MD, Chifundo Kajombo, MB, BS, FCS, Anthony G Charles, MD, FACS, Rebecca Maine, MD, MPH, Trista Reid, MD, MPH University of North Carolina, Chapel Hill, Chapel Hill, NC; Kamuzu Central Hospital, Lilongwe, Malawi INTRODUCTION: Sex disparities are present throughout health- care. There is a paucity of data regarding sex-based disparities in surgical care delivery, particularly in low- and middleeincome countries (LMICs). We sought to determine if sex disparities are present in patients who present with surgical conditions in Malawi. We hypothesized that compared to men fewer women present to the hospital with surgical conditions, and women have delayed pre- sentation, worse outcomes, longer lengths of stay, and increased morbidity and mortality. METHODS: A retrospective analysis of prospectively collected data of all general surgery patients with peritonitis presenting to Kamuzu Central Hospital in Lilongwe, Malawi from 2013 to 2016. Independent variables evaluated included baseline character- istics, diagnoses, transfer status, and comorbidities. Multivariable logistic regression was used to assess the direct effect of sex on in-hospital mortality, mortality in casualty, length of stay, operative intervention, complications, and time to presentation after adjust- ing for potential confounders. RESULTS: Of 462 patients presenting with peritonitis, 68.8% were men and 31.2% were women. After adjustments, women had signif- icantly increased odds of delayed presentation (odds ratio [OR] 2.52, 95% CI 1.00-6.41, p¼0.05), delays to operation (OR 1.91, 95% CI 1.12-3.27, p¼0.02), longer lengths of stay (OR 1.67, 95% CI 1.00- 2.80, p¼0.05), and higher odds of nonoperative management when compared to men (OR 2.17, 95% CI 1.30-3.62, p¼0.003). We found no significant differences in complications or mortality. CONCLUSIONS: Sex disparities exists with the general surgery population cohort in Malawi. Fewer women present with surgical problems and women experience delays in presentation, longer lengths of stay, and undergo fewer operations. Surgical Repair of Cleft Lip and Palate in North Kivu Province of Eastern Democratic Republic of Congo Sarah B Cairo, MD, MPH, Bake F Jacques, MD, Bake Elisee, BS, Kavira Nyavandu, MD, Robert Perry, MD, David H Rothstein, MD, MS, FACS, FAAP, MD, MS, FACS, Luc Malemo Kalisya, MD, MMS HEAL Africa Hospital, Goma, Congo {Democratic Rep}; John R Oishei Children’s Hospital, Buffalo, NY INTRODUCTION: There is a high prevalence of orofacial deformity in low- and middle-income countries (LMICs) with significant unmet need. The Democratic Republic of Congo (DRC), one of the poorest and least-developed countries in the world, lacks designated pediatric surgical care despite having 50% of the population under 18 years of age. METHODS: This is a retrospective study of patients treated for cleft lip/palate at a tertiary referral hospital in the province of North Kivu, DRC between 2008 and 2018. RESULTS: A total of 1,112 procedures were performed for an average of 121.6 annually. All procedures were performed by general surgeons after training with SmileTrain; 59.2% of patients were male and the average age was 8.7 years (SD 12.1). The average distance traveled from home to hospital was 242.6 km ranging from 2 to 1,375 km; 82.1% of patients received general anesthesia (GA) with significant dif- ferences in use of GA, age, weight, and length of stay by major deformity category; 83.4% of patients had unilateral cleft lip with or without cleft palate; cleft palate or soft palate deformity alone was least common. The majority of procedures (93.7%) performed were for cleft lip despite a 22.9% reported incidence of palate involvement overall. CONCLUSIONS: The burden of cleft lip and palate is high in the DRC with a large number of procedures for cleft lip being per- formed by trained general surgeons, despite a high incidence of complex cleft palate. Multiple factors including risk of bleeding, procedural complexity, and aesthetics may contribute to the distri- bution of procedures performed. Teaching Basic Bleeding Control in Sierra Leone during a Short-Term Surgical Mission: A Unique Opportunity to “Stop the Bleed” Peter F Johnston, MD, Samba Jalloh, MD, Vennila Padmanaban, MD, Rolando G Valenzuela, MD, DTMH, Ashley Tran, BS, Adam D Fox, DO, FACS, Ziad C Sifri, MD, FACS Rutgers New Jersey Medical School, Newark, NJ; College of Medicine and Allied Health Sciences, Freetown, Sierra Leone; Stony Brook University Medical Center, Stony Brook, NY INTRODUCTION: As injury represents a disproportionately com- mon cause of death in low-income countries, basic bleeding control techniques (B-Con) can save lives globally. Short-term surgical mis- sions (STSMs) represent a unique opportunity to disseminate this public health initiative around the world. We aim to examine the feasibility of teaching B-Con as part of a STSM. METHODS: In December 2017 the International Surgical Health Initiative (ISHI) organized a STSM to Kabala, Sierra Leone. Concurrently, the hour-long official American College of Surgeons B-Con course was offered daily to hospital staff and members of the community. Information including number and size of classes, type of trainee, instructors trained, and success rate of demon- strating the core B-Con principles and techniques was collected. RESULTS: In 1 week, 300 people were successfully trained in B- Con over 11 sessions in Kabala and Freetown, with an average 27 trainees and 2-4 instructors per class. One hundred percent of e154 Scientific Poster Presentations J Am Coll Surg