There are a number of challenges for managing children with acute appendicitis in the SSA setting. Children present late with 25-67% perforation rates; re-operation for intra-abdominal sepsis is as high as 40%. Differential diagnoses in SSA are more varied. In America, 82% of peritonitis in children is secondary to appendicitis whereas in SSA children present with peritonitis secondary to typhoid perforation, tuberculosis and ascariasis. There is often a lack of appropriate antibiotics, paediatric intensive care, blood products and parental nutrition. HIV may impact on the spectrum and severity of surgical infection in African children.