The study is a prospective analysis of anaesthesia-associated complications and deaths in Malawi. During a period of 6 months 51 complications and 14 deaths in 3022 anaesthetics were reported. Low blood pressure caused by septicaemia or acute blood loss was responsible for 53% of the complications and 71% of deaths. Intubating difficulties were responsible for 25% of the complications and 14% of the deaths. Eleven of the 14 deaths were identified as avoidable [avoidable mortality rate (AMR) 1:275]. Avoidable factors were classified into three groups. The anaesthetic AMR was 1:504. Poor fluid management and poor airway management were the main avoidable factors. The surgical AMR was 1:3022, and the administrative AMR 1:756. Insufficient or no blood is the only factor responsible for the administrative AMR. The anaesthetic AMR in Malawi is 6-100 times higher than in developed countries such as France, USA or UK. To reduce this very high anaesthetic AMR in Malawi further developing aid programmes should concentrate on training courses for the anaesthetists and setting up blood donation programmes.