Abstract
IntroductionOver 5 billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed. In order to improve health outcomes in patients with surgical conditions, both access to care and the quality of care need to be improved. A recent commission on high-quality health systems highlighted that poor-quality care is now a bigger barrier than non-utilisation of the health system for reducing mortality.AimTo carry out a systematic review to provide an evidence-based summary of hospital-based interventions associated with improved quality of surgical and anaesthesia care in sub-Saharan African countries (SSACs).Methods and analysisThree search strings (1) surgery and anaesthesia, (2) quality improvement hospital-based interventions and (3) SSACs will be combined. The following databases EMBASE, Global Health, MEDLINE, CINAHL, Web of Science and Scopus will be searched. Further relevant studies will be identified from national and international health organisations and publications and reference lists of all selected full-text articles. The review will include all type of original articles in English published between 2008 and 2019. Article screening, data extraction and assessment of methodological quality will be done by two reviewers independently and any disputes will be resolved by a third reviewer or team consensus. Three types of outcomes will be collected including clinical, process and implementation outcomes. The primary outcome will be mortality. Secondary outcomes will include other clinical outcomes (major and minor complications), as well as process and implementation outcomes. Descriptive statistics and outcomes will be summarised and discussed. For the primary outcome, the methodological rigour will be assessed.Ethics and disseminationThe results will be published in a peer reviewed open access journal and presented at national and international conferences. As this is a review of secondary data no formal ethical approval is required.PROSPERO registration numberCRD42019125570.
Highlights
Over 5 billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed
Untreated surgical diseases are among the top 15 causes of physical disability worldwide, with injuries accounting for 15% of all ill-health worldwide and 90% of deaths from injuries occurring in low-income or middle-income countries (LMICs),3 85% of all sub-Saharan African countries (SSACs) are classified as either low-income or middle-income
The poorest countries account for 34·8% of the global population, yet annually, only 6% of surgical procedures worldwide take place in these countries[4] and sub-S aharan Africa (SSA) region has the greatest unmet need for surgical procedures.[1]
Summary
►► A comprehensive search strategy for original articles and grey literature both published and unpublished was created and included. Billion people worldwide being deprived access to safe, affordable and timely surgical and anaesthesia care when needed.[1] Sub- Saharan African countries (SSACs) are disproportionally affected where 93% of the population do not have access to basic surgical care.[1] Mortality and morbidity from treatable surgical diseases are high and continues to grow. The poorest countries account for 34·8% of the global population, yet annually, only 6% of surgical procedures worldwide take place in these countries[4] and sub-S aharan Africa (SSA) region has the greatest unmet need for surgical procedures.[1] Surgical patients in Africa are two times as likely to die after surgeries, despite being younger, lower-risk profile and developing fewer complications, compared with the global average.[5]. This study will inform future efforts to improve the quality of hospital-based care for patients requiring surgical and anaesthesia care
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