The Development and Inclusion of Questions on Surgery in the 2018 Zambia Demographic and Health Survey.

Vatshalan Santhirapala,Sabrina Juran,Lina Roa,Mark G Shrime,Emmanuel Makasa,David Ljungman,Sanna Moren,Stefanie J Klug,Jose Miguel Guzman,Hampus Holmer,Lars Hagander,John G Meara,Thomas G Weiser,Justine Davies

doi:10.9745/ghsp-d-20-00619

Abstract

While primary data on the unmet need for surgery in low- and middle-income countries is lacking, household surveys could provide an entry point to collect such data. We describe the first development and inclusion of questions on surgery in a nationally representative Demographic and Health Survey (DHS) in Zambia. Questions regarding surgical conditions were developed through an iterative consultative process and integrated into the rollout of the DHS survey in Zambia in 2018 and administered to a nationwide sample survey of eligible women aged 15-49 years and men aged 15-59 years. In total, 7 questions covering 4 themes of service delivery, diagnosed burden of surgical disease, access to care, and quality of care were added. The questions were administered across 12,831 households (13,683 women aged 15-49 years and 12,132 men aged 15-59 years). Results showed that approximately 5% of women and 2% of men had undergone an operation in the past 5 years. Among women, cesarean delivery was the most common surgery; circumcision was the most common procedure among men. In the past 5 years, an estimated 0.61% of the population had been told by a health care worker that they might need surgery, and of this group, 35% had undergone the relevant procedure. For the first time, questions on surgery have been included in a nationwide DHS. We have shown that it is feasible to integrate these questions into a large-scale survey to provide insight into surgical needs at a national level. Based on the DHS design and implementation mechanisms, a country interested in including a set of questions like the one included in Zambia, could replicate this data collection in other settings, which provides an opportunity for systematic collection of comparable surgical data, a vital role in surgical health care system strengthening.

Highlights

It is estimated that 5 billion people do not have access to essential surgical, obstetric, and anesthesia care.[1]
The World Health Organization (WHO) along with the 3rd edition of the Disease Control Priorities recommend basic surgical health care to the essential packages of interventions delivered at first-level hospitals in low- and middle-income countries (LMICs).[5,6]
Many LMICs continue to have a large unmet need for surgical health care,[7,8,9,10,11,12] while most public health data collection tools remain blind to the problem

Summary

Introduction

It is estimated that 5 billion people do not have access to essential surgical, obstetric, and anesthesia care.[1]. The Lancet Commission on Global Surgery developed 6 indicators for data collection and developed methods to create standardized and comparable datasets across countries over time These indicators assess the preparedness, delivery, and impact of surgical health care.[1] Some of these indicators have been recognized as World Bank Development Indicators,[13] and all 6 are included in the WHO list of 100 core health indicators.[14] the availability of data regarding surgical, anesthesia, and obstetric care remains low.[15] To become part of routine data collection processes, it is necessary to establish nationally driven sustainable data collection mechanisms pertinent to surgical care. Based on the DHS design and implementation mechanisms, a country interested in including a set of questions like the one included in Zambia, could replicate this data collection in other settings, which provides an opportunity for systematic collection of comparable surgical data, a vital role in surgical health care system strengthening

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