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Juran S, Moren S, Santhirapala V, Roa L, Makasa E, Davies J, Guzman JM, Hagander L, Holmer H, Shrime MG, Weiser TG, Meara JG, Klug SJ, Ljungman D. The Development and Inclusion of Questions on Surgery in the 2018 Zambia Demographic and Health Survey. Glob Health Sci Pract 2021; 9:905-914. [PMID: 34933985 PMCID: PMC8691885 DOI: 10.9745/ghsp-d-20-00619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
Data from household surveys serve as the backbone to sustainable development planning. For the first time, questions on surgery have been included in a nationwide Demographic and Health Survey, showing that it is feasible to integrate these questions into a large-scale survey. Background: 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. Method: 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. Results: 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. Conclusion: 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.
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Affiliation(s)
- Sabrina Juran
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Germany
| | - Sanna Moren
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden
| | | | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
| | - Emmanuel Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | | | - Lars Hagander
- WHO Collaborating Centre on Surgery and Public Health, Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hampus Holmer
- WHO Collaborating Centre on Surgery and Public Health, Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, CA, USA
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Stefanie J Klug
- Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Germany
| | - David Ljungman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden
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