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. The present study describes the first development and inclusion of questions on surgery in a nationally representative Demographic and Health Survey (DHS) in Zambia and presents initial results from the survey.
Questions regarding surgical conditions were developed through an iterative consultative process. Consensus was reached regarding four themes for which questions were developed and integrated into the DHS questionnaires. The questions were 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 and men aged 15-59 years of age.
In total, seven questions covering the themes of service delivery, diagnosed burden of surgical disease, access to care, and quality of care were added to the questionnaires. The questions were administered across 12,831 households (13,683 women age 15-49 years and 12,132 men age 15-59 years). Results showed that approximately 5% of women and 2% of men had undergone an operation in the past five years. Among women, cesarean section was the most common surgery, while circumcision represented the most common procedure among men. In the past five years an estimated 0.61% of the population had been told by a healthcare worker that they might need surgery, and out of this group, 35% had undergone the relevant procedure. Not trusting the recommended operation would improve health was the most common reason for not accessing surgical care.
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. Needs and access to care data need validation by clinical assessment and comparisons to facility logs. 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.