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ORIGINAL ARTICLE
Open Access

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

Sabrina Juran, Sanna Moren, Vatshalan Santhirapala, Lina Roa, Emmanuel Makasa, Justine Davies, Jose Miguel Guzman, Lars Hagander, Hampus Holmer, Mark G. Shrime, Thomas G. Weiser, John G. Meara, Stefanie J. Klug and David Ljungman
Global Health: Science and Practice December 2021, 9(4):905-914; https://doi.org/10.9745/GHSP-D-20-00619
Sabrina Juran
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
bEpidemiology, Department of Sport and Health Sciences, Technical University Munich, Germany.
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  • For correspondence: sabrina_juran{at}hms.harvard.edu
Sanna Moren
cDepartment of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
dRegion Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden.
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Vatshalan Santhirapala
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
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Lina Roa
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
eDepartment of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada.
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Emmanuel Makasa
fWits Centre of Surgical Care for Primary Health and Sustainable Development, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
gMRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
hCentre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
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Justine Davies
iInstitute of Applied Health Research, University of Birmingham, United Kingdom.
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Jose Miguel Guzman
jNoBrainerData, Columbia, MD, USA.
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Lars Hagander
kWHO Collaborating Centre on Surgery and Public Health, Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
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Hampus Holmer
kWHO Collaborating Centre on Surgery and Public Health, Pediatric Surgery, Department of Clinical Sciences in Lund, Faculty of Medicine, Lund University, Lund, Sweden.
lDepartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Mark G. Shrime
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
mInstitute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Thomas G. Weiser
nDepartment of Surgery, Stanford University, Stanford, CA, USA.
oDepartment of Clinical Surgery, University of Edinburgh, Edinburgh, United Kingdom.
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John G. Meara
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
pDepartment of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
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Stefanie J. Klug
bEpidemiology, Department of Sport and Health Sciences, Technical University Munich, Germany.
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David Ljungman
aProgram in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
cDepartment of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
dRegion Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, Gothenburg, Sweden.
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Figures & Tables

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    FIGURE

    Type of Surgerya Performed in the Last 5 Years Among Women (n=630) and Men (n=230), 2018 Zambia Demographic and Health Survey

    aCesarean delivery (3.4% of women) has been omitted, as the frequency was much higher than the second most common procedure.

Tables

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    TABLE 1.

    Surgery-Related Questions Added to the 2018 Zambia Demographic and Health Survey

    Women's and Men's Questionnaire
    Have you ever undergone a surgical operation in the past 5 years?
        Yes
        No
    What type of operation(s) were they? (Name all that apply)
        Hernia operation
        Cesarean delivery (women's questionnaire only)
        Hydrocele operation (men's questionnaire only)
        Laparotomy (cutting open the abdomen)
        Lump removal
        Abscess drainage
        Wound closure
        Open fracture
        Other (specify)
    In the last 5 years has a doctor or another healthcare worker told you that you might need (another) operation?
        Yes
        No
    Were you able to access it?
        Yes
        No
    Why did you not access it? (Record all mentioned)
        I could not reach the doctor
        I could not afford the operation
        I could not afford to get to the hospital
        I could not afford the time off work
        It was too far to get to the hospital
        I did not trust the operation would make me better
        Fear of care
        Out of shame
        My spouse/family would not let me go
        Other (specify)
    Maternal Mortality Module
    Did (name) receive a cesarean delivery?
    Did (name) die in the hospital?
    • View popup
    TABLE 2.

    Reasons Why 2018 Zambia Demographic and Health Survey Respondents Reported Not Accessing Surgical Health Care in Zambia

    MenWomenTotalPopulation, %
    Did not trust the operation would make me better78150.06
    Fear of care68140.05
    Could not reach the doctor77140.05
    It was not needed anymore113140.05
    Could not afford the operation47110.04
    Spouse/family would not let me go55100.04
    Could not afford to get to the hospital3350.02
    Was too far to get to the hospital3140.02
    Could not afford time off work1230.01
    Other48120.05
    Sum41611020.40
    • View popup
    TABLE 3.

    2018 Zambia Demographic and Health Survey Respondents' Answers on Maternal Mortality

    Total Number of Female Siblings of Respondents36,114
    Total deaths among female siblings3,986 (11% of female siblings, 95% CI=10%, 12%)
    Total maternal deaths221 (5.5% of deaths among female siblings, 95% CI=2.5%, 8.6%)
    Total cesarean deliveries among maternal deaths81 (37% of maternal deaths, 95% CI=26%, 47%)
    Total maternal deaths in hospital48 (22% of maternal deaths, 95% CI=10%, 34%)
    • Abbreviation: CI, confidence interval.

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Global Health: Science and Practice: 9 (4)
Global Health: Science and Practice
Vol. 9, No. 4
December 31, 2021
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The Development and Inclusion of Questions on Surgery in the 2018 Zambia Demographic and Health Survey
Sabrina Juran, Sanna Moren, Vatshalan Santhirapala, Lina Roa, Emmanuel Makasa, Justine Davies, Jose Miguel Guzman, Lars Hagander, Hampus Holmer, Mark G. Shrime, Thomas G. Weiser, John G. Meara, Stefanie J. Klug, David Ljungman
Global Health: Science and Practice Dec 2021, 9 (4) 905-914; DOI: 10.9745/GHSP-D-20-00619

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The Development and Inclusion of Questions on Surgery in the 2018 Zambia Demographic and Health Survey
Sabrina Juran, Sanna Moren, Vatshalan Santhirapala, Lina Roa, Emmanuel Makasa, Justine Davies, Jose Miguel Guzman, Lars Hagander, Hampus Holmer, Mark G. Shrime, Thomas G. Weiser, John G. Meara, Stefanie J. Klug, David Ljungman
Global Health: Science and Practice Dec 2021, 9 (4) 905-914; DOI: 10.9745/GHSP-D-20-00619
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