RT Journal Article SR Electronic T1 The Development and Inclusion of Questions on Surgery in the 2018 Zambia Demographic and Health Survey JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 905 OP 914 DO 10.9745/GHSP-D-20-00619 VO 9 IS 4 A1 Sabrina Juran A1 Sanna Moren A1 Vatshalan Santhirapala A1 Lina Roa A1 Emmanuel Makasa A1 Justine Davies A1 Jose Miguel Guzman A1 Lars Hagander A1 Hampus Holmer A1 Mark G. Shrime A1 Thomas G. Weiser A1 John G. Meara A1 Stefanie J. Klug A1 David Ljungman YR 2021 UL http://www.ghspjournal.org/content/9/4/905.abstract AB Key FindingsBased on this pilot survey, which responded to the call to collect, aggregate, and analyze global anesthesia and surgery data, we conclude that it is feasible to integrate surgical questions into a large-scale sample survey to provide insight into surgical needs at a national level.Approximately 5% of women and 2% of men had undergone an operation in Zambia in the past 5 years. Among women, cesarean delivery was the most common surgery, while circumcision was the most common procedure among men.The diagnosed unmet need for surgical care in Zambia is estimated to be 65%.Key ImplicationsFor health system strengthening, baseline data and monitoring of progress are necessary. Improved data capabilities allow for mapping out and understanding systems.Data collection mechanisms pertinent to surgical care need to become part of routine data collection processes.There is a need to build on existing data collection mechanisms to avoid adding unnecessary burden, information overload, and data collection fatigue.The replicable design of the Demographic and Health Survey allows for the systematic collection of comparable surgical data in other settings. Similar questions could be included in other surveys as well.There is a need to establish data pathways to ensure clear responsibilities among national and international institutions and integrate surgical metrics into existing mechanisms for sustainable data collection.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.