{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:40:34Z","timestamp":1789486834093,"version":"build-2803163510"},"reference-count":43,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008069","name":"University of California, San Francisco","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2015, the Lancet Commission on Global Surgery promoted the adoption of six perioperative care indicators and increased their visibility in national health policies. However, regular reporting of these surgical indicators remains limited due to challenges with data infrastructure and workforce capacity. This study defines the surgical data ecosystem in a low\u2010income country and develops a tool for harmonizing national data ecosystems with validated global indicators.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory, mixed\u2010methods study examined the scope of Mozambique's surgical data ecosystem in 2023. Data were obtained in three phases: qualitative interviews with health data stakeholders, analysis of data instruments from four purposively selected public hospitals, and review of aggregate Ministry of Health reports used for surgical system monitoring and evaluation. These data were organized by domains and compared with international reporting standards, informing development of the Surgical Data Availability and Transferability Assessment (S\u2010DATA) tool for evaluating surgical data availability, transferability, and usability for global benchmarking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Metadata and data instruments were inconsistent across hospitals, which carried into aggregate reports. Facility\u2010level data elements and national reports did not align with national and international guidelines, respectively. Processes for aggregating data varied between data managers, leading to loss of information in summary reports. The flow of surgical data from facility to national reports revealed multiple parallel data streams. These findings informed development and pilot application of the S\u2010DATA tool, with variable data ecosystem performance at the facility level, ranging from fair to poor, yet excellent metadata availability at the highest levels of aggregation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study represents the first structured evaluation of a surgical data ecosystem in Mozambique and the development of a novel framework for benchmarking surgical data availability against international standards. Data management analysis revealed gaps, redundancies, and inefficiencies at each level of aggregation. Standardized data instruments and reporting processes may facilitate monitoring and evaluation of surgical systems. Future studies are necessary to validate the S\u2010DATA tool in additional settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70507","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T06:09:54Z","timestamp":1785996594000},"page":"2680-2691","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Surgical Data Availability and Transferability Assessment Tool and Its Use in Evaluating Mozambique's Surgical Data Ecosystem"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8248-3204","authenticated-orcid":false,"given":"Ism\u00e9nia","family":"Simbine","sequence":"first","affiliation":[{"name":"Surgery Department Maputo Central Hospital Eduardo Mondlane University  Maputo Mozambique"},{"name":"Center for Health Equity in Surgery and Anesthesia University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4672-9414","authenticated-orcid":false,"given":"Greta L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Center for Health Equity in Surgery and Anesthesia University of California San Francisco  San Francisco California USA"},{"name":"Division of Plastic and Reconstructive Surgery Department of Surgery University of California San Francisco Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8874-1900","authenticated-orcid":false,"given":"Emilia V.","family":"Noormahomed","sequence":"additional","affiliation":[{"name":"Department of Microbiology Faculty of Medicine Universidade Eduardo Mondlane (UEM)  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8266-8359","authenticated-orcid":false,"given":"Chadreque","family":"Muluana","sequence":"additional","affiliation":[{"name":"Ministry of Health (MISAU)  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2668-7838","authenticated-orcid":false,"given":"Edson","family":"Francisco","sequence":"additional","affiliation":[{"name":"Ministry of Health (MISAU)  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2626-2407","authenticated-orcid":false,"given":"Stephen W.","family":"Bickler","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Pediatric Surgery University of California San Diego  La Jolla California USA"},{"name":"Rady Children's Hospital  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9399-9527","authenticated-orcid":false,"given":"Matchecane","family":"Cossa","sequence":"additional","affiliation":[{"name":"Surgery Department Maputo Central Hospital Eduardo Mondlane University  Maputo Mozambique"},{"name":"Ministry of Health (MISAU)  Maputo Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-5892","authenticated-orcid":false,"given":"John","family":"Rose","sequence":"additional","affiliation":[{"name":"Center for Health Equity in Surgery and Anesthesia University of California San Francisco  San Francisco California USA"},{"name":"Division of Plastic and Reconstructive Surgery Department of Surgery University of California San Francisco Medical Center  San Francisco California USA"},{"name":"Philip R. Lee Institute for Health Policy Studies University of California San Francisco Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010015\u20103153\u2010y"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.12268"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(25)00985\u20107"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1101\/2024.12.24.24316011"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010023\u201007029\u2010x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2017.01.009"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10151"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.11061"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.5334\/aogh.4251"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60806\u20106"},{"key":"e_1_2_12_13_1","volume-title":"World Bank Country and Lending Groups","author":"World Bank"},{"key":"e_1_2_12_14_1","volume-title":"Population, Total (SP.POP.TOTL)","author":"World Bank"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010020\u201005925\u20100"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12992\u2010019\u20100508\u20104"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12314"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003749"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpopen.2021.100048"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.827253"},{"key":"e_1_2_12_21_1","unstructured":"DHIS2 Health Data Toolkit: DHIS2; [cited 2025 Aug 2] https:\/\/dhis2.org\/health\u2010data\u2010toolkit\/."},{"key":"e_1_2_12_22_1","unstructured":"UNITAR. 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