{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T17:10:40Z","timestamp":1765041040881,"version":"build-2065373602"},"reference-count":17,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,29]],"date-time":"2020-05-29T00:00:00Z","timestamp":1590710400000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["GHRU 16\/136\/54"],"award-info":[{"award-number":["GHRU 16\/136\/54"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,4,29]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Over 5\u2009billion people in the world do not have access to safe, affordable surgical and anaesthesia care when needed. In order to improve health outcomes in patients with surgical conditions, both access to care and the quality of care need to be improved. A recent commission on high-quality health systems highlighted that poor-quality care is now a bigger barrier than non-utilisation of the health system for reducing mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To carry out a systematic review to provide an evidence-based summary of hospital-based interventions associated with improved quality of surgical and anaesthesia care in sub-Saharan African countries (SSACs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and analysis<\/jats:title>\n                  <jats:p>Three search strings (1) surgery and anaesthesia, (2) quality improvement hospital-based interventions and (3) SSACs will be combined. The following databases EMBASE, Global Health, MEDLINE, CINAHL, Web of Science and Scopus will be searched. Further relevant studies will be identified from national and international health organisations and publications and reference lists of all selected full-text articles. The review will include all type of original articles in English published between 2008 and 2019. Article screening, data extraction and assessment of methodological quality will be done by two reviewers independently and any disputes will be resolved by a third reviewer or team consensus. Three types of outcomes will be collected including clinical, process and implementation outcomes. The primary outcome will be mortality. Secondary outcomes will include other clinical outcomes (major and minor complications), as well as process and implementation outcomes. Descriptive statistics and outcomes will be summarised and discussed. For the primary outcome, the methodological rigour will be assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Ethics and dissemination<\/jats:title>\n                  <jats:p>The results will be published in a peer reviewed open access journal and presented at national and international conferences. As this is a review of secondary data no formal ethical approval is required.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PROSPERO registration number<\/jats:title>\n                  <jats:p>CRD42019125570.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-036615","type":"journal-article","created":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T16:46:59Z","timestamp":1590857219000},"page":"e036615","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Improving quality of surgical and anaesthesia care at hospital level in sub-Saharan Africa: a systematic review protocol of health system strengthening interventions"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6930-5166","authenticated-orcid":false,"given":"Nataliya","family":"Brima","sequence":"first","affiliation":[{"name":"King\u2019s Centre for Global Health & Health Partnerships, King's College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justine","family":"Davies","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew JM","family":"Leather","sequence":"additional","affiliation":[{"name":"King\u2019s Centre for Global Health & Health Partnerships, King's College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,5,30]]},"reference":[{"key":"2025101813360877000_10.5.e036615.1","first-page":"6569-","article-title":"Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development","volume":"38","author":"Meara","year":"2015","journal-title":"Lancet"},{"key":"2025101813360877000_10.5.e036615.2","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1016\/S2214-109X(14)70384-5","article-title":"Global burden of surgical disease: an estimation from the provider perspective","volume":"3 Suppl 2","author":"Shrime","year":"2015","journal-title":"Lancet Glob Health"},{"key":"2025101813360877000_10.5.e036615.3","doi-asserted-by":"crossref","DOI":"10.2471\/BLT.08.052290","article-title":"Injuries: the neglected burden in developing countries","volume":"87","author":"Gosselin","year":"2009","journal-title":"Bull World Health Organ"},{"key":"2025101813360877000_10.5.e036615.4","doi-asserted-by":"crossref","DOI":"10.1016\/S0140-6736(15)60806-6","article-title":"Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes","volume":"385 Suppl 2","author":"Weiser","year":"2015","journal-title":"Lancet"},{"key":"2025101813360877000_10.5.e036615.5","unstructured":"Biccard BM , Madiba TE , Medical Research Council, South Africa . African surgical outcomes study (ASOS) Investigators. Available: https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=African+Surgical+Outcomes+Study+(ASOS)+investigators%5BCorporate+Author%5D [Accessed 19th December 2019]."},{"key":"2025101813360877000_10.5.e036615.6","unstructured":"Weiser TG , Debas HT , Gawande A , et al . Chapter 2. In: Source Essential Surgery:Disease Control Priorities. Third Edition (Volume 1). Washington (DC): The International Bank for Reconstruction and Development \/ The World Bank, 2015."},{"key":"2025101813360877000_10.5.e036615.7","doi-asserted-by":"crossref","first-page":"e303","DOI":"10.1016\/S2214-109X(18)30529-1","article-title":"High-Quality health systems in the sustainable development goals era: time for a revolution","volume":"7","author":"Kruk","year":"2019","journal-title":"The Lancet global health"},{"key":"2025101813360877000_10.5.e036615.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"2025101813360877000_10.5.e036615.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g7647","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation","volume":"349","author":"Shamseer","year":"2015","journal-title":"BMJ"},{"key":"2025101813360877000_10.5.e036615.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"2025101813360877000_10.5.e036615.11","unstructured":"World Health Organization . Everybody\u2019s Business. In: Strengthening Health Systems toImprove Health Outcomes: WHO\u2019s Framework for Action. Geneva: World health Organization, 2007."},{"key":"2025101813360877000_10.5.e036615.12","unstructured":"World Bank . World bank country and lending groups, 2018. Available: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519-world-bank-country-and-lending-groups [Accessed 19th December 2019]."},{"key":"2025101813360877000_10.5.e036615.13","doi-asserted-by":"crossref","DOI":"10.1186\/s13643-017-0644-y","article-title":"Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study","volume":"6","author":"Bramer","year":"2017","journal-title":"Syst Rev"},{"key":"2025101813360877000_10.5.e036615.14","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"2025101813360877000_10.5.e036615.15","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-010-0319-7"},{"key":"2025101813360877000_10.5.e036615.16","doi-asserted-by":"crossref","unstructured":"2011a G , Guyatt G , Oxman AD , et al . Grade guidelines: 1. Introduction\u2014GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology;2011:383\u2013\u201394.","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2025101813360877000_10.5.e036615.17","first-page":"199","article-title":"Observational and interventional study design types; an overview","volume":"24","year":"2014","journal-title":"BioMed"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-036615","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:36:17Z","timestamp":1760819777000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-036615"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":17,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,30]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/bmjopen-2019-036615"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-036615","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}