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Why are people dying following surgery in Africa?

Bruce Biccard's picture

Surgery is a core component of health. It is a cost-effective intervention1 which is important for global health.2 However, to fully realize the health benefits of surgery, it needs to be safe. In the African continent—with a population of 1.2 billion people—it is estimated that approximately 95% do not have access to safe and affordable surgery. The Lancet Commission on Global Surgery has established six indicators to indicate the success of providing access to safe and affordable surgery.3 Four of them are included in the World Bank’s World Development Indicators (WDI) database. The perioperative mortality rate (POMR)—the number of in-hospital deaths from any cause in patients who have undergone a procedure done in an operating theatre, divided by the total number of procedures—is one of the indicators the success in achieving safe surgery, yet it is not included in the WDI as the data is sparse, including the one from Africa. The recent publication of the African Surgical Outcomes Study (ASOS) has cast an important light on the POMR in Africa.4

ASOS has shown that for patients in Africa fortunate enough to access surgical care, the patient outcomes following surgery are relatively poor. ASOS demonstrated that African surgical patients were twice as likely to die following surgery when compared to the global average, despite a similar complication rate to the global average (Table 1). This is despite the fact that surgical patients in Africa are relatively healthy when compared with similar international surgical patient cohorts,5 and one would thus expect them to do well postoperatively. Therefore, if the data from ASOS had been risk-adjusted for patient comorbidities, it is likely that the mortality following surgery in Africa is more than twice the global average. The results from ASOS are compelling as they provide comprehensive data on surgical outcomes in Africa, from 25 countries, 247 hospitals, and over 11,000 patients.

Table 1. Mortality, complications and ‘failure to rescue’ following surgery

Source: ISOS International Surgical Outcomes Study ASOS African Surgical Outcomes Study4
(elective surgery)
(elective surgery)
(elective and emergency surgery)
Mortality 207/44 814 (0.5%) 48/4792 (1.0%) 239/11193 (2.1%)
Complications 7508/44814 (16.8%) 624/4658 (13.4%) 1977/10885 (18.2%)
Death following complication
(failure to rescue)
207/7508 (2.8%) 30/620 (4.8%) 188/1970 (9.5%)

Introducing two new dashboards in the Health, Nutrition and Population data portal

Haruna Kashiwase's picture

We’re pleased to launch new dashboards in the Health, Nutrition and Population Portal, following the portal’s revamp last year. The renewed HNP portal has two main dashboards covering Population and Health. Both dashboards are designed to be interactive data visualization tools where users can see various population and health indicators. Users can access various charts and maps by selecting specific time, country or region and indicators. We have added new indicators, charts and new health topics such as Universal Health Coverage and Surgery and Anesthesia. Below are some examples of stories gleaned from our dashboards.

India’s population is projected to surpass that of China around 2022

China, with 1.4 billion people, is the most populous country in the world in 2017. However, India, the second most populous country with 1.3 billion people, is projected to surpass China’s population by 2022. China’s total fertility rate (the number of children per woman) has also declined sharply since the 1970s.

Applications open for third round of funding for collaborative data innovation projects

World Bank Data Team's picture
Photo Credit: The Crowd and The Cloud

The Global Partnership for Sustainable Development Data and the World Bank Development Data Group are pleased to announce that applications are now open for a third round of support for innovative collaborations for data production, dissemination, and use. This follows two previous rounds of funding awarded in 2017 and earlier in 2018.

This initiative is supported by the World Bank’s Trust Fund for Statistical Capacity Building (TFSCB) with financing from the United Kingdom’s Department for International Development (DFID), the Government of Korea and the Department of Foreign Affairs and Trade of Ireland.

Scaling local data and synergies with official statistics

The themes for this year’s call for proposals are scaling local data for impact, which aims to target innovations that have an established proof of concept which benefits local decision-making, and fostering synergies between the communities of non-official data and official statistics, which looks for collaborations that take advantage of the relative strengths and responsibilities of official (i.e. governmental) and non-official (e.g.,private sector, civil society, social enterprises and academia) actors in the data ecosystem.

The 2018 Atlas of Sustainable Development Goals: an all-new visual guide to data and development

World Bank Data Team's picture
Also available in: Español | العربية | Français
Download PDF (30Mb) / View Online

“The World Bank is one of the world’s largest producers of development data and research. But our responsibility does not stop with making these global public goods available; we need to make them understandable to a general audience.

When both the public and policy makers share an evidence-based view of the world, real advances in social and economic development, such as achieving the Sustainable Development Goals (SDGs), become possible.” - Shanta Devarajan

We’re pleased to release the 2018 Atlas of Sustainable Development Goals. With over 180 maps and charts, the new publication shows the progress societies are making towards the 17 SDGs.

It’s filled with annotated data visualizations, which can be reproducibly built from source code and data. You can view the SDG Atlas online, download the PDF publication (30Mb), and access the data and source code behind the figures.

This Atlas would not be possible without the efforts of statisticians and data scientists working in national and international agencies around the world. It is produced in collaboration with the professionals across the World Bank’s data and research groups, and our sectoral global practices.

Trends and analysis for the 17 SDGs

Surgical care – an overlooked entity in health systems

Emi Suzuki's picture
Also available in: Français | Español | العربية

Five billion peopletwo thirds of world populationlack access to safe and affordable surgical, anesthesia and obstetric (SAO) care while a third of the global burden of disease requires surgical and/or anesthesia decision-making or treatment. Treating the sick very often requires surgery and anesthesia. Despite such huge burden of disease, safe and affordable SAO care is often overlooked.

Why? It may be because surgery and anesthesia are not disease entities. They are treatment modalities that address the breadth of human disease — infections, non-communicable, maternal, child, geriatric and trauma-related disease and injuries, and international development agencies have been focusing on vertical disease-based programs.

Prior to 2015, global data on surgery, anesthesia and obstetric care was virtually nonexistent. With the idea that “We can’t manage what we don’t measure”, the Lancet Commission on Global Surgery developed six Surgical, Obstetric and Anesthesia (SAO) indicators (discussed here) and collected data for them. The analysis of these data show large gaps in SAO care across countries by income groups.

There are 70-times as many surgical workers per 100,000 people in high-income countries compared with low-income countries

The SAO or “surgical” workforce is extremely small in low-income countries (1 SAOs per 100,000 population) and lower middle-income countries (10 SAOs per 100,000 population) whereas there are 69 SAOs per 100,000 population in high-income countries. The discrepancy between high-income countries and low- and middle-income countries is even greater for surgical workforce density than that of physician density.

Measuring surgical systems worldwide: an update

Parisa Kamali's picture
Photo: Chhor Sokunthea / World Bank

Five billion people—two thirds of world population—lack access to safe and affordable surgical, obstetric and anesthesia care with low and middle income countries (LMICs) taking a lead.1-3 Surgical care is a crucial component of building strong health systems and one that is often overlooked (Dr. Jim Kim UHC 2017 video). All people are entitled to quality essential health services, no matter who they are, where they live, or how much money they have. This simple but powerful belief underpins the growing movement towards universal health coverage (UHC), a global commitment under the Sustainable Development Goals (SDGs). Inherent in the framework of UHC is access to safe surgical, obstetric and anesthesia (SOA) care.

An estimated 33 million undergo financial hardship every year from the direct costs of surgical care. And those are the individuals fortunate enough to have access to care.4 Moreover, about 11% of the world’s disability-adjusted life years are attributable to diseases that are often treated with surgery such as heart and cerebrovascular diseases, cancer, and injuries from road traffic accidents.2,5 Other surgically treatable disorders such as obstructed labour, obstetric fistulas, and congenital birth defects are major causes of morbidity and mortality in the developing world.5,7 The delivery of safe and quality SOA care is critical for the realization of many of the Sustainable Development Goals, including: Good health and well-being (Goal 3); No poverty (Goal 1); Gender equality (Goal 5), and Reducing inequalities (Goal 10).

Announcing Funding for 12 Development Data Innovation Projects

World Bank Data Team's picture
Also available in: Français | 中文

We’re pleased to announce support for 12 projects which seek to improve the way development data are produced, managed, and used. They bring together diverse teams of collaborators from around the world, and are focused on solving challenges in low and lower middle-income countries in Sub-Saharan Africa, East Asia, Latin America, and South Asia.

Following the success of the first round of funding in 2016, in August 2017 we announced a $2.5M fund to support Collaborative Data Innovations for Sustainable Development. The World Bank’s Development Data group, together with the Global Partnership for Sustainable Development Data, called for ideas to improve the production, management, and use of data in the two thematic areas of “Leave No One Behind” and the environment. To ensure funding went to projects that solved real people’s problems, and built solutions that were context-specific and relevant to its audience, applicants were required to include the user, in most cases a government or public entity, in the project team. We were also looking for projects that have the potential to generate learning and knowledge that can be shared, adapted, and reused in other settings.

From predicting the movements of internally displaced populations in Somalia to speeding up post-disaster damage assessments in Nepal; and from detecting the armyworm invasive species in Malawi to supporting older people in Kenya and India to map and advocate for the better availability of public services; the 12 selected projects summarized below show how new partnerships, new methods, and new data sources can be integrated to really “put data to work” for development.

This initiative is supported by the World Bank’s Trust Fund for Statistical Capacity Building (TFSCB) with financing from the United Kingdom’s Department for International Development (DFID), the Government of Korea and the Department of Foreign Affairs and Trade of Ireland.

2018 Innovation Fund Recipients

Chart: 100 Million People Pushed into Poverty by Health Costs in 2010

Tariq Khokhar's picture
Also available in: 中文 | Español | العربية | Français

Universal health coverage (UHC) means that all people can obtain the health services they need without suffering financial hardship. A new report produced by the World Bank and the World Health Organization, finds that health expenditures are pushing about 100 million people per year into “extreme poverty,” those who live on $1.90 or less a day; and about 180 million per year into poverty using a $3.10 per day threshold.

You can access the report, data, interactive visualizations, and background papers at:

Malawi’s Fourth Integrated Household Survey 2016-2017 & Integrated Household Panel Survey 2016: Data and documentation now available

Heather Moylan's picture
Malawi IHS4 Enumerator administering household questionnaire
using World Bank Survey Solutions
Photo credit: Heather Moylan, World Bank

The Malawi National Statistical Office (NSO), in collaboration with the World Bank’s Living Standards Measurement Study (LSMS), disseminated the findings from the Fourth Integrated Household Survey 2016/17 (IHS4), and the Integrated Household Panel Survey 2016 (IHPS), on November 22, 2017 in Lilongwe, Malawi. Both surveys were implemented under the World Bank Living Standards Measurement Study-Integrated Surveys on Agriculture (LSMS-ISA) initiative, with funding from the United States Agency for International Development (USAID).

The IHS4 is the fourth cross-sectional survey in the IHS series, and was fielded from April 2016 to April 2017. The IHS4 2016/17 collected information from a sample of 12,447 households, representative at the national-, urban/rural-, regional- and district-levels.

In parallel, the third (2016) round of the Integrated Household Panel Survey (IHPS) ran concurrently with the IHS4 fieldwork. The IHPS 2016 targeted a national sample of 1,989 households that were interviewed as part of the IHPS 2013, and that could be traced back to half of the 204 panel enumeration areas that were originally sampled as part of the Third Integrated Household Survey (IHS3) 2010/11.

The panel sample expanded each wave through the tracking of split-off individuals and the new households that they formed. The IHPS 2016 maintained a 4 percent household-level attrition rate (the same as 2013), while the sample expanded to 2,508 households. The low attrition rate was not a trivial accomplishment given only 54 percent of the IHPS 2016 households were within one kilometer of their 2010 location.

New child mortality estimates show that 15,000 children died every day in 2016

Emi Suzuki's picture
Also available in: Español | Français | العربية | 中文

This blog is based on new child mortality estimates released today by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)

There has been substantial progress in reducing child mortality in the past several decades. Between 1990 and 2016, the global under-five mortality rate dropped by 56 percent from 93 deaths per 1,000 live births to 41 deaths per 1,000 live births. Over the last sixteen years, the reduction in child mortality rates accelerated, compared to the previous decade. As a consequence, around 50 million more young children survived the first five years of life since 2000 who would have died had under-five mortality remained at the same level as in 2000.

But even in 2016, 15,000 children died every day (totaling 5.6 million a year). While a substantial reduction from the 35,000 deaths a day in 1990 (12.6 million a year), more needs to be done to meet target 3.2 of the Sustainable Development Goals, which aims for all countries fewer than 25 deaths of under-5s per 1,000 live births.