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

Author

Juran, S, Moren, S, Santhirapala, V, Roa, L, Makasa, E, Davies, J, Guzman, JM, Hagander, L, Holmer, H, Shrime, MG, Weiser, TG, Meara, JG, Klug, SJ, Ljungman, D, Juran, S, Moren, S, Santhirapala, V, Roa, L, Makasa, E, Davies, J, Guzman, JM, Hagander, L, Holmer, H, Shrime, MG, Weiser, TG, Meara, JG, Klug, SJ, and Ljungman, D

Abstract

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.

Published
2021

8. Access to paediatric surgery: the geography of inequality in Nigeria

Author

El Vilaly, MAS, Jones, MA, Stankey, MC, Seyi-Olajide, J, Onajin-Obembe, B, Dasogot, A, Klug, SJ, Meara, J, Ameh, EA, Osagie, OO, Juran, S, El Vilaly, MAS, Jones, MA, Stankey, MC, Seyi-Olajide, J, Onajin-Obembe, B, Dasogot, A, Klug, SJ, Meara, J, Ameh, EA, Osagie, OO, and Juran, S

Abstract

BACKGROUND: About 96.3 million children and adolescents aged 0-19 years reside in Nigeria, comprising 54% of the population. Without adequate access to surgery for commonly treatable diseases, many face disability and increased risk of mortality. Due to this population's unique perioperative needs, increasing access to paediatric surgical care requires a situational evaluation of the distribution of paediatric surgeons and anaesthesiologists. This study's aim is to identify the percentage of Nigerian youth who reside within 2 hours of paediatric surgical care at the state and national level. METHODS: The Association of Paediatric Surgeons of Nigeria and the Nigeria Society of Anaesthetists provided surgical and anaesthesia workforce data by state. Health facilities with paediatric surgeons were converted to point locations and integrated with ancillary geospatial layers and population estimates from 2016 and 2017. Catchment areas of 2 hours of travel time around a facility were deployed as the benchmark indicator to establish timely access. RESULTS: Across Nigeria's 36 states and Federal Capital Territory, the percentage of Nigeria's 0-19 population residing within 2 hours of a health facility with a paediatric surgical and anaesthesia workforce ranges from less than 2% to 22.7%-30.5%. In 3 states, only 2.1%-4.8% of the population can access a facility within 2 hours, 12 have 4.9%-13.8%, and 8 have 13.9%-22.6%. CONCLUSION: There is significant variation across Nigerian states regarding access to surgical care, with 69.5%-98% of Nigeria's 0-19 population lacking access. Developing paediatric surgical services in underserved Nigerian states and investing in the training of paediatric surgical and anaesthesia workforce for those states are key components in improving the health of Nigeria's 0-19 population and reducing Nigeria's burden of surgical disease, in line with Nigeria's National Surgical, Obstetrics, Anaesthesia and Nursing Plan.

Published
2021

10. Cervical cancer and HIV

Author

Tanaka LF, Stelzle D, Klug SJ. and Tanaka LF, Stelzle D, Klug SJ.

Published
2020

14. Estimates of the global burden of cervical cancer associated with HIV

Author

Stelzle D, Tanaka LF, Lee KK, Ibrahim-Khalil A, Baussano I, Shah SV A, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F, Baggaley R, Clifford G, Broutet N, Dalal S and Stelzle D, Tanaka LF, Lee KK, Ibrahim-Khalil A, Baussano I, Shah SV A, McAllister DA, Gottlieb SL, Klug SJ, Winkler AS, Bray F, Baggaley R, Clifford G, Broutet N, Dalal S

Published
2019

16. Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

Author

Juran, S, Broer, PN, Klug, SJ, Snow, RC, Okiro, EA, Ouma, PO, Snow, RW, Tatem, AJ, Meara, JG, Alegana, VA, Juran, S, Broer, PN, Klug, SJ, Snow, RC, Okiro, EA, Ouma, PO, Snow, RW, Tatem, AJ, Meara, JG, and Alegana, VA

Abstract

INTRODUCTION: Despite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level. METHODS: Major district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level. RESULTS: Overall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern. CONCLUSION: The study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

Published
2018

21. Prevention of Cervical Cancer - Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) – Part 2 on Triage, Treatment and Follow-up

Author

Hillemanns P, Dannecker C, Klug SJ, Iftner T, Löning T, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Beckmann M, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Petry KU, Schäfer APA, Pawlita M, Fehr M, Grimm C, Reich O, Jentschke M. and Hillemanns P, Dannecker C, Klug SJ, Iftner T, Löning T, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Beckmann M, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Petry KU, Schäfer APA, Pawlita M, Fehr M, Grimm C, Reich O, Jentschke M.

Published
2018

23. HPV-Impfung auch für Jungen: Die neue STIKO-Empfehlung

Author

Klug SJ, Takla A, Meerpohl J, Röbl-Mathieu M, Terhardt M, van der Sande M, Zepp F, Wiese-Posselt M, Harder T, Wichmann O. and Klug SJ, Takla A, Meerpohl J, Röbl-Mathieu M, Terhardt M, van der Sande M, Zepp F, Wiese-Posselt M, Harder T, Wichmann O.

Published
2017

24. The need to collect, aggregate, analyze global anesthesia and surgery data

Author

Juran S, Gründl M, Marks I, Broer PN, Guzman JM, Davies J, Shrime M, Johnson W, Holmer H, Peck G, Makasa E, Hagander L, Klug SJ, Meara JG, Gelb AW, Ljungman D. and Juran S, Gründl M, Marks I, Broer PN, Guzman JM, Davies J, Shrime M, Johnson W, Holmer H, Peck G, Makasa E, Hagander L, Klug SJ, Meara JG, Gelb AW, Ljungman D.

Published
2017

25. HPV-Impfung: Auch Jungen können profitieren

Author

Klug SJ; Meerpohl J; Röbl-Mathieu M; Terhardt M; van der Sande M; Zepp F; Takla A; Wiese-Posselt M; Harder T; Wichmann O and Klug SJ; Meerpohl J; Röbl-Mathieu M; Terhardt M; van der Sande M; Zepp F; Takla A; Wiese-Posselt M; Harder T; Wichmann O

Published
2017

42. Das Peniskarzinom - Gemeldete Fälle und Überleben in Sachsen, 2000-2008

Author

Klug, SJ, Böhm, WD, Neumann, A, Gonsior, A, Horn, LC, Kriegel, C, Stolzenberg, JU, Stabenow, R, Klinische Krebsregister Sachsen, Chemnitz, Dresden, Görlitz, Leipzig, Zwickau, Klug, SJ, Böhm, WD, Neumann, A, Gonsior, A, Horn, LC, Kriegel, C, Stolzenberg, JU, Stabenow, R, and Klinische Krebsregister Sachsen, Chemnitz, Dresden, Görlitz, Leipzig, Zwickau

Published
2011

44. Das Peniskarzinom - Gemeldete Fälle und Überleben in Sachsen, 2000-2008

Author

Klug, SJ, Böhm, WD, Neumann, A, Gonsior, A, Horn, LC, Kriegel, C, Stolzenberg, JU, Stabenow, R, Klinische Krebsregister Sachsen, Chemnitz, Dresden, Görlitz, Leipzig, Zwickau, Klug, SJ, Böhm, WD, Neumann, A, Gonsior, A, Horn, LC, Kriegel, C, Stolzenberg, JU, Stabenow, R, and Klinische Krebsregister Sachsen, Chemnitz, Dresden, Görlitz, Leipzig, Zwickau

Published
2011

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