ArticleWorld journal of surgery2016
Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures.
Article in World journal of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 71 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
71 citing papers in PubMed, 4 syntheses or guidelines pooled it, 143 citations in OpenAlex.
- Factors associated with prolonged 'decision-to-delivery intervals' during emergency caesarean deliveries in Ethiopia: systematic review with meta-analysis, 2024.BMC pregnancy and childbirth · 2026Pooled it
- Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review.World journal of surgery · 2023Pooled it
- Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis.World journal of surgery · 2022Pooled it
- Surgical Task-Sharing to Non-specialist Physicians in Low-Resource Settings Globally: A Systematic Review of the Literature.World journal of surgery · 2020Pooled it
- GO-Tibia: a masked, randomized control trial evaluating gentamicin versus saline in open tibia fractures.Trials · 2023Trial
- Intramedullary Nailing Versus External Fixation in the Treatment of Open Tibial Fractures in Tanzania: Results of a Randomized Clinical Trial.The Journal of bone and joint surgery. American volume · 2020Trial
- Surgical Infrastructure and Workforce Readiness in Rwanda's District and Level 2 Teaching Hospitals: A Nationwide Facility-Based Survey.World journal of surgery · 2026Article
- Catastrophic health expenditure associated to bellwether surgery care in Northcentral Ethiopia.BMC surgery · 2026Observational
- Geospatial analysis in addressing surgical care inequities: A scoping review and methodological guide.PLOS digital health · 2026Article
- Evaluating bellwether surgical outcomes in Ethiopia: insights from a multicentre 7-day prospective cohort study.BMC surgery · 2026Observational
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Defining the bellwether procedures and processes for global trauma care: an international Delphi study.BMJ global health · 2026Article
- Retrospective analysis of a surgical service in a rural district hospital in the Eastern Cape.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2026Article
- Emergency, critical and operative care in Afghanistan: pathways to overcoming fragmentation and strengthening access in a post-conflict setting-a mixed-method study.BMJ public health · 2026Article
- Assessing the Perioperative Capacity in the Republic of Zambia in Preparation for the First Revision of the National Surgical Obstetric and Anesthesia Plan (NSOAP): A Rapid Survey Method.World journal of surgery · 2025Article
- Community Perceptions of Accessing Surgical and Anesthetic Care in Rural Guatemala: A Cross-Sectional Survey.Cureus · 2025Article
- Surveying anesthesia care provision and deficiencies among the secondary public sector hospitals of rural Sindh, Pakistan.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2025Article
- Adherence to Enhanced Recovery After Surgery (ERAS) With Bellwether Surgical Procedures in Ethiopia: A Retrospective Study.World journal of surgery · 2025Article
- Determinant of adverse early neonatal outcomes following emergency cesarean section in North West, Ethiopia: institutional-based case-control study.BMC pregnancy and childbirth · 2024Article
- Predictors of quality of life, economic impact, and loss to follow-up after open tibial shaft fractures in Ghana.OTA international : the open access journal of orthopaedic trauma · 2024Article
11 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 8 institutions in 6 countries.
Funding
Abstract
backgroundSurgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care.
methodsWe convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures-which we term "bellwether procedures"-was associated with performing a full range of essential surgical procedures.
findingsThe ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures.
interpretationCaesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.