Reporting of surgical response to disasters in low-income and middle-income countries: a literature review

Background: Natural and man-made disasters can overwhelm the capacity of surgical systems in low-income and middle-income countries (LMICs). Most studies addressing peri-disaster surgical care focus on international relief efforts rather than on how disasters stress local surgical capacity. Our understanding of factors that affect the ability of health systems to absorb increased volume and case-complexity is poor. We conducted a structured literature review to identify whether components of capacity were reported as part of surge response in local surgical care after disasters. Methods: We searched PubMed and Medline databases for articles published between January, 2008, and August, 2018, using English language search terms for LMICs, surgery, and disasters. We extracted information about the WHO region, disaster classification, and the components of surge capacity using the 4S framework: Staff (human resources), Stuff (equipment/supplies), Space (infrastructure), and Systems (logistics). The 4S components were further classified by data quality into the following categories: quantitative description, qualitative description, or no description. Findings: We identified 7704 articles but after applying exclusion criteria, including foreign aid response, we selected 84 articles for analysis. Most articles (59/84 [70%]) described earthquakes and 40/84 (48%) reported events in the Western Pacific region. Using the 4S framework, we identified articles that reported quantitative data: 16 (19%) for Staff, 3 (4%) for Stuff, 21 (25%) for Space, and 9 (11%) for Systems. Despite a low threshold for quantitative categorisation, only 1/84 (1%) articles described all four components with quantitative data. By comparison, 51/84 (61%) articles provide no quantitative data on any of the four components. Interpretation: There is no organised framework for evaluation of surgical surge capacity in disasters. Our analysis shows that there are very few descriptions of capacity within disaster literature and a limited understanding of LMIC health system response to surges in surgical volume. Without a structured framework to collect data on health system response, we miss opportunities to identify and strengthen areas of insufficient capacity. We encourage the incorporation of quantitative surgical metrics when reporting outcomes after disaster response, and propose the 4S framework as a conceptual model for reporting such metrics and understanding the surgical system response to disasters. Funding: None