It is time for Africa to lead the way in pragmatic clinical trials

Abstract

The African Surgical Outcomes Study (ASOS), which was published at the beginning of this year, showed that although African surgical patients are generally of a low surgical risk, one in five of these patients will develop complications, and the mortality following surgery is twice the global average.¹ In reality, mortality following surgery in Africa is probably more than twice the global average, as the data in ASOS is not risk adjusted for patient comorbidities. It is estimated that approximately five billion people globally are unable to access safe surgical treatment, and nearly 95% of these people live in low- and middle-income countries.² ASOS provides important data on how surgery may be made safer in Africa. In ASOS, nearly 95% of all deaths occurred after the day of the surgery, predominantly on the surgical ward.¹ ASOS also revealed that the number of specialists providing surgery and anaesthesia per 100 000 population were 20 to 50 fold less³ than the recommended safe minimum as proposed by the Lancet Commission for Global Surgery.² It appears that the lack of human resources is a significant contributor to postoperative mortality in Africa.