RT Journal Article SR Electronic T1 Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study JF BMJ Quality & Safety JO BMJ Qual Saf FD BMJ Publishing Group Ltd SP 950 OP 960 DO 10.1136/bmjqs-2020-012751 VO 30 IS 12 A1 Clarke, Morgane A1 Pittalis, Chiara A1 Borgstein, Eric A1 Bijlmakers, Leon A1 Cheelo, Mweene A1 Ifeanyichi, Martilord A1 Mwapasa, Gerald A1 Juma, Adinan A1 Broekhuizen, Henk A1 Drury, Grace A1 Lavy, Chris A1 Kachimba, John A1 Mkandawire, Nyengo A1 Chilonga, Kondo A1 Brugha, RuairĂ­ A1 Gajewski, Jakub YR 2021 UL http://qualitysafety.bmj.com/content/30/12/950.abstract AB Background In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.Aim To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.Methods A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.Results 53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.Conclusions Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.Data (deidentified participant data) are available on reasonable request from the corresponding author.