Background

Surgery is an essential part of healthcare, yet patients undergoing surgery in Africa experience significantly higher mortality than those in many other parts of the world. Previous African Surgical Outcomes Study (ASOS) projects have identified important factors associated with poor outcomes, but many questions remain about why patients die following surgery and which factors are potentially modifiable.

The African Surgical Outcomes Study – Continental Audit Project (ASOS-CAP) is a large prospective, mixed-methods observational study designed to better understand the factors associated with perioperative mortality across Africa. By combining hospital surveys, surgical activity data and structured anonymous reviews of perioperative deaths, the study aims to identify opportunities to improve the safety of surgical care.

The findings will support evidence-based recommendations for hospitals, health systems and policymakers to improve surgical outcomes across the continent.

Study Objective

The objectives of this study are to determine:

  • The preparedness of the African surgical environment for surgery and managing surgical complications.
  • Who does what surgical procedures, where they are performed, and when they are conducted in Africa
  • How many patients die perioperatively, and when, where and how do these patients die perioperatively
  • What factors are potentially modifiable to improve patient outcomes in Africa
  • What policy changes would improve surgical outcomes in African countries

Study Design

ASOS-CAP is a pmixed-methods international, prospective, observational study.

The study consists of five components:

  • A baseline survey assessing institutional and individual preparedness for surgery.
  • An activity survey describing surgical caseload at all sites over one week period.
  • An anonymous case registry of perioperative deaths over a 2 to 8 week period dependent on sampling
  • Structured panel review and classification of a representative sample of submitted cases
  • A policy recommendation panel to review findings and recommend policies for safe surgery.

Preparatory Work

The study is coordinated by the African Perioperative Research Group (APORG), which has established one of Africa's largest collaborative surgical research networks. APORG has successfully delivered continent-wide studies including the African Surgical Outcomes Study (ASOS), ASOS-2, the African COVID-19 Critical Care Outcomes Study (ACCCOS), the African Paediatric Surgical Outcomes Study (ASOS-Paeds), and the African Critical Illness Outcomes Study (ACIOS).

Importance of this Study

Improving surgical outcomes in Africa requires a better understanding of why patients die following surgery and which factors can be changed. ASOS-CAP will provide the first continent-wide anonymous audit of perioperative mortality using a structured review methodology adapted from established national audit projects. The results will help identify practical, evidence-based recommendations for hospitals, healthcare professionals and policymakers to improve the safety and quality of surgical care across Africa.

Study Dates

Study dates will be announced following completion of national approvals and site selection.

Declare your interest

If you are interested in participating in ASOS-CAP as a National Leader, Hospital Leader or Investigator, please email us at This email address is being protected from spambots. You need JavaScript enabled to view it.


Participating Countries and Territories

Countries and territories confirmed to be participating in ASOS-CAP:

  • Benin

    • National Leader: Donaldo Yétongnon

  • Botswana

    • National Leader: Alemayehu Bedada
    National Leader: Karabo Ngwako

  • Burkina Faso

    • National Leader: Bertille Ki Kelan

  • Burundi

    • National Leader: Gilles Eloi Rwibuka

  • Cameroon

    • National Leader: Raymond Ndikontar

  • Congo

    • National Leader: Marie Elombila

  • Democratic Republic of the Congo

    • National Leader: Dolly Munlemvo
    National Leader: Ted Likongo

  • Egypt

    • National Leader: Mahmoud Elfiky

  • Ethiopia

    • National Leader: Fitsum Kefle

  • Gambia

    • National Leader: Mustapha Bittaye
    National Leader: Ahmadou Samateh

  • Ghana

    • National Leader: Christian Owoo

  • Kenya

    • National Leader: Michael Mwachiro

  • Libya

    • National Leader: Muhammed Elhadi

  • Mali

    • National Leader: Boubacar Diallo

  • Mauritania

    • National Leader: Bilal Dah

  • Mauritius

    • National Leader: Kushal Ramkalawan

  • Morocco

    • National Leader: Meryem Essafti

  • Mozambique

    • National Leader: Atilio Morais

  • Nigeria

    • National Leader: Babatunde Babasola Osinaike

  • Somalia

    • National Leader: Mohamed Omar

  • Somaliland

    • National Leader: Hassan Daoud

  • South Africa

    • National Leader: Hyla Kluyts

  • Sudan

    • National Leader: Tarig Fadalla

  • Tunisia

    • National Leader: Nahla Kechiche

  • Uganda

    • National Leader: Adam Hewitt-Smith

  • Zimbabwe

    • National Leader: Pisirai Ndarukwa

    If you want to participate in the ACIOS Study, feel free to contact us at This email address is being protected from spambots. You need JavaScript enabled to view it.