Gender and Equity-related Risk Factors for Surgical Site Infections in Low-and Middle-Income Countries: A Review Protocol

Abstract Background Antimicrobial resistance (AMR) significantly worsens surgical site infections (SSIs), especially among vulnerable groups such as women, children, the elderly, persons with disabilities, and migrants, due to structural inequities and limited healthcare access. National Action Plans on AMR often overlook gender-sensitive and inclusive strategies, resulting in interventions that fail to address the unique risks shaped by gender roles and socioeconomic conditions. This scoping review seeks to explore these intersecting vulnerabilities to inform more equitable and effective AMR and SSI interventions. Methods: This review will adopt a systematic and targeted approach to identify, appraise, and synthesize existing evidence on gender and equity-related risk factors for surgical site infections (SSIs). A comprehensive search will be conducted across multiple databases (e.g., PubMed, Web of Science, Scopus, Embase) using predefined keywords and inclusion criteria focused on gender, social determinants, and SSIs. Studies will be screened and selected based on relevance, methodological quality, and representation of diverse populations, particularly in low- and middle-income settings. Data will be extracted and thematically analyzed to identify patterns, gaps, and implications for policy and practice in addressing inequities in SSI outcomes. Discussion: The findings from this systematic and targeted review have the potential to inform policymakers, healthcare practitioners, and development partners on the critical social and structural determinants contributing to SSI risk and outcomes. The application of equity and gender lens in the review process will help provide a deeper understanding of how intersecting factors—such as gender, age, disability, and socioeconomic status—influence vulnerability to SSIs.