The study aims 1) to adapt, 2) to develop implementation strategies for and 3) to evaluate the effect of implementing a practice guideline for acute abdomen at primary care level in Zambia. We employ a sequential exploratory mixed method study design. Qualitative and quantitative data from health care workers will be used to adapt a practice guideline developed in a high-income into a low- and middle-income (LMIC) context and to develop strategies for successful implementation. The primary outcome of interest is the prospective change in length of stay in hospital among patients presenting with acute abdomen in the intervention site compared to the control site. The study will address the scarcity of literature on practice guidelines for acute abdomen in the LMIC context. The implementation of an adapted guideline may contribute to a reduction of the morbidity and mortality rates associated with acute abdomen in this setting by increasing management capacity at the primary care level.

Inclusion Criteria:

• Data from all patients 18 year and older with acute abdomen including surgical, gynecological and medical acute abdomen managed at the intervention site and control site will be collected during the study period.

Exclusion Criteria:

• All cases of acute abdomen secondary to trauma will be excluded from the study. All patients in the immediate postoperative phase operated from other facilities presenting with acute abdomen.