Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa.

Published on Jan 1, 2017in Anesthesia & Analgesia5.178
路 DOI :10.1213/ANE.0000000000001690
Isabella Epiu4
Estimated H-index: 4
(MUHAS: Muhimbili University of Health and Allied Sciences),
Jossy Verel Bahe Tindimwebwa3
Estimated H-index: 3
+ 5 AuthorsGerald Dubowitz14
Estimated H-index: 14
Sources
Abstract
BACKGROUND:The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be aver
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References17
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#1Robin T. Petroze (University of Virginia Health System)H-Index: 16
#2Albert Nzayisenga (NUR: National University of Rwanda)H-Index: 3
Last. J. F. Calland (University of Virginia Health System)H-Index: 1
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Background: Disparities in the global availability of operating theatres, essential surgical equipment and surgically trained providers are profound. Although efforts are ongoing to increase surgical care and training, little is known about the surgical capacity in developing countries. The aim of this study was to create a baseline for surgical development planning at a national level. Methods: A locally adapted World Health Organization survey was conducted in November 2010 to assess emergency...
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#1Caris E GrimesH-Index: 14
#2Kendra G. Bowman (Brigham and Women's Hospital)H-Index: 3
Last. Chris Lavy (University of Oxford)H-Index: 27
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Background There is increasing evidence that lack of facilities, equipment, and expertise in district hospitals across many low- and middle-income countries constitutes a major barrier to accessing surgical care. However, what is less clear, is the extent to which people perceive barriers when trying to access surgical care.
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#1Isabeau Walker (GOSH: Great Ormond Street Hospital)H-Index: 16
#2Mark W. Newton (Vandy: Vanderbilt University)H-Index: 10
Last. Adrian T. Bosenberg (Seattle Children's)H-Index: 10
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Summary Access to safe surgery should be considered as part of the basic human right for health, but unfortunately, this ideal is far from being reached in many low-income countries. Pulse oximetry is recommended as a minimum standard of monitoring by all anesthesia organizations that have set standards, yet around 78聽000 operating theaters worldwide lack this essential monitor. The WHO Safe Surgery Saves Lives Program has identified evidence-based guidelines for safe surgery that are applicable...
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These standards1 are recommended for anesthesia professionals throughout the world. They are intended to provide guidance and assistance to anesthesia professionals, their professional societies, hospital and facility administrators, and governments for improving and maintaining the quality and safety of anesthesia care. They were adopted by the World Federation of Societies of Anaesthesiologists on the 13th June 1992, and revisions were ratified on 5th March 2008 and on 19th March 2010. For som...
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#1Robert A. Dyer (UCT: University of Cape Town)H-Index: 24
#2A.R. Reed (UCT: University of Cape Town)H-Index: 12
Last. Michael F. M. James (UCT: University of Cape Town)H-Index: 41
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Close co-operation between obstetricians and obstetric anaesthesia providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. Maternal and foetal mortality is unacceptably high, and the practice of obstetric anaesthesia has an important influence on outcome. Well-conducted national audits have identified the contributing factors to anaesthesia-related deaths. Spinal anaesthesia for caesarean section is the method of choice in the absence of contrai...
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#1Margaret E Kruk (Columbia University)H-Index: 68
#2Andreas Wladis (KI: Karolinska Institutet)H-Index: 17
Last. Sarah B. Macfarlane (UCSF: University of California, San Francisco)H-Index: 23
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Background: There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in th...
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#1Ndola Prata (University of California, Berkeley)H-Index: 30
#2Paige Passano (University of California, Berkeley)H-Index: 6
Last. Caitlin Gerdts (University of California, Berkeley)H-Index: 20
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Although maternal mortality is a significant global health issue, achievements in mortality decline to date have been inadequate. A review of the interventions targeted at maternal mortality reduction demonstrates that most developing countries face tremendous challenges in the implementation of these interventions, including the availability of unreliable data and the shortage in human and financial resources, as well as limited political commitment. Examples from developing countries, such as ...
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#1Adam L. KushnerH-Index: 19
#2Meena CherianH-Index: 23
Last. Carissa EtienneH-Index: 1
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Hypothesis Surgical and anesthetic care is increasingly recognized as a neglected but cost-effective component of primary health care in low- and middle-income countries (LMICs). Strengthening delivery can help achieve Millennium Development Goals 4, 5, and 6. Large gaps in access to essential surgical care in LMICs result in considerable morbidity and mortality. The goal of this study was to provide a baseline overview of essential surgical and anesthetic capacity at district-level health facil...
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#1S. Morris (Cardiff and Vale University Health Board)H-Index: 2
#2P. Clyburn (Cardiff and Vale University Health Board)H-Index: 2
Last. Judith Elizabeth Hall (University Hospital of Wales)H-Index: 35
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Summary An anaesthetic charity 鈥楳others of Africa鈥 has been established as a link between the academic departments of anaesthesia in Togo and Benin and the University Hospital of Wales. Visits by UK consultant anaesthetists have identified a number of clinical areas where collaborative working in both classroom and theatre has the potential to improve outcomes in maternal mortality and morbidity.
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#1P. Clyburn (Cardiff and Vale University Health Board)H-Index: 2
#2S. Morris (Cardiff and Vale University Health Board)H-Index: 2
Last. Judith Elizabeth Hall (University Hospital of Wales)H-Index: 35
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Summary The challenges of obstetric care in the developing world are enormous. Many fit young mothers die or suffer disabling birth injuries from preventable complications of pregnancy that are easily treated with basic facilities. Maternal mortality rates in excess of 1% have been recorded in a number of countries. Access to Caesarean section is a particular problem, with rates lower than 1% being commonplace. The provision of appropriate anaesthesia services is of international concern.
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Objective null To evaluate the safety and effectiveness of a ketamine-based anesthesia package to support emergency cesarean section when no anesthetist is available. null Methods null A prospective case-series was conducted between December 11, 2013 and September 30, 2021 across nine sub-county hospitals in Kenya. Non-anesthetist healthcare providers undertook an evidence-based five-day training course. A structured instrument was used to collect preoperative, intraoperative, and postoperative ...
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BACKGROUND Access to safe surgery has been recognized as an indispensable component of universal health coverage. A competent anesthesia workforce is a prerequisite for safe surgical care. In Ethiopia, non-physician anesthetists are the main anesthesia service providers. The Government of Ethiopia implemented a program intervention to improve the quality of non-physician anesthetists' education, which included faculty development, curricula strengthening, student support, educational resources, ...
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#1GC Sund (Africa University)
#2Michael S Lipnick (UC: University of California)H-Index: 17
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Background: Data regarding the capacity to provide safe anaesthesia is lacking in many low-income countries. With the increasing popularity of WhatsApp for both personal and professional communication in Africa, we sought to test the feasibility of using this platform to administer a brief survey of anaesthesia equipment availability in Burundi. The aims of the study were to survey a subset of anaesthesia equipment availability in Burundi and to assess the suitability of using a WhatsApp chat gr...
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#4Yewbmirt Sharew (Debre markos University)
#7Tebikew Yeneabat (UTS: University of Technology, Sydney)H-Index: 7
BACKGROUND Uterine rupture is the leading cause of maternal and perinatal morbidity and it accounts for 36% of the maternal mortality in Ethiopia. The maternal and perinatal outcomes of uterine rupture were inconclusive for the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled maternal and perinatal mortality and morbidity of uterine rupture and its association with prolonged duration of operation. METHODS The Preferred Reporting Items for Systematic Revie...
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The medical treatment process, particularly surgery, is inescapably bound to potential complications or undesirable adverse events. This narrative review aims to present the causes and effects of the introduction of the WHO Surgery Safety Checklist (SSC), the use of which is expected to reduce the number of perioperative errors, complications, and mortality. To achieve this objective, we performed a bibliometric analysis of medical citations indexed in the PubMed database using the SSC subject h...
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