Anesthesia Capacity in Rural Zambia, Malawi, and Tanzania: The Anesthesiologist’s Perspective

Kasole-Zulu, Tuma; Ndebea, Ansbert Sweetbert; Chikumbanje, Singatiya Stella; Bould, M. Dylan

doi:10.1213/ane.0000000000004638

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Surgical and anesthesia capacity continues to be constrained in Zambia and targeted improvements in this area could improve perioperative care. [ 22 – 24 ] Qualitative studies in other Sub-Saharan African countries have also found that while many providers acknowledged pulse oximetry assessment was important for hospitalized patients, its use was limited by inadequate availability of pulse oximeters and inadequate education on oximetry benefits for the entire healthcare team. [ 25 – 27 ] Our study found that participant non-physician anesthetists perceived that, often, nurses did not have training in pulse oximetry monitoring and some hospitals lacked pulse oximetry in wards and postoperative recovery areas.…”

Section: Discussionmentioning

confidence: 99%

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

Peterson

Mattingly

Merrell

et al. 2022

BMC Health Serv Res

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Background Pulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists’ perioperative care and what, if any, capacity gaps remain. Methods We identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa > 0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care. Results Ten of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial. Conclusion Among a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.

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Section: Discussionmentioning

confidence: 99%

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

Peterson

Mattingly

Merrell

et al. 2022

BMC Health Serv Res

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“…1,4 Like other countries in East Africa, Tanzania has a severe shortage of qualified anesthesia providers, and most hospitals have no physician anesthesiologist. [6][7][8] Despite a population of more than 50 million people, previous surveys estimated that Tanzania has <0.1 anesthesiologist per 100,000 population. 7,8 Although recent graduating residents have increased that number, there remains a critical shortage, and >90% of anesthesia providers are nonphysicians.…”

Section: Glossarymentioning

confidence: 99%

“…[6][7][8] Despite a population of more than 50 million people, previous surveys estimated that Tanzania has <0.1 anesthesiologist per 100,000 population. 7,8 Although recent graduating residents have increased that number, there remains a critical shortage, and >90% of anesthesia providers are nonphysicians. 8 As with other LMICs, obtaining basic anesthesia supplies and medications can be problematic.…”

Section: Glossarymentioning

confidence: 99%

Patient Satisfaction With, and Outcomes of, Ultrasound-Guided Regional Anesthesia at a Referral Hospital in Tanzania: A Cross-Sectional Study

Mohamed¹,

Temu

Komba

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Regional anesthesia techniques are increasingly used in high-income countries (HICs) for both surgical anesthesia and postoperative analgesia. However, regional anesthesia has not been utilized to the same degree in low-to middle-income countries (LMICs) due to a lack of resources and trained personnel. This study evaluates patient satisfaction with, and outcomes of, ultrasound-guided regional anesthesia for extremity surgery at Kilimanjaro Christian Medical Center (KCMC) in the Northeastern zone of Tanzania. METHODS: Study patients were ≥18 years of age; American Society of Anesthesiologists (ASA) physical status I, II, or III; and underwent extremity surgery under peripheral nerve block with ultrasound guidance at KCMC. After placement, blocks were assessed for effectiveness intraoperatively, as demonstrated by the need for supplemental analgesic or sedative medication or conversion to a general anesthetic. Postoperatively, patients were assessed for satisfaction with their nerve block and pain at 12 and 24 hours. Adverse events related to regional anesthesia were assessed immediately, 45 minutes after block placement, and at 12 and 24 hours postoperatively. The primary outcome was patient satisfaction at 12 hours. Secondary outcomes were block success rate and analgesia at 12 and 24 hours postoperatively. RESULTS: A convenience sample of 170 patients was included in the study, of whom 156 (95% confidence interval [CI], 87-95) were either satisfied or very satisfied with their block. Block placement was highly successful with only 8 of 170 participants (95% CI, 2.4-8.3), requiring conversion to a general anesthetic. Analgesia continued in the postoperative period, with 164 of 170 (95% CI, 93-98) patients and 145 of 170 (95% CI, 80-90) patients reporting acceptable analgesia at 12 and 24 hours, respectively. No major adverse events, such as local anesthetic toxicity, infection, bleeding, nerve injury, or pneumothorax, were observed. CONCLUSIONS: Our study found that ultrasound-guided regional anesthesia in a resource-constrained setting was effective for extremity surgery and resulted in high patient satisfaction. No complications occurred. The use of ultrasound-guided regional anesthesia shows promise for the safe and effective care of patients undergoing extremity surgery in LMICs. (Anesth Analg 2024;138:180-6) KEY POINTS• Question: Can ultrasound-guided regional anesthesia be effective in a resource-constrained setting? • Findings: Ultrasound-guided regional anesthesia can result in high patient satisfaction and be highly effective in a resource-constrained setting. • Meaning: Emphasizing training of anesthesia providers in low-to middle-income countries in regional anesthesia techniques may help reduce the high morbidity and mortality associated with general anesthesia and surgery in resource-constrained settings.

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“…12,13 The World Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia therefore highly recommend the intraoperative monitoring of end-tidal CO 2 for all intubated patients. 14 Anesthesia providers in sub-Saharan Africa, mostly nonphysicians, 15 care for a huge volume of surgical patients. Capnometry devices are usually not available due to relatively high costs, limited durability of devices, difficulty of maintenance, and lack of available consumables.…”

mentioning

confidence: 99%

“…Anesthesia providers in sub-Saharan Africa, mostly nonphysicians, 15 care for a huge volume of surgical patients. Capnometry devices are usually not available due to relatively high costs, limited durability of devices, difficulty of maintenance, and lack of available consumables.…”

mentioning

confidence: 99%

Instructions for a Highly Relevant Tool in Line With the United Nations Goals for Sustainable Development

Luedi

Enright

2021

Anesthesia &Amp; Analgesia

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Anesthesia Capacity in Rural Zambia, Malawi, and Tanzania: The Anesthesiologist’s Perspective

Cited by 6 publications

References 13 publications

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training

Patient Satisfaction With, and Outcomes of, Ultrasound-Guided Regional Anesthesia at a Referral Hospital in Tanzania: A Cross-Sectional Study

Instructions for a Highly Relevant Tool in Line With the United Nations Goals for Sustainable Development

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