Exploring the Use of a Fit‐for‐Purpose Surgical Headlight in Sub‐Saharan Africa: Mixed Methods Study

Abstract

Background High-quality surgical lighting is often lacking in low-resource settings. Commercial surgical headlights are unavailable due to high cost and supply and maintenance challenges. We aimed to understand user needs of a surgical headlight for low-resource settings by evaluating a preselected robust but relatively inexpensive headlight and lighting conditions. Methods We observed headlight use by ten surgeons in Ethiopia and six in Liberia. All surgeons completed surveys about their lighting environment and experience using headlight, and were subsequently interviewed. Twelve surgeons completed logbooks on headlight use. We distributed headlights to 48 additional surgeons, and all surgeons were surveyed for feedback. Results In Ethiopia, five surgeons ranked operating room light quality as poor or very poor; seven delayed or cancelled operations within the last year and five described intraoperative complications due to poor lighting. In Liberia, lighting was rated as ''good'', however fieldnotes, and interviews noted generator fuel-rationing, and poor lighting conditions. In both countries, the headlight was considered extremely useful. Surgeons recommended nine improvements, including comfort, durability, affordability and availability of multiple rechargeable batteries. Thematic analysis identified factors influencing headlight use, specifications and feedback, and infrastructure challenges. Conclusion Lighting in surveyed operating rooms was poor. Although conditions and need for the headlights differed between Ethiopia and Liberia, headlights were considered highly useful. However, discomfort was a major limiting factor for ongoing use, and the hardest to objectively characterise for specification and engineering purposes. Specific needs for surgical headlights include comfort and durability. Refinement of a fit-for-purpose surgical headlight is ongoing.

Supporting Safe Surgery with Simple, Low‐Cost Solutions

“…This issue of the World Journal of Surgery includes a paper on the evaluation of surgical headlights in the Sub-Saharan Africa [ 1 ]. Both countries involved in the study (Ethiopia and Liberia) are low-income countries experiencing frequent power outages and unreliable back-up generators, the latter due to fuel shortages or dis-repair.…”

“…Those who provided longer-term follow-up (20 out of 64 surgeons) after six months generally reported improved surgical outcomes, more confidence in performing procedures and less hospital-initiated postponements [ 1 ]. However, one of the disappointing findings of this mixed methods study was the relatively poor response rate by surgeons who received a free, donated headlight, and, as a group, their limited reporting of the operations they performed.…”

“…Patients and the community expect us to reflect on our practice and to be aware of our perioperative outcomes. An additional 45 headlights were distributed to surgeons in Liberia (51 in total), yet only 10 (20%) provided long-term (> 6 months) feedback [ 1 ].…”