Gastrointestinal endoscopy capacity in Eastern Africa

Abstract

Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity. Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020. Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services. Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.

Distance to Health Care Facilities, Lifestyle Risk Factors, and Stage at Diagnosis in relation to Geographic Pattern of Esophageal Cancer in Tanzania, 2006–2016

“…Diagnosis of EC is difficult as systems could be nonspecific Gastrointestinal reflux Disease-(GERD-) like symptoms [27]. First, remote areas of Tanzania may not be served by a regional hospital that can provide diagnostic laboratory services and radiology, compared to ORCI, which provides these services and can aid in detecting EC [28][29][30]. Second, many remote areas lack the endoscopic equipment and endoscopists that would allow for greater detection of EC independent of laboratory and radiology services [30].…”

“…First, remote areas of Tanzania may not be served by a regional hospital that can provide diagnostic laboratory services and radiology, compared to ORCI, which provides these services and can aid in detecting EC [28][29][30]. Second, many remote areas lack the endoscopic equipment and endoscopists that would allow for greater detection of EC independent of laboratory and radiology services [30]. Increasing the capacity of referral hospitals to offer more advanced diagnostic laboratory and radiology services and providing greater endoscopic equipment and training would allow for earlier detection of EC., Patients with esophageal cancer in remote areas face more travel barriers (transportation costs, time) to receive a diagnosis at ORCI.…”

Starting gastrointestinal endoscopy in a lower middle-income country in Africa: Training, creating an endoscopy facility and developing telemedicine

“…A recent survey from the European Society of Gastrointestinal Endoscopy (ESGE) showed that many African countries have few gastrointestinal endoscopy centers with adequate resources and the shortage of endoscopy training, lack of national endoscopy societies, and deficiencies in equipment and basic infrastructure, as well as poor water and power supplies, are the probable reasons [9]. This is especially valid in sub-Saharan Africa [9,16,17]. Mwachiro et al [17] recently analyzed gastrointestinal endoscopy volume in Eastern sub-Saharan Africa and showed a limited endoscopy capacity to meet the burden of digestives diseases.…”

“…This is especially valid in sub-Saharan Africa [9,16,17]. Mwachiro et al [17] recently analyzed gastrointestinal endoscopy volume in Eastern sub-Saharan Africa and showed a limited endoscopy capacity to meet the burden of digestives diseases. An overall capacity of 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 inhabitants was calculated.…”

An Analysis of 644 Upper GI Endoscopies Performed in a Nigerian Tertiary Health Institution

“…Upper Gastrointestinal Endoscopy (UGIE) or Oesophago-Gastro-Duodenoscopy (OGD) is an important aspect of daily practice for gastroenterologists, gastrointestinal surgeons and others involved in the diagnosis and treatment of various gastrointestinal disorders Original Research Article [1]. It is arguably the procedure of choice in the diagnosis of mucosal-based lesions of the GI tract as it permits real-time observation of the oesophageal, gastric, and duodenal mucosae, as well as permits diagnostic sampling for further pathologic studies.…”