Practice of standard monitoring during anaesthesia in hospitals of North Kivu: a survey of health facilities of the health antenna of Butembo

Abstract

Background: Standard monitoring during anaesthesia is a core element of patient safety and practice of safe anesthesia has reduced morbidity and mortality worldwide. The main objective of this study was to assess the practice of standard monitoring during anaesthesia in the hospitals of North Kivu, so as to establish a baseline overview of the situation, and orientate plans towards safe anaesthesia in the region. Methods: This study was a cross-sectional survey of health facilities of the Health Antenna of Butembo in Democratic Republic of Congo and was conducted from October to December 2018. Questionnaires were brought to anaesthesia providers in the health facilities. The study included 1 answer from the anaesthesia practitioners who accepted to participate. The practices of standard monitoring in the health facilities were compared to WHO-WSFA guidelines. Data was captured and analyzed with Epi Info 7. Results: Forty out of 90 health facilities (44.4%) of 10 health zones responded on the questionnaire. Twenty-three health facilities (57.5%) were from private sector and 17 (42.5%) from public sector. Sixteen health facilities (40.0%) were from the Butembo health zone. The median number of anaesthesia providers was 2 per health facility. Of all the anaesthesia providers, none were physicians, 47.5% were nurses practicing anaesthesia without any training in anaesthesia and 47.5% were nurse anaesthetists. All the health facilities were providing general anaesthesia whereas spinal anaesthesia was provided in 22 out of 40 centers (55%). Seventy percent (28/40) of the facilities were below standard according to WHO-WSFA guidelines. Only 40% (16/40) were using a pulse oximeter and 10% (4/40) declared that ECG was occasionally used. Conclusion: The practice of standard monitoring is poor in health facilities of the Health Antenna of Butembo. Efforts should be made to improve monitoring which is a key element of safe anaesthesia.

Challenges of Anesthetic Monitoring in Low- and Middle-Income Countries: Availability of Equipment in Major Referral Hospitals in Kenya

“…Improper size of blood pressure monitoring equipment could lead to errors in measurement or the omission of blood pressure monitoring. Our study findings nearly match those of Pascal et al, 8 in which 20% to 39% of the instances of poor monitoring were attributed to lack of monitoring equipment or equipment parts.…”

“…4 The inadequate availability of monitoring devices is similar and comparable to that found by other studies done in other lower-to middle-income countries. [8][9][10][11]15,26,27,30 This situation is challenging for anesthesia providers and poses a threat to safe anesthesia practice in these countries.…”

“…7 In low-to middle-income countries, there is limited availability of equipment for basic anesthetic monitoring, and anesthetic monitoring is often incomplete. [8][9][10][11] These data include some Sub-Saharan countries, and there are scarce data on Kenyan hospitals. We sought to determine the availability of basic anesthetic monitoring devices in major referral hospitals in Kenya.…”

General anaesthesia related mortality in a limited resource settings region: a retrospective study in two teaching hospitals of Butembo

“…None of the hospitals had a fully working anaesthesia machine during the period of study. A recent study done by Blaise Pascal et al on practice of standard monitoring in the same region support these hypotheses [ 37 ]. Lack of proper infrastructure, drugs, equipment and trained providers are facts limiting safe anaesthesia [ 38 , 39 ].…”