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Capnography access and use in Kenya and Ethiopia

Accès à et utilisation de la capnographie au Kenya et en Éthiopie

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Abstract

Purpose

Lack of access to safe and affordable anesthesia and monitoring equipment may contribute to higher rates of morbidity and mortality in low- and middle-income countries (LMICs). While capnography is standard in high-income countries, use in LMICs is not well studied. We evaluated the association of capnography use with patient and procedure-related characteristics, as well as the association of capnography use and mortality in a cohort of patients from Kenya and Ethiopia.

Methods

For this retrospective observational study, we used historical cohort data from Kenya and Ethiopia from 2014 to 2020. Logistic regression was used to study the association of capnography use (primary outcome) with patient/procedure factors, and the adjusted association of intraoperative, 24-hr, and seven-day mortality (secondary outcomes) with capnography use.

Results

A total of 61,792 anesthetic cases were included in this study. Tertiary or secondary hospital type (compared with primary) was strongly associated with use of capnography (odds ratio [OR], 6.27; 95% confidence interval [CI], 5.67 to 6.93 and OR, 6.88; 95% CI, 6.40 to 7.40, respectively), as was general (vs regional) anesthesia (OR, 4.83; 95% CI, 4.41 to 5.28). Capnography use was significantly associated with lower odds of intraoperative mortality in patients who underwent general anesthesia (OR, 0.31; 95% CI, 0.17 to 0.48). Nevertheless, fully-adjusted models for 24-hr and seven-day mortality showed no evidence of association with capnography.

Conclusion

Capnography use in LMICs is substantially lower compared with other standard anesthesia monitors. Capnography was used at higher rates in tertiary centres and with patients undergoing general anesthesia. While this study revealed decreased odds of intraoperative mortality with capnography use, further studies need to confirm these findings.

Résumé

Objectif

Le manque d’accès à des équipements d’anesthésie et de monitorage sécuritaires et abordables peut contribuer à des taux plus élevés de morbidité et de mortalité dans les pays à revenu faible et intermédiaire (PRFI). Alors que la capnographie est une modalité standard dans les pays à revenu élevé, son utilisation dans les PRFI n’est pas bien étudiée. Nous avons évalué l’association de l’utilisation de la capnographie avec les caractéristiques des patient·es et des interventions, ainsi que l’association de l’utilisation de la capnographie et de la mortalité dans une cohorte de patient·es du Kenya et d’Éthiopie.

Méthode

Pour cette étude observationnelle rétrospective, nous avons utilisé des données de cohortes historiques du Kenya et de l’Éthiopie de 2014 à 2020. Une régression logistique a été utilisée pour étudier l’association entre l’utilisation de la capnographie (critère d’évaluation principal) et les facteurs patient·es/interventions, ainsi que pour étudier l’association ajustée entre la mortalité peropératoire, à 24 h et à sept jours (critères d’évaluation secondaires) et l’utilisation de la capnographie.

Résultats

Au total, 61 792 cas d’anesthésie ont été inclus dans cette étude. Le type d’hôpital tertiaire ou secondaire (par rapport à un établissement primaire) était fortement associé à l’utilisation de la capnographie (rapport de cotes [RC], 6,27; intervalle de confiance [IC] à 95 %, 5,67 à 6,93 et RC, 6,88; IC 95 %, 6,40 à 7,40, respectivement), tout comme l’était l’anesthésie générale (vs régionale) (RC, 4,83; IC 95 %, 4,41 à 5,28). L’utilisation de la capnographie était significativement associée à une probabilité plus faible de mortalité peropératoire chez les patient·es ayant reçu une anesthésie générale (RC, 0,31; IC 95 %, 0,17 à 0,48). Néanmoins, les modèles entièrement ajustés pour la mortalité à 24 heures et à sept jours n’ont montré aucune donnée probante d’association avec la capnographie.

Conclusion

L’utilisation de la capnographie dans les PRFI est considérablement moins répandue que celle d’autres moniteurs d’anesthésie standard. La capnographie a été utilisée à des taux plus élevés dans les centres tertiaires et chez des patient·es sous anesthésie générale. Bien que cette étude ait révélé une diminution de la probabilité de mortalité peropératoire avec l’utilisation de la capnographie, d’autres études doivent confirmer ces résultats.

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Author contributions

Maziar M. Nourian and Bantayehu Sileshi contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of the data; and drafting the article. Amany Alshibli contributed to analysis and interpretation of data and drafting of the article. John Kamau, Susan Nabulindo, Denis Amollo, Rahel Seyoum, Masresha G. Teklehaimanot, Gebrehiwot A. Tegu, and Haftom B. Desta contributed to data collection and analysis. Jennifer Connell contributed to data analysis and drafting the article. Svetlana Eden contributed to data analysis, data interpretation, and drafting the article. Mark Newton contributed to study conception and design and manuscript review. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgements

The authors would like to acknowledge Phillis Ngure, Mercy Kithengi, Wycliffe Odhiambo, and Aziz Munubi for their work as data managers. In addition, the authors would like to acknowledge KRNA students at Kijabe Hospital and nonphysician anesthesia students at Ayder Hospital, Felege Hiwot Hospital, and Tibebe Ghion Hospital for helping with data collection. Lastly, the authors would like to acknowledge Martha Tanner for her editorial support.

Disclosures

The authors declare that they have no conflicts of interest.

Funding statement

This work was supported by grants from the GE Foundation and ELMA Foundation.

Editorial responsibility

This submission was handled by Dr. Adrian Gelb, Guest Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA

    Mark Newton MD & Bantayehu Sileshi MD

  2. Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA

    Amany Alshibli MD

  3. African Mission Healthcare, ImPACT Africa-Tanzania, Nairobi, Kenya

    John Kamau BSc

  4. Department of Anesthesiology, University of Nairobi, Nairobi, Kenya

    Susan Nabulindo MD

  5. African Population and Health Research Center, Nairobi, Kenya

    Dennis A. Amollo BSc

  6. Vanderbilt University School of Medicine, Nashville, TN, USA

    Jennifer Connell BS

  7. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Svetlana K. Eden PhD

  8. Department of Anesthesiology, Bahir Dar University, Bahir Dar, Ethiopia

    Rahel Seyoum MSc & Gebrehiwot A. Tegu MSc

  9. Department of Anesthesiology, Mekelle University, Mekelle, Ethiopia

    Masresha G. Teklehaimanot BSc & Haftom B. Desta MSc

  10. Department of Anesthesiology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37232, USA

    Maziar M. Nourian MD

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  1. Maziar M. Nourian MD
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Correspondence to Maziar M. Nourian MD.

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Nourian, M.M., Alshibli, A., Kamau, J. et al. Capnography access and use in Kenya and Ethiopia. Can J Anesth/J Can Anesth 71, 95–106 (2024). https://doi.org/10.1007/s12630-023-02607-y

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