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The Rate-Limiting Step: The Provision of Safe Anesthesia in Low-Income Countries

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Abstract

Background

The importance of safe anesthesia for the best possible surgical outcomes in every patient is not disputed in high resource settings. Low-income countries lag far behind in the provision of, and training for, safe anesthesia practice. Too little is known about numbers and types of providers in a majority of low-income countries.

Methods

A review of the member societies of the World Federation of Societies of Anaesthesiologists was undertaken, and membership statistics of national societies were requested. Of the 126 members of the federation, only 14 represent low-income countries. Many non-federation-member countries are also low-income countries.

Results

The anesthesia infrastructure and personnel challenges in low-income countries contribute to poor patient outcomes and limited access to emergency and essential surgery. The presence of a functional anesthesia society provides a measure of the numbers of providers and a snapshot of local professional activities.

Conclusion

The establishment and maintenance of an anesthesia society is an indicator of respect for the profession and commitment to standards of practice, quality initiatives, and continuing medical education within the country.

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References

  1. Murray CJ (2012) The global burden of disease study. Lancet 380:2053–2260

    Article  Google Scholar 

  2. Mayosi BM, Flisher AJ, Lalloo UG, Sitas F, Tollman SM, Bradshaw D (2009) The burden of non-communicable diseases in South Africa. Lancet 374:934–947

    Article  PubMed  Google Scholar 

  3. McQueen KA, Casey KM (2010) The impact of global anesthesia and surgery: professional partnerships and humanitarian outreach. Int Anesthesiol Clin 48(2):79–90

    Article  PubMed  Google Scholar 

  4. McQueen KA, Ozgediz D, Riviello R et al (2010) Essential surgery: integral to the right to health. Health Hum Rights 12:137–152

    PubMed  Google Scholar 

  5. Ouro-Bang’na Maman AF, Kabore RA, Zoumenou E, Gnassingbe K, Chobli M (2009) Anesthesia for children in sub-Saharan Africa: a description of settings, common presenting conditions, techniques and outcomes. Paediatr Anaesth 19(1):5–11

    Article  PubMed  Google Scholar 

  6. Ouro-Bang’na Maman AF, Tomta K, Ahouangbevi S, Chobli M (2005) Deaths associated with anaesthesia in Togo, West Africa. Trop Doct 35(4):220–222

    Article  PubMed  Google Scholar 

  7. Walker I, Wilson I, Bogod D (2007) Anaesthesia in developing countries. Anaesthesia 62(Suppl 1):2–3

    Article  PubMed  Google Scholar 

  8. Fenton PM, Whitty CJ, Reynolds F (2003) Caesarean section in Malawi: prospective study of early maternal and perinatal mortality. BMJ 327(7415):587

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mackay P, Cousins M (2006) Safety in anaesthesia. Anaesth Intensive Care 34:303–304

    CAS  PubMed  Google Scholar 

  10. Bainbridge D, Martin J, Arango M, Cheng D (2012) Evidence-based Peri-operative clinical outcomes research G. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. Lancet 380:1075–1081

    Article  PubMed  Google Scholar 

  11. Hansen D, Gausi SC, Merikebu M (2000) Anaesthesia in Malawi: complications and deaths. Trop Doct 30:146–149

    CAS  PubMed  Google Scholar 

  12. Heywood AJ, Wilson IH, Sinclair JR (1989) Perioperative mortality in Zambia. Ann R Coll Surg Engl 71:354–358

    PubMed Central  CAS  PubMed  Google Scholar 

  13. McKenzie AG (1996) Mortality associated with anaesthesia at Zimbabwean teaching hospitals. S Afr Med J 86(4):338–342

    CAS  PubMed  Google Scholar 

  14. Oluwasanmi JO (1969) Burns in Western Nigeria. Br J Plast Surg 22:216–223

    Article  CAS  PubMed  Google Scholar 

  15. Glenshaw M, Madzimbamuto FD (2005) Anaesthesia associated mortality in a district hospital in Zimbabwe: 1994 to 2001. Cent Afr J Med 51:39–44

    CAS  PubMed  Google Scholar 

  16. Grady K (2009) Building capacity for anaesthesia in low resource settings. BJOG 116(Suppl 1):15–17

    Article  PubMed  Google Scholar 

  17. Hadley GP (2006) Paediatric surgery in the third world. S Afr Med J 96:1139–1140

    CAS  PubMed  Google Scholar 

  18. Hauge K, Haile S (1987) Anesthesia in developing countries. Tidsskr Nor Laegeforen 107:3023–3026

    CAS  PubMed  Google Scholar 

  19. Hodges SC, Mijumbi C, Okello M, McCormick BA, Walker IA, Wilson IH (2007) Anaesthesia services in developing countries: defining the problems. Anaesthesia 62(1):4–11

    Article  CAS  PubMed  Google Scholar 

  20. Iddriss A, Shivute N, Bickler S et al (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89(8):565–572

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127 discussion 8

    Article  PubMed  Google Scholar 

  22. Kushner AL, Cherian MN, Noel L, Spiegel DA, Groth S, Etienne C (2010) Addressing the millennium development goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145:154–159

    Article  PubMed  Google Scholar 

  23. Lebrun DG, Dhar D, Sarkar MI, Imran TM, Kazi SN, McQueen KA (2013) Measuring global surgical disparities: a survey of surgical and anesthesia infrastructure in Bangladesh. World J Surg 37:24–31. doi:10.1007/s00268-012-1806-7

    Article  PubMed  Google Scholar 

  24. Linden AF, Sekidde FS, Galukande M, Knowlton LM, Chackungal S, McQueen KA (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065. doi:10.1007/s00268-012-1482-7

    Article  PubMed  Google Scholar 

  25. Bianchi S, Cherian MN, Vo D, McCunn M (2011) Lack of trained anesthesia workforce in low and middle income countries. Alliance for Anesthesia and Surgery Presence, San Diego

    Google Scholar 

  26. Bickler SW, Rode H (2002) Surgical services for children in developing countries. Bull World Health Organ 80:829–835

    PubMed Central  CAS  PubMed  Google Scholar 

  27. Bickler SW, Telfer ML, Sanno-Duanda B (2003) Need for paediatric surgery care in an urban area of The Gambia. Trop Doct 33:91–94

    PubMed  Google Scholar 

  28. Bosenberg AT (2007) Pediatric anesthesia in developing countries. Curr Opin Anaesthesiol 20:204–210

    Article  PubMed  Google Scholar 

  29. Cappello CS, Gainer VG, Adkisson GH (1995) The safe practice of anesthesia in developing countries. CRNA 6(2):91–95

    CAS  PubMed  Google Scholar 

  30. Chao TE, Burdic M, Ganjawalla K et al (2012) Survey of surgery and anesthesia infrastructure in Ethiopia. World J Surg 36:2545–2553. doi:10.1007/s00268-012-1729-3

    Article  PubMed  Google Scholar 

  31. Cherian M, Choo S, Wilson I et al (2010) Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? Bull World Health Organ 88:637–639

    Article  PubMed Central  PubMed  Google Scholar 

  32. Dubowitz G, Detlefs S, McQueen KA (2010) Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg 34:438–444. doi:10.1007/s00268-009-0229-6

    Article  PubMed Central  PubMed  Google Scholar 

  33. Enohumah KO, Imarengiaye CO (2006) Factors associated with anaesthesia-related maternal mortality in a tertiary hospital in Nigeria. Acta Anaesthesiol Scand 50:206–210

    Article  CAS  PubMed  Google Scholar 

  34. McQueen KA (2010) Anesthesia and the global burden of surgical disease. Int Anesthesiol Clin 48:91–107

    Article  PubMed  Google Scholar 

  35. Misra S, Koshy T (2009) Anesthesia in developing countries: one-way traffic? Anesth Analg 108:674–675 author reply 5

    Article  PubMed  Google Scholar 

  36. Mock C, Cherian M, Juillard C et al (2010) Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg 34:381–385. doi:10.1007/s00268-009-0263-4

    Article  PubMed  Google Scholar 

  37. Walker IA, Wilson IH (2008) Anaesthesia in developing countries: a risk for patients. Lancet 371:968–969

    Article  PubMed  Google Scholar 

  38. Zoumenou E, Gbenou S, Assouto P et al (2010) Pediatric anesthesia in developing countries: experience in the two main university hospitals of Benin in West Africa. Paediatr Anaesth 20:741–747

    Article  PubMed  Google Scholar 

  39. Henderson K (2007) Lessons from working overseas. Anaesthesia 62(Suppl 1):113-7

    PubMed  Google Scholar 

  40. Hodges AM, Hodges SC (2000) A rural cleft project in Uganda. Br J Plast Surg 53:7–11

    Article  CAS  PubMed  Google Scholar 

  41. Howie SR, Hill S, Ebonyi A et al (2009) Meeting oxygen needs in Africa: an options analysis from the Gambia. Bull World Health Organ 87:763–771

    Article  PubMed Central  PubMed  Google Scholar 

  42. Lipnick M, Mijumbi C, Dubowitz G et al (2013) Surgery and anesthesia capacity-building in resource-poor settings: description of an ongoing academic partnership in Uganda. World J Surg 37:488–497. doi:10.1007/s00268-012-1848-x

    Article  PubMed  Google Scholar 

  43. McCormick BA, Eltringham RJ (2007) Anaesthesia equipment for resource-poor environments. Anaesthesia 62(Suppl 1):54–60

    Article  PubMed  Google Scholar 

  44. Mellin-Olsen J, Staender S, Whitaker DK, Smith AF (2010) The helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol 27:592–597

    Article  PubMed  Google Scholar 

  45. Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH (2010) International standards for a safe practice of anesthesia 2010. Can J Anaesth 57:1027–1034

    Article  PubMed Central  PubMed  Google Scholar 

  46. Costello A, Azad K, Barnett S (2006) An alternative strategy to reduce maternal mortality. Lancet 368:1477–1479

    Article  PubMed  Google Scholar 

  47. World Federation of Societies of Anaesthesiologists. National member societies. http://www.wfsahq.org/about-us/national-member-societies. Accessed Feb 2014

  48. World Health Organization. Countries. http://www.who.int/countries/en/. Accessed 28 Feb 2014

  49. The World Bank Country and lending groups data http://data.worldbank.org/about/country-classifications/country-and-lending-groups-Low_income. Accessed 28 Feb 2014

  50. McQueen KA, Malviya S, Gathuya ZN, Tyler DC (2012) International advocacy for education and safety. Paediatr Anaesth 22:962–968

    Article  PubMed  Google Scholar 

  51. Newton M, Bird P (2010) Impact of parallel anesthesia and surgical provider training in sub-Saharan Africa: a model for a resource-poor setting. World J Surg 34:445–452. doi:10.1007/s00268-009-0195-z

    Article  PubMed  Google Scholar 

  52. Greene NM (1991) Anesthesia in underdeveloped countries: a teaching program. Yale J Biol Med 64:403–407

    PubMed Central  CAS  PubMed  Google Scholar 

  53. Groen RS, Kamara TB, Dixon-Cole R, Kwon S, Kingham TP, Kushner AL (2012) A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. World J Surg 36:1970–1977. doi:10.1007/s00268-012-1591-3

    Article  PubMed  Google Scholar 

  54. Manikandan S, Gitanjali B (2012) National list of essential medicines of India: the way forward. J Postgrad Med 58:68–72

    Article  CAS  PubMed  Google Scholar 

  55. Notrica MR, Evans FM, Knowlton LM, Kelly McQueen KA (2011) Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 35:1770–1780. doi:10.1007/s00268-011-1125-4

    Article  PubMed  Google Scholar 

  56. Rosseel P, Trelles M, Guilavogui S, Ford N, Chu K (2010) Ten years of experience training non-physician anesthesia providers in Haiti. World J Surg 34:453–458. doi:10.1007/s00268-009-0192-2

    Article  PubMed  Google Scholar 

  57. Life Box (2014) What is the pulse oximetry gap? http://www.lifebox.org/about-lifebox/faq-2/what-is-the-pulse-oximetry-gap/). Accessed Feb 2014

  58. Sherman L, Clement PT, Cherian MN et al (2011) Implementing Liberia’s poverty reduction strategy: an assessment of emergency and essential surgical care. Arch Surg 146:35–39

    Article  PubMed  Google Scholar 

  59. Penoyar T, Cohen H, Kibatala P et al (2012) Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2:e000369

    Article  PubMed Central  PubMed  Google Scholar 

  60. Hodges S, Wilson J, Hodges A (2009) Plastic and reconstructive surgery in Uganda: 10 years experience. Paediatr Anaesth 19:12–18

    Article  PubMed  Google Scholar 

  61. McQueen KA (2013) Editorial perspective: global surgery: measuring the impact. World J Surg 37:2505–2506. doi:10.1007/s00268-013-2198-z

    Article  PubMed  Google Scholar 

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Hendel, S., Coonan, T., Thomas, S. et al. The Rate-Limiting Step: The Provision of Safe Anesthesia in Low-Income Countries. World J Surg 39, 833–841 (2015). https://doi.org/10.1007/s00268-014-2775-9

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