Anesthesia Disparities Between High-Income Countries and Low-and Middle-Income Countries: Providers, Training, Equipment, and Techniques

Boggs, Steven D.; Chee, Nicholas

doi:10.1007/978-3-319-09423-6_4

Cited by 3 publications

(5 citation statements)

References 37 publications

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“…For instance, a 2012 survey of 22 LICs reported that only 50% of facilities had an anesthesia machine and pulse oximeter ( 18 ). Another report estimated that 40–80% of equipment in LICs is out of service and that 70% of operating rooms in SSA lack pulse oximetry ( 19 ). Our survey, conversely, found that 95% of graduates had access to an anesthesia machine and pulse oximeter.…”

Section: Discussionmentioning

confidence: 99%

“…The reported number of deaths, however, underscores the need to reinforce safe practice and vigilance while also improving access to emergency equipment and supplies. The risk of anesthesia-related maternal death is estimated to be the highest in SSA (1.5 per 1000) compared to other LICs ( 19 ). This highlights the need for better data and root cause analysis to maximize training and quality-improvement efforts ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…The risk of anesthesia-related maternal death is estimated to be the highest in SSA (1.5 per 1000) compared to other LICs ( 19 ). This highlights the need for better data and root cause analysis to maximize training and quality-improvement efforts ( 19 ). Future queries might seek clarification into the specific causes of maternal mortality in the experience of graduates in order to more appropriately allocate resources and direct didactics on sentinel events.…”

Section: Discussionmentioning

confidence: 99%

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Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Potisek

Hatch

Atito-Narh

et al. 2017

Front. Public Health

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Ghana, like other countries in sub-Saharan African, has limited access to surgery. One contributing factor is the inadequate number of anesthesia providers. To address this need, Kybele, Inc., a US-based non-governmental organization, partnered with the Ghana Health Service to establish the third nurse anesthesia training school (NATS) in Ghana. The school, based at Ridge Regional Hospital (RRH) in Accra, opened in October 2009. This paper describes the evolution of the training program and presents the curriculum. Second, the results of a voluntary survey conducted among the first four classes of graduates (2011–2014) are presented to determine their perceived strengths and gaps in training and to identify employment locations and equipment availability. Seventy-five of 93 graduates (81%) responded to the survey. The graduates reported working in 39 hospitals across 7 of the 10 regions in Ghana. Six providers (8%) worked alone and 16 (21%) were one of only two providers. Fifty-three providers (71%) had no physician anesthesiologist at their facility. Most providers had access to basic anesthesia equipment; however, there was limited access to emergency airway equipment. While most graduates felt that their training had prepared them for their current positions, 21% reported experiencing a patient death during anesthesia. The NATS at RRH has been sustained and most of the graduates are working in Ghana, filling an important void. Quality improvement and continuing education must be emphasized in an effort to reduce surgical morbidity and mortality in Ghana.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Potisek

Hatch

Atito-Narh

et al. 2017

Front. Public Health

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“…Les données de l'Organisation mondiale de la santé (OMS) suggèrent que d'ici 2030, « la charge mondiale de morbidité due au paludisme, à la tuberculose, et au VIH sera éclipsée par les maladies chirurgicales ». 1 Actuellement, 30 % de la charge mondiale de morbidité est due à des affections qui peuvent être résolues par la chirurgie; plus de 30 millions de personnes sont confrontées chaque année à des dépenses médicales catastrophiques, c'est-à-dire plus de 10 % de leur revenu total ou 40 % du revenu après déduction des dépenses pour les besoins fondamentaux. 2 La mortalité anesthésique dans les pays à revenu élevé (PRÉ ) est très faible, en particulier pour les patients en bonne santé, de l'ordre d'un décès pour cent à deux cent mille cas, bien que la morbidité majeure soit de 3 % à 16 %.…”

Section: Collaborative Researchunclassified

“…2 La mortalité anesthésique dans les pays à revenu élevé (PRÉ ) est très faible, en particulier pour les patients en bonne santé, de l'ordre d'un décès pour cent à deux cent mille cas, bien que la morbidité majeure soit de 3 % à 16 %. 1 Les pays à revenu intermédiaire ou faible (PRIF) souffrent d'un manque de disponibilité en équipement, tels que les oxymètres, les médicaments anesthésiques (y compris l'oxygène) et parfois même de l'absence de commodités de base comme l'eau et l'électricité. Dans une étude portant sur 22 PRIF (y compris l'Inde), Vo et coll.…”

Section: Collaborative Researchunclassified

Contributions of academic institutions in high income countries to anesthesia and surgical care in low- and middle-income countries: are they providing what is really needed?

Chellam

Lundeg

Gadgil

et al. 2018

Can J Anesth/J Can Anesth

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Data from the World Health Organization (WHO) suggest that by 2030, ''the global burden of disease from malaria, tuberculosis, and HIV will be overshadowed by surgical diseases''. 1 Currently, 30% of the global disease burden is due to surgically correctable conditions with more than 30 million people facing catastrophic medical expenditure each year, defined as [ 10% of total income or 40% of income after basic needs are met. 2 Anesthesia mortality in high income countries (HIC) is very low, especially for healthy patients, at one in 100,000-200,000 cases, although major morbidity ranges between 3-16%. 1 Low and middle-income countries (LMIC) on the other hand, may have 1 death in 100-200 cases. Anesthesia can be challenging due to non-availability of equipment, such as pulse oximeters, anesthesia medications (including oxygen), and sometimes even basic amenities such as water and electricity. Vo et al. found in a study of 22 LMIC (including India) that 35% of healthcare facilities studied had no access to oxygen, 50% did not have continuous access to anesthesia machines or pulse oximeters, and 40-70% of medical devices and equipment were either broken, unused, or unfit for use. 3 Lack of certified trained anesthesia providers compounds the problem. Indeed, HIC have 20-30 physician anesthesia providers per 100,000 individuals while LMIC have a ratio of one physician anesthesia provider per 100,000 individuals; in sub-Saharan Africa, the number drops to 0.1 per 100,000 population. 4 There is a long tradition of interest by HIC academic anesthetic centres in aiding LMIC, and this interest continues to grow. 5 A large proportion of this aid is in the form of shortterm medical missions, provision of equipment, and to a lesser extent, the training of personnel in LMIC. It is therefore appropriate to discuss whether the aid LMIC receive from HIC addresses the shortfall in anesthesia and surgery services adequately and appropriately. We present here the perspective of anesthesia and surgery providers in two Asian middle-income countries (India and Mongolia), both with large poor and underserviced populations. Charities and missions Short-term medical missions fulfill the immediate requirements for patient care, but are often cost ineffective and are unable to provide multidisciplinary long-term support to the very patients being operated upon. 6 A hazard is that the mission doctors may not be

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Case 41: Essential Equipment

Brock‐Utne

2021

Anesthesia in Low-Resourced Settings

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Anesthesia Disparities Between High-Income Countries and Low-and Middle-Income Countries: Providers, Training, Equipment, and Techniques

Cited by 3 publications

References 37 publications

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates

Contributions of academic institutions in high income countries to anesthesia and surgical care in low- and middle-income countries: are they providing what is really needed?

Case 41: Essential Equipment

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