Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia

Abstract

Background. Ear, nose, and throat (ENT) diseases are an oft overlooked global health concern. Despite their high prevalence and associated morbidity and mortality, ENT diseases have remained neglected in health care delivery. In Zambia and many other low-income countries, ENT services are characterized by poor funding, unavailable surgical procedures, and erratic supply of essential drugs. Objective. To investigate ENT service provision in Zambia with regard to availability of surgical procedures and supply of essential drugs. Methods. A descriptive cross-sectional survey was conducted using a piloted structured questionnaire between 17 January 2017 and 2 January 2018. Included in the study were the 109 hospitals registered with the Ministry of Health (MoH) across the 10 provinces of Zambia. Results. Of the participating hospitals, only 5.9% (n=1) and 40% (n=2) of Second-Level Hospitals (SLH) and Third-Level Hospitals (TLH), respectively, carried out tympanoplasty, myringotomy, and grommet insertion (M+G). Frontal trephination and external ethmoidectomy were offered in 11.7% (n=2) and 40% (n=2) of SLH and TLH, respectively. While tracheostomy (39.3%, n=24), tonsillectomy (27.9%, n=17), and adenoidectomy (27.9%, n=17) were the most widely performed head and neck procedures, laryngectomy was carried out by 1 hospital. Between 14.8% (n=9) and 36.1% (n=22) of hospitals lacked antibiotic and/or antiseptic ear drops. Despite 96.7% (n=59) of the respondents acknowledging ENT as an important branch of clinical practice, only 15.3% (n=4) of the hospitals had a budget for ENT. Also, 6.6% (n=4) of the respondents thought the discipline of ENT had received enough attention. Conclusion. ENT service delivery in Zambia is limited with regard to performed surgical procedures and availability of essential drugs, necessitating urgent intervention. The findings from this study may be used to direct national policy on the improvement of provision of ENT services in Zambia.

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…The information systems-related barriers to EDL implementation identified include the absence of clinical case registries 97, 115 and the unavailability of operational data on EDL accessibility in some facilities 101 . Similar barriers were identified in the implementation of EML 43, 49, 65, 173 . Other barriers unique to the EML included poor information management practices 50, 110, 111, 122, 125, 137, 142 consisting of poor record- keeping, lack of standardized treatment protocols in health facilities, lack of reporting procedures and structured ordering systems 107, 131, 146, 176 , and inadequate capacity to support information systems 70, 105, 138 .…”

“…Similar financial constraints were also reported in implementing the more established EML. Inadequate funding was the most prominent theme within financial constraints barrier to the implementation of EML 95,34,46,172,131,159,173,174,43,137,153,154,158,94,109,110,146,149,163,175 .…”

The Cost of Setting Up An Ent Endoscopic Practice in Lower Middle-Income Countries of Sub-Saharan Africa

“…Therefore, it is advisable to have ENT services decentralised to reach more people in the rural settings and effectively reduce the ENT disease-related morbidity and mortality. [ 9 ] Salisu and Jibril,[ 10 ] for example, have shown that providing endoscopic ear surgery in the rural settings will result in an effective performance of the bulk of ear surgeries needing magnification in those settings and eliminating the costs associated with patient transportation to tertiary centres and long-waiting queues. There is a rising demand for endoscopic-assisted surgical procedures in Nigeria, because of their applications for diagnostic and therapeutic purposes.…”

“…[ 16 ] Furthermore, during the last couple of decades, both functional and extended endoscopic sinus surgeries have been widely advocated and employed in the management of CRS, especially for those that were not amenable to medical management and also complications arising from the disease or from the traditional open surgical management of chronic nasal and sinus diseases in HICs. [ 9 17 ]…”

“…In a review of the availability of ENT surgical procedures in Zambia, Lukama et al . [ 9 ] noticed that 70% of the hospitals available have no expertise to carry out these procedures in LIMCs; the general population is therefore exposed to complications of sinus infections and tumors such as orbital sepsis, blindness, brain abscesses, and eventually death. The problems with an incomplete excision of sinus disease, especially the complicated cases, could be better assessed and resolved with sinus endoscopy.…”