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Samenjo KT, Ramanathan A, Gwer SO, Bailey RC, Otieno FO, Koksal E, Sprecher B, Price RA, Bakker C, Diehl JC. Design of a syringe extension device (Chloe SED®) for low-resource settings in sub-Saharan Africa: a circular economy approach. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1183179. [PMID: 37727273 PMCID: PMC10505716 DOI: 10.3389/fmedt.2023.1183179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023] Open
Abstract
Underfunded healthcare infrastructures in low-resource settings in sub-Saharan Africa have resulted in a lack of medical devices crucial to provide healthcare for all. A representative example of this scenario is medical devices to administer paracervical blocks during gynaecological procedures. Devices needed for this procedure are usually unavailable or expensive. Without these devices, providing paracervical blocks for women in need is impossible resulting in compromising the quality of care for women requiring gynaecological procedures such as loop electrosurgical excision, treatment of miscarriage, or incomplete abortion. In that perspective, interventions that can be integrated into the healthcare system in low-resource settings to provide women needing paracervical blocks remain urgent. Based on a context-specific approach while leveraging circular economy design principles, this research catalogues the development of a new medical device called Chloe SED® that can be used to support the provision of paracervical blocks. Chloe SED®, priced at US$ 1.5 per device when produced in polypropylene, US$ 10 in polyetheretherketone, and US$ 15 in aluminium, is attached to any 10-cc syringe in low-resource settings to provide paracervical blocks. The device is designed for durability, repairability, maintainability, upgradeability, and recyclability to address environmental sustainability issues in the healthcare domain. Achieving the design of Chloe SED® from a context-specific and circular economy approach revealed correlations between the material choice to manufacture the device, the device's initial cost, product durability and reuse cycle, reprocessing method and cost, and environmental impact. These correlations can be seen as interconnected conflicting or divergent trade-offs that need to be continually assessed to deliver a medical device that provides healthcare for all with limited environmental impact. The study findings are intended to be seen as efforts to make available medical devices to support women's access to reproductive health services.
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Affiliation(s)
- Karlheinz Tondo Samenjo
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Aparna Ramanathan
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Department of Obstetrics and Gynecology, National Center for Advanced Pelvic Surgery, Medstar Washington Hospital Center, Georgetown University, Washington, DC, United States
| | - Stephen Otieno Gwer
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Department of Obstetrics and Gynaecology, Maseno University, Kisumu, Kenya
| | - Robert C. Bailey
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | | | | | - Benjamin Sprecher
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Rebecca Anne Price
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Conny Bakker
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Jan Carel Diehl
- Department of Sustainable Design Engineering, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Guasch E, Brogly N, Gilsanz F. Teaching and Learning Obstetric Anaesthesia in Low- and Middle-Income Countries: Current Situation and Perspectives. CURRENT ANESTHESIOLOGY REPORTS 2023; 13:76-82. [PMID: 37168832 PMCID: PMC10113969 DOI: 10.1007/s40140-023-00557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Purpose of Review Our goal in this review is to describe the current context and peculiarities of obstetric anaesthesia in low- and middle-income countries (LMIC) and the ongoing actions and perspectives in terms of teaching and learning, focusing on improving maternal outcomes. Recent Findings Correct identification of barriers and lack of infrastructures and anaesthesia providers are still major problems despite efforts of different stakeholders. International consensus and commitment for 2030 goals are trying to be achieved. Summary Structured training courses look a good option as short- and long-term evaluations show a positive impact. Future efforts will have to be also focused on indicators that may help to decrease the high mortality and morbidity ratios in LMIC.
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Affiliation(s)
- Emilia Guasch
- Anaesthesia and Reanimation Department, Hospital Universitario La Paz, Servicio Anestesia Y Reanimación, Paseo Castellana, 261, 28046 Madrid, Spain
- WFSA Obstetric Anaesthesia Committee and WFSA Council Member, London, UK
| | - Nicolas Brogly
- Anesthesia and Reanimation Department, European Society of Anaesthesia and Intensive Care (ESAIC), Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Gilsanz
- European Society of Anaesthesia and Intensive Care (ESAIC), Spanish Royal Academy of Medicine (RANME), Universidad Autónoma de Madrid, Madrid, Spain
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Lonnée HA, Taule K, Knoph Sandvand J, Koroma MM, Dumbuya A, Jusu KS, Shour MA, Duinen AJ. A survey of anaesthesia practices at all hospitals performing caesarean sections in Sierra Leone. Acta Anaesthesiol Scand 2021; 65:404-419. [PMID: 33169383 DOI: 10.1111/aas.13736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/07/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Providing safe anaesthesia is essential when performing caesarean sections, one of the most commonly performed types of surgery. Anaesthesia-related causes of maternal mortality are generally considered preventable. The primary aim of our study was to assess the type of anaesthesia used for caesarean sections in Sierra Leone. Secondary aims were to identify the type and training of anaesthesia providers, availability of equipment and drugs and use of perioperative routines. METHODS All hospitals in Sierra Leone performing caesarean sections were included. In each facility, one randomly selected anaesthesia provider was interviewed face-to-face using a predefined questionnaire. RESULTS In 2016, 36 hospitals performed caesarean sections in Sierra Leone. The most commonly used anaesthesia method for caesarean section was spinal anaesthesia (63%), followed by intravenous ketamine without intubation; however, there was a wide variety between hospitals. Of all anaesthesia providers, 33% were not qualified to provide anaesthesia independently, as stipulated by local regulations. Of those, 50% expressed high confidence in their skills to handle obstetric emergencies. There were discrepancies among hospitals in the availability of essential drugs, the use of post-operative recovery and the presence of a functioning blood bank. CONCLUSION Anaesthesia for caesarean sections in Sierra Leone showed a predominance for spinal anaesthesia. The workforce consisted mainly of non-physicians, of which a third was not trained to provide anaesthesia independently. Both the type of anaesthesia and the presence of qualified anaesthetic providers was widely variable between hospitals. Significant gaps were identified in the availability of equipment, essential drugs and perioperative routines.
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Affiliation(s)
- Herman A. Lonnée
- Department of Anaesthesia and Intensive Care St. Olav’s Hospital Trondheim Norway
| | - Katinka Taule
- Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | | | - Michael M. Koroma
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
- Department of Anaesthesia Princess Christian Maternity Hospital (PCMH) Freetown Sierra Leone
| | | | - Kakpama S.K. Jusu
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Mohamed A. Shour
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Alex J. Duinen
- Department of Cancer Research and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olav’s HospitalTrondheim University Hospital Trondheim Norway
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Nanji JA, Carvalho B. Pain management during labor and vaginal birth. Best Pract Res Clin Obstet Gynaecol 2020; 67:100-112. [PMID: 32265134 DOI: 10.1016/j.bpobgyn.2020.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 11/20/2022]
Abstract
Neuraxial analgesia provides excellent pain relief in labor. Optimizing initiation and maintenance of neuraxial labor analgesia requires different strategies. Combined spinal-epidurals or dural puncture epidurals may offer advantages over traditional epidurals. Ultrasound is useful in certain patients. Maintenance of analgesia is best achieved with a background regimen (either programmed intermittent boluses or a continuous epidural infusion) supplemented with patient-controlled epidural analgesia and using dilute local anesthetics combined with opioids such as fentanyl. Nitrous oxide and systemic opioids are also used for pain relief. Nitrous oxide may improve satisfaction despite variable effects on pain. Systemic opioids can be administered by healthcare providers or using patient-controlled analgesia. Appropriate choice of drug should take into account the stage and progression of labor, local safety protocols, and maternal and fetal/neonatal side effects. Pain in labor is complex, and women should fully participate in the decision-making process before any one modality is selected.
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Affiliation(s)
- Jalal A Nanji
- Department of Anesthesiology and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive MC: 5640, Stanford, CA, 94305, USA.
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McCauley M, Actis Danna V, Mrema D, van den Broek N. "We know it's labour pain, so we don't do anything": healthcare provider's knowledge and attitudes regarding the provision of pain relief during labour and after childbirth. BMC Pregnancy Childbirth 2018; 18:444. [PMID: 30428840 PMCID: PMC6236945 DOI: 10.1186/s12884-018-2076-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 10/29/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Most women experience pain during labour and after childbirth. There are various options, both pharmacological and non-pharmacological, available to help women cope with and relieve pain during labour and after childbirth. In low resource settings, women often do not have access to effective pain relief. Healthcare providers have a duty of care to support women and improve quality of care. We investigated the knowledge and attitudes of healthcare providers regarding the provision of pain relief options in a hospital in Moshi, Tanzania. METHODS Semi-structured key informant interviews (n = 24) and two focus group discussions (n = 10) were conducted with healthcare providers (n = 34) in Tanzania. Transcribed interviews were coded and codes grouped into categories. Thematic framework analysis was undertaken to identify emerging themes. RESULTS Most healthcare providers are aware of various approaches to pain management including both pharmacological and non-pharmacological options. Enabling factors included a desire to help, the common use of non-pharmacological methods during labour and the availability of pharmacological pain relief for women who have had a Caesarean section. Challenges included shortage of staff, lack of equipment, no access to nitrous oxide or epidural medication, and fears regarding the effect of opiates on the woman and/or baby. Half of all healthcare providers consider labour pain as 'natural' and necessary for birth and therefore do not routinely provide pharmacological pain relief. Suggested solutions to increase evidence-based pain management included: creating an enabling environment, providing education, improving the use of available methods (both pharmacological and non-pharmacological), emphasising the use of context-specific protocols and future research to understand how best to provide care that meets women's needs. CONCLUSIONS Many healthcare providers do not routinely offer pharmacological pain relief during labour and after childbirth, despite availability of some resources. Most healthcare providers are open to helping women and improving quality of pain management using an approach that respects women's culture and beliefs. Women are increasingly accessing care during labour and there is now a window of opportunity to adapt and amend available maternity care packages to include comprehensive provision for pain relief (both pharmacological and non-pharmacological) as an integral component of quality of care.
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Affiliation(s)
- Mary McCauley
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Valentina Actis Danna
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Dorah Mrema
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro Tanzania
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
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Lonnée HA, Madzimbamuto F, Erlandsen ORM, Vassenden A, Chikumba E, Dimba R, Myhre AK, Ray S. Anesthesia for Cesarean Delivery. Anesth Analg 2018; 126:2056-2064. [DOI: 10.1213/ane.0000000000002733] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Failure of spinal anaesthesia for caesarean section may have deleterious consequences for the mother as well as the newborn baby. In this article, we discuss the mechanisms of failure of spinal anaesthesia as well as the approach to a failed block. We performed a literature search in Google Scholar, PubMed, and Cochrane databases for original and review articles concerning failed spinal anaesthesia and caesarean section. Strategies for a failed spinal anaesthetic include manoeuvers to salvage the block, repeating the block, epidural anaesthesia or a combined spinal-epidural (CSE) technique, or resorting to general anaesthesia. Factors influencing the choice of these alternative options are discussed. A "failed spinal algorithm" can guide the anaesthesiologist and help reduce morbidity and mortality.
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Affiliation(s)
- Ketan S Parikh
- Department of Anesthesia, Breach Candy Hospital, Mumbai, Maharashtra, India.,Department of Anesthesia, Bombay Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Shwetha Seetharamaiah
- Department of Anesthesia, Janani Anesthesia and Critical Care Services, Shimoga, Karnataka, India
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Diaconu K, Chen YF, Cummins C, Jimenez Moyao G, Manaseki-Holland S, Lilford R. Methods for medical device and equipment procurement and prioritization within low- and middle-income countries: findings of a systematic literature review. Global Health 2017; 13:59. [PMID: 28821280 PMCID: PMC5563028 DOI: 10.1186/s12992-017-0280-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 07/27/2017] [Indexed: 05/29/2023] Open
Abstract
Background Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue. We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries. We explore the factors/evidence-base proposed for consideration within such methods and identify prioritization criteria. Results We included 217 documents (corresponding to 250 texts) in the narrative synthesis. Of these 111 featured in the meta-summary. We identify experience and needs-based methods used to reach procurement decisions. Equipment costs (including maintenance) and health needs are the dominant issues considered. Extracted data suggest that procurement officials should prioritize devices with low- and middle-income country appropriate technical specifications – i.e. devices and equipment that can be used given available human resources, infrastructure and maintenance capacity. Conclusion Suboptimal device use is directly linked to incomplete costing and inadequate consideration of maintenance services and user training during procurement planning. Accurate estimation of life-cycle costing and careful consideration of device servicing are of crucial importance. Electronic supplementary material The online version of this article (doi:10.1186/s12992-017-0280-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin Diaconu
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK. .,Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Yen-Fu Chen
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
| | - Carole Cummins
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK.
| | - Gabriela Jimenez Moyao
- Medicins Sans Frontieres, Artsen Zonder Grenzen, Rue de l'Arbre Benit 46, 1050, Bruxelles, Belgium
| | - Semira Manaseki-Holland
- Institute for Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands, UK
| | - Richard Lilford
- Warwick Centre for Applied Health Research and Delivery, University of Warwick, Coventry, CV4 7AL, UK
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Ayebale ET, Kwizera A, Mijumbi C, Kizito S, Roche AM. Ringer's Lactate Versus Normal Saline in Urgent Cesarean Delivery in a Resource-Limited Setting: A Pragmatic Clinical Trial. Anesth Analg 2017; 125:533-539. [PMID: 28682955 DOI: 10.1213/ane.0000000000002229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Crystalloids are used routinely for perioperative fluid management in cesarean delivery. Few studies have determined the crystalloid of choice in obstetric anesthesia. We compared the effects of Ringer's lactate (RL) versus 0.9% normal saline (NS) on maternal and neonatal blood pH and 24-hour postoperative morbidity in urgent cesarean delivery in a low-resource setting. Our hypothesis was that RL would result in 30% less acidosis than NS. METHODS This was a pragmatic prospective double-blind randomized controlled trial in the Mulago National Referral Hospital Labor Ward Theater from September 2011 to May 2012. Five hundred parturients were studied; 252 were randomly assigned to NS and 248 to RL groups. Preoperative and postoperative maternal venous blood gases and placental umbilical arterial cord blood gases were analyzed. The primary outcome was incidence of maternal acidosis, as defined by a postoperative drop in venous pH below 7.32 or reduction in base excess below -3 in a previously normal parturient. Maternal 24-hour postoperative morbidity, neonatal pH, and neonatal base excess were the main secondary outcomes. The study was registered in ClinicalTrials.gov as NCT01585740. RESULTS The overall incidence of maternal acidosis was 38% in NS and 29% in RL (relative risk, 1.29; 95% confidence interval, 1.01-1.66; P = .04). Thirty-two percent of parturients in NS experienced a drop in venous pH below 7.32 postoperatively, compared with 19% in RL (relative risk, 1.65; 95% confidence interval, 1.18-2.31; P = .003). The comparative drop in base excess postoperatively below -3 between the 2 groups was not statistically significant. There were no significant differences in the incidence of maternal 24-hour postoperative morbidity events and neonatal outcomes between the 2 groups. CONCLUSIONS NS may be a safe choice for intraoperative fluid therapy in urgent cesarean delivery as RL, albeit with an increased incidence of metabolic acidosis.
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Affiliation(s)
- Emmanuel Timarwa Ayebale
- From the *Department of Anesthesia, Makerere University College of Health Sciences, Kampala, Uganda; †Department of Anesthesia, Mulago National Referral Hospital, Kampala, Uganda; ‡Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda; and §Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Epiu I, Tindimwebwa JVB, Mijumbi C, Chokwe TM, Lugazia E, Ndarugirire F, Twagirumugabe T, Dubowitz G. Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa. Anesth Analg 2017; 124:290-299. [PMID: 27918334 DOI: 10.1213/ane.0000000000001690] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The United Nations 2015 Millennium Development Goals targeted a 75% reduction in maternal mortality. However, in spite of this goal, the number of maternal deaths per 100,000 live births remains unacceptably high across Sub-Saharan Africa. Because many of these deaths could likely be averted with access to safe surgery, including cesarean delivery, we set out to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa. METHODS A cross-sectional survey was conducted at 5 main referral hospitals in East Africa: Uganda, Kenya, Tanzania, Rwanda, and Burundi. Using a questionnaire based on the World Federation of the Societies of Anesthesiologists (WFSA) international guidelines for safe anesthesia, we interviewed anesthetists in these hospitals, key informants from the Ministry of Health and National Anesthesia Society of each country (Supplemental Digital Content, http://links.lww.com/AA/B561). RESULTS Using the WFSA checklist as a guide, none of respondents had all the necessary requirements available to provide safe obstetric anesthesia, and only 7% reported adequate anesthesia staffing. Availability of monitors was limited, and those that were available were often nonfunctional. The paucity of local protocols, and lack of intensive care unit services, also contributed significantly to poor maternal outcomes. For a population of 142.9 million in the East African community, there were only 237 anesthesiologists, with a workforce density of 0.08 in Uganda, 0.39 in Kenya, 0.05 in Tanzania, 0.13 in Rwanda, and 0.02 anesthesiologists in Burundi per 100,000 population in each country. CONCLUSIONS We identified significant shortages of both the personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases across East Africa. There is a need to increase the number of physician anesthetists, to improve the training of nonphysician anesthesia providers, and to develop management protocols for obstetric patients requiring anesthesia. This will strengthen health systems and improve surgical outcomes in developing countries. More funding is required for training physician anesthetists if developing countries are to reach the targeted specialist workforce density of the Lancet Commission on Global Surgery of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.
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Affiliation(s)
- Isabella Epiu
- From the *Department of Anaesthesia, University of California Global Health Institute - Makerere University College of Health Sciences, Kampala, Uganda; †Department of Anaesthesia, Mulago Hospital, Kampala, Uganda; ‡Department of Anaesthesia, University of Nairobi, Nairobi, Kenya; §Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ‖Centre Hospitalo-Universitaire de Kamenge, Bujumbura, Burundi; ¶University of Rwanda, Kigali, Rwanda; and #Department of Anaesthesia and Perioperative Care, University of California, San Francisco
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Baysinger CL, Pujic B, Velickovic I, Owen MD, Serafin J, Shotwell MS, Braveman F. Increasing Regional Anesthesia Use in a Serbian Teaching Hospital through an International Collaboration. Front Public Health 2017. [PMID: 28649565 PMCID: PMC5465237 DOI: 10.3389/fpubh.2017.00134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many low- and middle-income countries (LMICs) report low rates of regional anesthesia (RA) use for cesarean delivery (CD), despite its association with lower maternal major morbidity and mortality. Also, the prevalence of neuraxial analgesia for labor (NAL) is often low in LMICs. We report on the results of a collaboration in clinical education over a multi-year period between Kybele Inc., an international non-profit organization, and Klinicki Centar Vojvodine (CCV), a teaching hospital in Novi Sad, Serbia, to increase RA use for CD and NAL at CCV. From late 2011 through 2015, teams from Kybele participated in annual to biannual didactic conferences and week-long bedside teaching efforts involving obstetric and anesthesia staff from CCV and surrounding hospitals. Ongoing contact occurred at least weekly between Kybele and the host to discuss progress. De-identified quality improvement data on total deliveries, numbers of elective and non-elective CDs, number of vaginal deliveries, type of anesthesia for CD, and the number of NALs were collected. RA use for CD increased to 25% in year 2015 versus 14% in base year 2011 [odds ratio (OR): 2.05; 95% confidence interval (CI): 1.73,2.42; p < 0.001]. NAL increased to 10.5% of laboring women in 2015 versus 1.2% in 2011 (OR: 9.6; 95% CI: 7.2, 12.8; p < 0.001). Greater increases for RA use during non-elective CD were observed between 2011 and 2015 (1.4 versus 7.5% of total CD; OR: 5.52; 95% CI: 2.63, 8.41; p < 0.001) relative to elective CD (12.5 versus 17.5% of total CD; OR: 1.48; 95% CI: 1.23, 1.77; p < 0.001). Overall, RA for CD increased during the 4 year collaboration but was not as great as reported in other countries with similar health-care demographics utilizing a similar program. Detailed descriptions of program interventions and barriers to change at CCV are presented.
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Affiliation(s)
- Curtis L Baysinger
- Division of Obstetric Anesthesia, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Borislava Pujic
- Klinika za Ginekologiju I Akuserstvo, Klinickog Centra Vojvodine, Novi Sad, Serbia
| | - Ivan Velickovic
- Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Medge D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Joanna Serafin
- Department of Biostatistics, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Ferne Braveman
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, United States
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Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol 2017. [DOI: 10.1016/j.bpa.2016.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Epiu I, Tindimwebwa JVB, Mijumbi C, Ndarugirire F, Twagirumugabe T, Lugazia ER, Dubowitz G, Chokwe TM. Working towards safer surgery in Africa; a survey of utilization of the WHO safe surgical checklist at the main referral hospitals in East Africa. BMC Anesthesiol 2016; 16:60. [PMID: 27515450 PMCID: PMC4982013 DOI: 10.1186/s12871-016-0228-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Mortality from anaesthesia and surgery in many countries in Sub-Saharan Africa remain at levels last seen in high-income countries 70 years ago. With many factors contributing to these poor outcomes, the World Health Organization (WHO) launched the “Safe Surgery Saves Lives” campaign in 2007. This program included the design and implementation of the “Surgical Safety Checklist”, incorporating ten essential objectives for safe surgery. We set out to determine the knowledge of and attitudes towards the use of the WHO checklist for surgical patients in national referral hospitals in East Africa. Methods A cross-sectional survey was conducted at the main referral hospitals in Mulago (Uganda), Kenyatta (Kenya), Muhimbili (Tanzania), Centre Hospitalier Universitaire de Kigali (Rwanda) and Centre Hospitalo-Universitaire de Kamenge (Burundi). Using a pre-set questionnaire, we interviewed anaesthetists on their knowledge and attitudes towards use of the WHO surgical checklist. Results Of the 85 anaesthetists interviewed, only 25 % regularly used the WHO surgical checklist. None of the anaesthetists in Mulago (Uganda) or Centre Hospitalo-Universitaire de Kamenge (Burundi) used the checklist, mainly because it was not available, in contrast with Muhimbili (Tanzania), Kenyatta (Kenya), and Centre Hospitalier Universitaire de Kigali (Rwanda), where 65 %, 19 % and 36 %, respectively, used the checklist. Conclusion Adherence to aspects of care embedded in the checklist is associated with a reduction in postoperative complications. It is therefore necessary to make the surgical checklist available, to train the surgical team on its importance and to identify local anaesthetists to champion its implementation in East Africa. The Ministries of Health in the participating countries need to issue directives for the implementation of the WHO checklist in all hospitals that conduct surgery in order to improve surgical outcomes.
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Affiliation(s)
- Isabella Epiu
- Fogarty Global Health Fellow, University of California Global Health Institute (UCGHI), San Francisco, California, USA. .,Department of Anaesthesia, Makerere University College of Health Sciences, P.O. BOX 7072, Kampala, Uganda.
| | | | | | | | | | | | | | - Thomas M Chokwe
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
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15
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Al-Kazwini H, Sandven I, Dahl V, Rosseland LA. Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review. Scand J Pain 2016; 13:36-42. [PMID: 28850533 DOI: 10.1016/j.sjpain.2016.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Single-shot spinal with bupivacaine plus fentanyl or sufentanil is commonly used as analgesia during labour, but the short duration limits the clinical feasibility. Different drugs have been added to prolong the analgesic duration. The additional effect of intra-thecal morphine has been studied during labour pain as well as after surgery. We assessed whether adding morphine to intra-thecal bupivacaine+fentanyl or sufentanil prolongs pain relief during labour. METHODS Meta-analysis of placebo-controlled randomized clinical trials of analgesia prolongation after single-shot intrathecal morphine ≤250μg during labour when given in combination with bupivacaine+fentanyl or sufentanil. After identifying 461 references, 24 eligible studies were evaluated after excluding duplicate publications, case reports, studies of analgesia after caesarean delivery, and epidural labour analgesia. Mean duration in minutes was the primary outcome measure and was included in the calculation of the standardized mean difference. Duration was defined as the time between a single shot spinal until patient request of rescue analgesia. All reported side effects were registered. Results of individual trials were combined using a random effect model. Cochrane tool was used to assess risk of bias. RESULTS Five randomized placebo-controlled clinical trials (286 patients) were included in the meta-analysis. A dose of 50-250μg intrathecal morphine prolonged labour analgesia by a mean of 60.6min (range 3-155min). Adding morphine demonstrated a medium beneficial effect as we found a pooled effect of standardized mean difference=0.57 (95% CI: -0.10 to 1.24) with high heterogeneity (I2=88.1%). However, the beneficial effect was statistically non-significant (z=1.66, p=0.096). The lower-bias trials showed a small statistically non-significant beneficial effect with lower heterogeneity. In influential analysis, that excluded one study at a time from the meta-analysis, the effect size appears unstable and the results indicate no robustness of effect. Omitting the study with highest effects size reduces the pooled effect markedly and that study suffers from inadequate concealment of treatment allocation and blinding. Trial quality was generally low, and there were too few trials to explore sources of heterogeneity in meta-regression and stratified analyses. In general, performing meta-analyses on a small number of trials are possible and may be helpful if one is aware of the limitations. As few as one more placebo-controlled trial would increase the reliability greatly. CONCLUSIONS Evidence from this systematic review suggests a possible beneficial prolonging effect of adding morphine to spinal analgesia with bupivacaine+fentanyl or +sufentanil during labour. The study quality was low and heterogeneity high. No severe side effects were reported. More adequately-powered randomized trials with low bias are needed to determine the benefits and harms of adding morphine to spinal local anaesthetic analgesia during labour. IMPLICATIONS Epidural analgesia is documented as the most effective method for providing pain relief during labour, but from a global perspective most women in labour have no access to epidural analgesia. Adding morphine to single shot spinal injection of low dose bupivacaine, fentanyl or sufentanil may be efficacious but needs to be investigated.
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Affiliation(s)
- Hadeel Al-Kazwini
- Department of Anaesthesia, Skien Hospital, Telemark Hospital Trust, Skien, Norway
| | - Irene Sandven
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Vegard Dahl
- Department of Anaesthesia and Intensive Care Medicine, Akershus University Hospital, Loerenskog, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leiv Arne Rosseland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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16
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Eriksson J, Baker T, Jörnvall H, Irestedt L, Mulungu M, Larsson E. Quality of anaesthesia for Caesarean sections: a cross-sectional study of a university hospital in a low-income country. Trop Med Int Health 2015; 20:1329-36. [DOI: 10.1111/tmi.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jesper Eriksson
- Department of Anaesthesia, Intensive Care and Surgical Services; Karolinska University Hospital; Solna Stockholm Sweden
- Section of Anaesthesiology and Intensive Care Medicine; Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - Tim Baker
- Department of Anaesthesia, Intensive Care and Surgical Services; Karolinska University Hospital; Solna Stockholm Sweden
- Section of Anaesthesiology and Intensive Care Medicine; Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
- Department of Public Health Sciences; Karolinska Institutet; Stockholm Sweden
| | - Henrik Jörnvall
- Department of Anaesthesia, Intensive Care and Surgical Services; Karolinska University Hospital; Solna Stockholm Sweden
| | - Lars Irestedt
- Department of Anaesthesia, Intensive Care and Surgical Services; Karolinska University Hospital; Solna Stockholm Sweden
- Section of Anaesthesiology and Intensive Care Medicine; Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - Moses Mulungu
- Department of Anaesthesia and Intensive Care; Muhimbili National Hospital; Dar es Salaam Tanzania
| | - Emma Larsson
- Department of Anaesthesia, Intensive Care and Surgical Services; Karolinska University Hospital; Solna Stockholm Sweden
- Section of Anaesthesiology and Intensive Care Medicine; Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
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17
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Teaching Neuraxial Anesthesia Techniques for Obstetric Care in a Ghanaian Referral Hospital. Anesth Analg 2015; 120:1317-22. [DOI: 10.1213/ane.0000000000000464] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Anabah T, Olufolabi A, Boyd J, George R. Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1013322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Murray AW, Beaman ST, Kampik CW, Quinlan JJ. Simulation in the operating room. Best Pract Res Clin Anaesthesiol 2015; 29:41-50. [PMID: 25902465 DOI: 10.1016/j.bpa.2015.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/06/2015] [Accepted: 02/17/2015] [Indexed: 11/17/2022]
Abstract
Simulation has become a significant training tool in the operating room (OR). It can be used in both simple task training and complex scenarios. The challenge for simulation in the OR is how to translate that which is learned, and perceived to beneficial, into behavioral change and improved patient outcomes. Simulation in the developing world is progressing, but is still hampered by a shortage of material, personnel funding.
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Affiliation(s)
- Andrew W Murray
- University of Pittsburgh, C-200 UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Shawn T Beaman
- University of Pittsburgh, Suite 910 Liliane S Kaufmann Building, 3471 5th Avenue, Pittsburgh, PA, 15213, USA.
| | - Christian W Kampik
- Inkosi Albert Luthuli Hospital, Central Hospital University of KwaZulu Natal, Durban, South Africa.
| | - Joseph J Quinlan
- University of Pittsburgh, C-200 UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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20
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Livingston P, Evans F, Nsereko E, Nyirigira G, Ruhato P, Sargeant J, Chipp M, Enright A. Safer obstetric anesthesia through education and mentorship: a model for knowledge translation in Rwanda. Can J Anaesth 2014; 61:1028-39. [DOI: 10.1007/s12630-014-0224-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022] Open
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21
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Defining the anesthesia gap for reproductive health procedures in resource-limited settings. Int J Gynaecol Obstet 2014; 127:229-33. [DOI: 10.1016/j.ijgo.2014.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/18/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022]
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22
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Theron A, Rout CC. Obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal: human resources, caseloads and the experience of doctors. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Theron
- King Edward VIII Hospital, Durban
| | - CC Rout
- Department of Anaesthesiology, University of KwaZulu-Natal, Durban
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23
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Kodali BS, Jagannathan DK, Owen MD. Establishing an obstetric neuraxial service in low-resource areas. Int J Obstet Anesth 2014; 23:267-73. [PMID: 24986562 DOI: 10.1016/j.ijoa.2014.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/22/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022]
Abstract
The proportion of laboring women utilizing neuraxial techniques for labor analgesia has steadily increased over the past decades in North America, the UK and parts of Europe. Anesthesiologists in many other countries may want to introduce an obstetric neuraxial service but may lack the knowledge and experience necessary to ensure its safety. The focus of this article is to address the necessity, benefit and challenges of establishing such a service in a resource-limited environment. Even successful financial institutions may be considered resource-limited if critical components necessary for an obstetric neuraxial service are missing due to either perceived unimportance or non-availability. There is a need to deploy a culture of safety by ensuring the availability of resuscitation equipment, developing protocols and training, fostering communication among members of the care team and initiating quality-control measures. Patient education and satisfaction are additional key components of a successful service. Even in financially low-resource settings, proper safety measures must be adopted so that the neuraxial procedure itself does not contribute to morbidity and mortality. A viable and safe neuraxial service can be developed using innovative strategies based on local constraints.
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Affiliation(s)
- B S Kodali
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - D K Jagannathan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M D Owen
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC, USA
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24
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Dyer RA, Vorster AD, Arcache MJ, Vasco M. New trends in the management of postpartum haemorrhage. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2014.10844564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Dyer
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - AD Vorster
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - MJ Arcache
- Department of Anaesthesia, University of Cape Town and Groote Schuur Hospital, Cape Town
| | - M Vasco
- Unisanitas and Clinica Reina Sofia, Bogota, Colombia
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25
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Bharati SJ, Chowdhury T, Gupta N, Schaller B, Cappellani RB, Maguire D. Anaesthesia in underdeveloped world: Present scenario and future challenges. Niger Med J 2014; 55:1-8. [PMID: 24970961 PMCID: PMC4071655 DOI: 10.4103/0300-1652.128146] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The overall mortality and morbidity in underdeveloped countries are still unchanged and preventable risks factors constitute the main burden. Among these, anaesthesia-related mortality is largely preventable. Various contributory factors related to human resources, technical resources, education/teaching system and other utilities needs further attention in poor income group countries. Therefore, we have made an attempt to address all these issues in this educational article and have given special reference to those factors that might gain importance in (near) future. Proper understanding of anaesthesia-related resources, their overall impact on health care system and their improvisation methods should be thoroughly evaluated for providing safer anaesthesia care in these countries which would certainly direct better outcome and consequently influence mortality.
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Affiliation(s)
- Sachidanand Jee Bharati
- Department of Anesthesia, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Science, New Delhi, India
| | - Tumul Chowdhury
- Department of Anesthesia and Perioperative Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Canada
| | - Nishkarsh Gupta
- Department of Anesthesia, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Science, New Delhi, India
| | - Bernhard Schaller
- Department of Research, University of Southampton, Southampton, United Kingdom
| | - Ronald B Cappellani
- Department of Anesthesia and Perioperative Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Canada
| | - Doug Maguire
- Department of Anesthesia and Perioperative Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Canada
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26
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Khaskheli MN, Baloch S, Sheeba A. Iatrogenic risks and maternal health: Issues and outcomes. Pak J Med Sci 2014; 30:111-5. [PMID: 24639842 PMCID: PMC3955553 DOI: 10.12669/pjms.301.4062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/22/2013] [Accepted: 11/11/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To observe acute maternal morbidity and mortality due to iatrogenic factors and outcomes. METHODS This observational cross sectional study was conducted at intensive care unit of Liaquat University of Medical and Health sciences Jamshoro from 1-January-2011 to 31-December-2012. In this study all the delivered or undelivered women who needed intensive care unit (ICU) admission due to management related life threatening complication referred from periphery or within this hospital were included, while those women who had pregnancy complicated by medical conditions were excluded. These women were registered on the predesigned proforma containing variables like Demographic characteristics, various iatrogenic risk factors, complications and management out comes. The data was collected and analyzed on SPSS version 20. RESULTS During these study period 51 women needed ICU care for different complications due to adverse effects of medical treatments. Majority of these women were between 20-40 years of age 41(80.39%), multiparous 29(56.86%), unbooked 38(74.50%), referred from periphery 39(76.47%), common iatrogenic factors were misuse of oxytocin 16(31.37%), fluid overload/cardiac failure 8(15.68%), blood reaction 7(13.72%), anesthesia related problems were delayed recovery 3(5.88%), cardiac arrest 2(3.92%), spinal shock 2(3.92%), surgical problems were bladder injury 5(9.8%), post operative internal haemorrhage 3(5.88%), 37(72.54%) women recovered and 14(27.45%) expired. CONCLUSION The maternal morbidity and mortality rate with iatrogenic factors was high and majority of these factors were avoidable.
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Affiliation(s)
- Meharun-nissa Khaskheli
- Dr. Meharun-nissa Khaskheli, MBBS, FCPS, Associate Professor, Department of Obstetrics & Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Shahla Baloch
- Dr. Shahla Baloch, MBBS, DGO, FCPS, Associate Professor, Department of Obstetrics & Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
| | - Aneela Sheeba
- Dr. Aneela Sheeba, MBBS, DMRD, (FCPS), Assistant Professor, Department of Obstetrics & Gynaecology, Liaquat University of Medical & Health Sciences Jamshoro, Sindh, Pakistan
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27
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Advancing obstetric anesthesia practices in Georgia through clinical education and quality improvement methodologies. Int J Gynaecol Obstet 2012; 120:296-300. [DOI: 10.1016/j.ijgo.2012.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 09/24/2012] [Accepted: 11/26/2012] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Reforms in the delivery of surgical and anaesthetic services in the UK have reduced the opportunity for trainees to acquire 'hands-on' training. These problems are seen in other European countries and in North America. CONTEXT Surgical and anaesthetic services within developed health care systems tend to be specialised, and are often consultant led. In rural South Africa there is a shortage of surgeons and anaesthetists to service the population, and the public health care system is vastly over-burdened. Trauma accounts for a large percentage of the surgical and anaesthetic workload. INNOVATION This report compares the anaesthetic and surgical training experience of two first-year registrars during a 6-month training period in rural South Africa and a 6-month training period in the UK. IMPLICATIONS Surgical and anaesthetic trainees from countries such as the UK can spend an out-of-programme training period in rural South Africa, thereby broadening their experience and exposure to trauma. They have the opportunity to take on a higher level of responsibility at an earlier stage of training, gaining 'hands-on' experience. Similarly, South African anaesthetic and surgical trainees can spend an out-of-programme training period in the UK, where they can learn the specialist procedures needed in their home country.
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Affiliation(s)
- David L Sanders
- Department of Upper GI Surgery, Royal Cornwall Hospital, Truro, Cornwall, UK.
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29
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Affiliation(s)
- Sunanda Gupta
- President, Association of Obstetric Anaesthesiologists, RNT Medical College, Udaipur, India E-mail:
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