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Lukama L, Aldous C, Kuhn W, Michelo C, Kalinda C. Ten years of ear, nose and throat (ENT) services in Southern Africa: a scoping review. Glob Health Action 2024; 17:2370102. [PMID: 38932660 PMCID: PMC11212562 DOI: 10.1080/16549716.2024.2370102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND While ear, nose, and throat (ENT) diseases are a substantial threat to global health, comprehensive reviews of ENT services in Southern Africa remain scarce. OBJECTIVE This scoping review provides a decade-long overview of ENT services in Southern Africa and identifies gaps in healthcare provision. From the current literature, we hope to provide evidence-based recommendations to mitigate the challenges faced by the resource-limited ENT service. DATA SOURCES PubMed, Web of Science, EBSCOhost, Cochrane Library, Cochrane Library, and Scopus. REVIEW METHODS On several databases, we conducted a comprehensive literature search on both quantitative and qualitative studies on ENT services in Southern Africa, published between 1 January 2014 and 27 February 2024. The extracted data from the analyzed studies was summarized into themes. RESULTS Four themes in the fourteen studies included in the final analysis described the existing ENT services in Southern Africa: 1. Workforce scarcity and knowledge inadequacies, 2. Deficiencies in ENT infrastructure, equipment, and medication, 3. Inadequate ENT disease screening, management, and rehabilitation and 4. A lack of telehealth technology. CONCLUSION The Southern African ENT health service faces many disease screening, treatment, and rehabilitation challenges, including critical shortages of workforce, equipment, and medication. These challenges, impeding patient access to ENT healthcare, could be effectively addressed by implementing deliberate policies to train a larger workforce, increase ENT funding for equipment and medication, promote telehealth, and reduce the patient cost of care.
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Affiliation(s)
- Lufunda Lukama
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Otorhinolaryngology, Head and Neck Surgery, Ndola Teaching Hospital, Ndola, Zambia
| | - Colleen Aldous
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Warren Kuhn
- College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Charles Michelo
- Global Health Institute, Nkwazi Research University, Lusaka, Zambia
| | - Chester Kalinda
- Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- Howard College Campus, College of Health Sciences, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Richard K, Sanchez R, Amado B, Lubner R, Niconchuk J, Chen H, Phillips J, Kynes M, Belcher RH. Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala. Otolaryngol Head Neck Surg 2024; 170:252-259. [PMID: 37466003 DOI: 10.1002/ohn.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes. STUDY DESIGN Retrospective cohort study. SETTING Guatemalan surgery center is called the Moore Center. METHODS Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. RESULTS A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. CONCLUSION This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
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Affiliation(s)
- Kelsey Richard
- Medical Doctorate Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Barbara Amado
- Centro Quirugico Pediatrico Moore, Guatemala City, Guatemala
| | - Rory Lubner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Niconchuk
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Phillips
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
| | - Matthew Kynes
- Department of Anesthesia, Pediatric Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Vanderbilt Children's Hospital, Nashville, Tennessee, USA
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Belcher RH, Patel SA, Kynes M, Carlucci JG, Hodson E, Zhao S, Lipscomb B, Heimburger DC. Demographics and trends of cleft lip and palate patients born in Tennessee from 2000 to 2017. Int J Pediatr Otorhinolaryngol 2022; 163:111312. [PMID: 36257171 DOI: 10.1016/j.ijporl.2022.111312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/26/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the prevalence of orofacial clefts (OFCs) in Tennessee over the span of 2000-2017, and evaluate the effects of race/ethnicity, sex, maternal/paternal age and socioeconomic status on the prevalence. METHODS Records of all live births and demographics of newborns in Tennessee from 2000 to 2017 were requested from the Tennessee Department of Health to calculate the prevalence of OFCs. Data from United States Census was also obtained. Data provided were deidentified. RESULTS Tennessee showed a significant decrease in prevalence rates of cleft lip, with and without cleft palate (CL ± P), when comparing the time periods of 2000-2007 to 2008-2017. A significant positive correlation was found with CL ± P prevalence rates in regions with higher Caucasian populations and a negative correlation in regions with higher African American populations. The CP prevalence rates showed a negative correlation with increased median household income. CONCLUSION To our knowledge, this is the first study to show a significant negative correlation with median household income and CP prevalence rates. Our study showing an increase in prevalence rates of OFCs with decreased socioeconomic status indicates that the areas of Tennessee with the lowest median household income averages would likely benefit from understanding other possible modifiable factors that are driving this correlation.
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Affiliation(s)
- Ryan H Belcher
- Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Pediatric Otolaryngology Division, USA; Vanderbilt Pediatric Cleft and Craniofacial Program, USA.
| | | | - Matthew Kynes
- Department of Anesthesia, Vanderbilt University Medical Center, USA
| | - James G Carlucci
- Department of Pediatrics, Indiana University School of Medicine, USA
| | | | - Shilin Zhao
- Vanderbilt Ingram Cancer Center, Department of Biostatistics, Vanderbilt University Medical Center, USA
| | - Brittany Lipscomb
- Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Pediatric Otolaryngology Division, USA; Surgical Outcomes Center for Kids at Monroe Carell Jr. Children's Hospital at Vanderbilt, USA
| | - Douglas C Heimburger
- Department of Medicine, Vanderbilt University Medical Center, USA; Vanderbilt Institute of Global Health, USA
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Belcher R, Virgin F, Duis J, Wootten C. Genetic and Non-genetic Workup for Pediatric Congenital Hearing Loss. Front Pediatr 2021; 9:536730. [PMID: 33829002 PMCID: PMC8020033 DOI: 10.3389/fped.2021.536730] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/25/2021] [Indexed: 01/06/2023] Open
Abstract
Hearing loss is one of the most common concerns for presentation for a geneticist. Presentation prior to the age of one (congenital hearing loss), profound sensorineural hearing loss (SNHL), and bilateral hearing loss are sensitive and should raise concern for genetic causes of hearing loss and prompt referral for genetic testing. Genetic testing particularly in this instance offers the opportunity for anticipatory guidance including possible course of the hearing loss over time and also connection and evaluation for additional congenital anomalies that may be associated with an underlying syndrome vs. isolated genetic hearing loss.
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Affiliation(s)
- Ryan Belcher
- Division of Pediatric Otolaryngology, Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, United States
| | - Frank Virgin
- Division of Pediatric Otolaryngology, Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, United States
| | - Jessica Duis
- Division of Pediatric Otolaryngology, Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, United States
| | - Christopher Wootten
- Division of Pediatric Otolaryngology, Vanderbilt Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, United States
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Jayawardena ADL, Ghersin ZJ, Mirambeaux M, Bonilla JA, Quiñones E, Zablah E, Callans K, Hartnick M, Sahani N, Cayer M, Hersh C, Gallagher TQ, Yager PH, Hartnick CJ. A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience. Otolaryngol Head Neck Surg 2020; 163:971-978. [PMID: 32600113 DOI: 10.1177/0194599820935042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. STUDY DESIGN Consecutive case series with chart review. SETTING This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. METHODS Demographic data, diagnostic and operative details, and operative outcomes were collected. A country's program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. RESULTS A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. CONCLUSION This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.
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Affiliation(s)
- Asitha D L Jayawardena
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Zelda J Ghersin
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marcos Mirambeaux
- Department of Otolaryngology, Roberto Reid Cabral, Santa Domingo, Dominican Republic
| | - Jose A Bonilla
- Department of Otolaryngology, Benjamin Bloom Hospital, San Salvador, El Salvador
| | - Ernesto Quiñones
- Hospital de los Valles, Universidad San Francisco de Quito, Quito, Ecuador
| | - Evelyn Zablah
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Callans
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Marina Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Nita Sahani
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Makara Cayer
- Department of Anesthesia, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Cheryl Hersh
- Pediatric Airway, Voice and Swallowing Center, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Thomas Q Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Phoebe H Yager
- Pediatric Intensive Care Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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