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Nabukenya MT, Newton MW, Gray RM, Kapoor I, Kuratani N, Moore J, Rai E, Evans FM. The role of collaboration in educating the global pediatric anesthesia workforce. Paediatr Anaesth 2024. [PMID: 38470009 DOI: 10.1111/pan.14877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/13/2024]
Abstract
An estimated 1.7 billion children and adolescents do not have access to safe and affordable surgical care, and the vast majority of these are located in low-middle-income countries (LMICs). Pediatric anesthesia, a specialized field that requires a diverse set of knowledge and skills, has seen various advancements over the years and has become well-established in upper-middle and high-income countries. However, in LMICs, due to a multitude of factors including severe workforce shortages, this has not been the case. Collaborations play a vital role in increasing the capacity of pediatric anesthesiology educators and training the pediatric anesthesia workforce. These efforts directly increase access for children who require surgical intervention. Collaboration models can be operationalized through bidirectional knowledge sharing, training, resource allocation, research and innovation, quality improvement, networking, and advocacy. This article aims to highlight a few of these collaborative efforts. Specifically, the role that the World Federation of Societies of Anaesthesiologists, the Safer Anesthesia from Education program, the Asian Society of Pediatric Anaesthesiologists, Pediatric Anesthesia Training in Africa, the Paediatric Anaesthesia Network New Zealand, the Safe Pediatric Anesthesia Network and two WhatsApp™ groups (global ped anesthesia and the Pediatric Difficult Intubation Collaborative) have played in improving anesthesiology care for children.
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Affiliation(s)
- Mary T Nabukenya
- Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mark W Newton
- Department of Anesthesiology, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebecca M Gray
- Division of Paediatric Anaesthesia, Department of Anaesthesia and Peri-operative Medicine, University of Cape Town, Cape Town, South Africa
| | - Indu Kapoor
- Te Whatu Ora Capital Coast and Hutt Valley, Department of Anaesthesia, Peri-operative Services and Pain Management, Wellington, New Zealand
| | - Norifumi Kuratani
- Department of Anesthesia, Saitama Children's Medical Center, Saitama, Japan
| | - Jolene Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK
| | - Ekta Rai
- Department of Anesthesiology, Christian Medical College and Hospital, Vellore, India
| | - Faye M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Lilaonitkul M, Zacharia A, Law TJ, Yusuf N, Saria P, Moore J. Evaluation of practice change following SAFE obstetric courses in Tanzania: a prospective cohort study. Anaesthesia 2023; 78:1354-1364. [PMID: 37431149 DOI: 10.1111/anae.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
Anaesthesia has been shown to contribute disproportionately to maternal mortality in low-resource settings. This figure exceeds 500 per 100,000 live births in Tanzania, where anaesthesia is mainly provided by non-physician anaesthetists, many of whom are working as independent practitioners in rural areas without any support or opportunity for continuous medical education. The three-day Safer Anaesthesia from Education (SAFE) course was developed to address this gap by providing in-service training in obstetric anaesthesia to improve patient safety. Two obstetric SAFE courses with refresher training were delivered to 75 non-physician anaesthetists in the Mbeya region of Tanzania between August 2019 and July 2020. To evaluate translation of knowledge into practice, we conducted direct observation of the SAFE obstetric participants at their workplace in five facilities using a binary checklist of expected behaviours, to assess the peri-operative management of patients undergoing caesarean deliveries. The observations were conducted over a 2-week period at pre, immediately post, 6-month and 12-month post-SAFE obstetric training. A total of 320 cases completed by 35 participants were observed. Significant improvements in behaviours, sustained at 12 months after training included: pre-operative assessment of patients (32% (pre-training) to 88% (12 months after training), p < 0.001); checking for functioning suction (73% to 85%, p = 0.003); using aseptic spinal technique (67% to 100%, p < 0.001); timely administration of prophylactic antibiotics (66% to 95%, p < 0.001); and checking spinal block adequacy (32% to 71%, p < 0.001). Our study has demonstrated positive sustained changes in the clinical practice amongst non-physician anaesthetists as a result of SAFE obstetric training. The findings can be used to guide development of a checklist specific for anaesthesia for caesarean section to improve the quality of care for patients in low-resource settings.
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Affiliation(s)
- M Lilaonitkul
- Department of Anesthesia and Peri-operative Care, University of California San Francisco, California, USA
| | - A Zacharia
- Mbeya Zonal Referral Hospital, University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - T J Law
- Department of Anesthesia and Peri-Operative Care, University of California San Francisco, California, USA
| | - N Yusuf
- Department of Anaesthesia, Tanga Regional Referral Hospital, Tanzania
| | - P Saria
- Department of Anesthesia, CCBRT Hospital, Dar es Salaam, Tanzania
| | - J Moore
- Department of Anaesthesia, NHS Grampian, Aberdeen, UK
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Fernandes NL, Lilaonitkul M, Subedi A, Owen MD. Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education. Int J Obstet Anesth 2023; 55:103646. [PMID: 37211512 DOI: 10.1016/j.ijoa.2023.103646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 05/23/2023]
Abstract
Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.
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Affiliation(s)
- N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - M Lilaonitkul
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - A Subedi
- Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - M D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Dharni N, Byrne-Davis LMT, Sanga E, Hart J, Shrestha AB, Gurung T, Shrestha RR, Vaidya PR, Hossain A, Lilaonitkul M, Snell D, Barrett-Chapman A, Walker I, Bull ER. Using behavioural science to explore impact and implementation of obstetric anaesthesia training in Tanzania, Nepal and Bangladesh: a qualitative evaluation study with obstetric anaesthesia providers. Psychol Health 2023:1-15. [PMID: 36622305 DOI: 10.1080/08870446.2022.2160472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 01/10/2023]
Abstract
Objective: High quality obstetric anaesthetic care is integral to reducing preventable maternal deaths in Low-and-Middle-Income-Countries (LMICs). We applied behavioural science to evaluate SAFE Obstetrics, a 3-day Continuing Professional Development (CPD) course, on physician and non-physician anaesthetists' practice behaviours across 3 LMICs.Methods: Seven anaesthetist Fellows from Bangladesh, Nepal and Tanzania were trained in qualitative methods and behavioural science. Structured interviews were undertaken by Fellows and two UK behavioural scientists with course participants. Interviews were based on the Theoretical Domains Framework: a comprehensive framework of influences on behaviour change. Interviews were recorded, transcribed and analysed using content and thematic analysis.Results: 78 physician and non-physician anaesthetists participated (n = 26 Bangladesh, n = 24 Nepal and n = 28 Tanzania). Participants reported positive improvements in patient-centered working, safety, teamwork and confidence. Across countries, we found similar barriers and facilitators: environmental resources, a strong professional identity and positive social influences were key facilitators of change.Conclusion: This multi-country theory-based evaluation highlighted the impact of SAFE Obstetrics on participants' clinical practice. A supportive work environment was crucial for implementing learning following training; CPD courses in LMICs must furnish participants with skills and equipment to address training implementation challenges. Building local behavioural science capacity can strengthen LMIC health intervention evaluations.
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Affiliation(s)
- Nimarta Dharni
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucie M T Byrne-Davis
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
| | - Evans Sanga
- Department of Anaesthesia, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jo Hart
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
| | - Amir Babu Shrestha
- Department of Anaesthesia, Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Tara Gurung
- Department of Anaesthesia, Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Ravi R Shrestha
- Department of Anaesthesia, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Pradip R Vaidya
- Department of Anaesthesia, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Amir Hossain
- Department of Anaesthesia, Shaheed Tajuddin Ahmad Medical College, Gazipur, Bangladesh
| | - Maytinee Lilaonitkul
- Department of Anaesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA
| | - David Snell
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | | | | | - Eleanor R Bull
- Faculty of Biology Medicine and Health, Division of Medical Education, University of Manchester, Manchester, UK
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
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Priorities for content for a short-course on postoperative care relevant for low- and middle-income countries: an e-Delphi process with training facilitators. Anaesthesia 2022; 77:570-579. [PMID: 35319098 PMCID: PMC9315034 DOI: 10.1111/anae.15675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Most surgical and anaesthetic mortality and morbidity occurs postoperatively, disproportionately affecting low- and middle-income countries. Various short courses have been developed to improve patient outcomes in low- and middle-income countries, but none specifically to address postoperative care and complications. We aimed to identify key features of a proposed short-course addressing this topic using a Delphi process with low- and middle-income country anaesthesia providers trained as short-course facilitators. An initial questionnaire was co-developed from literature review and exploratory workshops to include 108 potential course features. Features included content; teaching method; appropriate participants; and appropriate faculty. Over three Delphi rounds (panellists numbered 86, 64 and 35 in successive cycles), panellists indicated which features they considered most important. Responses were analysed by geographical regions: Africa, the Americas, south-east Asia and Western Pacific. Ultimately, panellists identified 60, 40 and 54 core features for the proposed course in each region, respectively. There were high levels of consensus within regions on what constituted core course content, but not between regions. All panellists preferred the small group workshop teaching method irrespective of region. All regions considered anaesthetists to be key facilitators, while all agreed that both anaesthetists and operating theatre nurses were key participants. The African and Americas regional panels recommended more multidisciplinary healthcare professionals for participant roles. Faculty from high-income countries were not considered high priority. Our study highlights variability between geographical regions as to which course features were perceived as most locally relevant, supporting regional adaptation of short-course design rather than a one-size-fits-all model.
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