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Ki BK, Onajin-Obembe B, Adekola O, Baele PL, Binam F, Daddy H, Diouf E, Fanou L, Gathuya ZN, Igaga EN, Jeque E, Mawandza P, Nabukenya MT, Nabulindo SM, Nicole Rakotoarison RC, Robert AR, Schwalbach T, Uwambazimana JD, Vilasco B, Zomahoun L. Women Anesthesiologists in Sub-Saharan Africa in the Pre-COVID Era: A Multinational Demographic Study. Anesth Analg 2024; 139:4-14. [PMID: 38300845 PMCID: PMC11155285 DOI: 10.1213/ane.0000000000006868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA. METHODS Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant. RESULTS Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%). CONCLUSIONS On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.
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Affiliation(s)
- Bertille K. Ki
- From the Service d’Anesthésie-Réanimation, CHU Pédiatrique Charles de Gaulle, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Bisola Onajin-Obembe
- Department of Anaesthesiology, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Oyebola Adekola
- Department of Anaesthesia, College of Medicine University of Lagos, Lagos, Nigeria
| | - Philippe L. Baele
- Department of Anesthesiology, Faculty of Medicine, Catholic University of Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Fidele Binam
- Department of Anaesthesia, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Hadjara Daddy
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | - Elizabeth Diouf
- Service d’Anesthésie-Réanimation, Faculté de Médecine, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Lionelle Fanou
- Hôpital d’instruction des armées, Centre hospitalier universitaire de Cotonou, Université d’Abomey-Calavi, Abomey-Calavi, Benin
| | | | - Elizabeth N. Igaga
- Uganda Heart Institute, Department of Anaesthesia and Critical care, Division of Cardiac Anaesthesia, Kampala, Uganda
| | - Emilia Jeque
- Faculdade de Medicina da Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Peggy Mawandza
- Faculté des Sciences de la Santé - Université Marien Ngouabi, Brazzaville, Congo
| | - Mary T. Nabukenya
- Uganda Heart Institute, Department of Anaesthesia and Critical care, Division of Cardiac Anaesthesia, Kampala, Uganda
| | | | | | - Annie R. Robert
- Department of Epidemiology & Biostatistics, IREC EPID UCLouvain, Brussels, Belgium
| | - Teresa Schwalbach
- Faculdade de Medicina da Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Jeanne D’Arc Uwambazimana
- Department of Anaesthesia, College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Brigitte Vilasco
- Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët-Boigny d’Abidjan, Cocody, Côte D’ivoire
| | - Lidwine Zomahoun
- Faculté des Sciences de la Santé, CHU Mère-Enfant Lagune, Université d’Abomey-Calavi, Cotonou, Benin
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Kurniati A, Efendi F, Ismawiningsih I, Mulyani N, Zakaria Z, Ambarwati R, Prasetyo HT, Muljandari E, Damayanti I, Noor AYM, McKenna L, Nurlinawati I. Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment. J Multidiscip Healthc 2024; 17:2215-2225. [PMID: 38741922 PMCID: PMC11090117 DOI: 10.2147/jmdh.s459158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach. Materials and Methods A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute. Results The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p<0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p<0.001). Both groups valued having an official residence (OR=3.6, p<0.001) as a factor for retention in remote areas. Conclusion Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.
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Affiliation(s)
- Anna Kurniati
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Ismawiningsih Ismawiningsih
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Nila Mulyani
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Zakaria Zakaria
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Retno Ambarwati
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Hutomo Tuhu Prasetyo
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Endro Muljandari
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Irni Damayanti
- Directorate of Health Workforce Deployment, Directorate General of Health Workforce, Ministry of Health, Jakarta, Indonesia
| | - Arif Yustian Maulana Noor
- Agriculture Socio-Economic Department, Faculty of Agriculture, Brawijaya University, Malang, Indonesia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Bailey JG, Mossenson AI, Whynot S, Nyirigira G, Gower S, Livingston P. A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings. Anesth Analg 2024:00000539-990000000-00730. [PMID: 38306670 DOI: 10.1213/ane.0000000000006870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
BACKGROUND Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. METHODS This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. RESULTS Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. CONCLUSIONS Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.
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Affiliation(s)
- Jonathan G Bailey
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
| | - Adam I Mossenson
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
- St John of God Midland Public and Private Hospitals, Perth, Australia
- Curtin Medical School, Curtin University, Perth, Australia
| | - Sara Whynot
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Gaston Nyirigira
- Department of Anesthesia and Critical Care, University of Rwanda, Kigali, Rwanda; and
| | - Shelley Gower
- Curtin School of Nursing, Curtin University, Perth, Australia
| | - Patricia Livingston
- From the Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada
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Nzasabimana P, Ignatowicz A, Alayande BT, Abdul-Latif AM, Odland ML, Davies J, Bekele A, Byiringiro JC. Barriers to equitable access to quality trauma care in Rwanda: a qualitative study. BMJ Open 2023; 13:e075117. [PMID: 37770259 PMCID: PMC10546151 DOI: 10.1136/bmjopen-2023-075117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Using the 'Four Delay' framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients', caregivers' and community leaders' perspectives. DESIGN A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically. SETTING This qualitative study was conducted in Rwanda's rural Burera District, located in the Northern Province, and in Kigali City, the country's urban capital, to capture both the rural and urban population's experiences of being injured. PARTICIPANTS Purposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders. RESULTS Multiple barriers were identified cutting across all levels of the 'Four Delays' framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients. CONCLUSIONS Future interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation.
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Affiliation(s)
- Pascal Nzasabimana
- Single Project Implementation Unit, University of Rwanda, Kigali, Rwanda
| | | | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Jean Claude Byiringiro
- School of Medicine and Pharmacy, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
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Toyin-Thomas P, Ikhurionan P, Omoyibo EE, Iwegim C, Ukueku AO, Okpere J, Nnawuihe UC, Atat J, Otakhoigbogie U, Orikpete EV, Erhiawarie F, Gbejewoh EO, Odogu U, Akhirevbulu ICG, Kwarshak YK, Wariri O. Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review. BMJ Glob Health 2023; 8:bmjgh-2023-012338. [PMID: 37156560 PMCID: PMC10174016 DOI: 10.1136/bmjgh-2023-012338] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs. METHODS We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers. RESULTS We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions. CONCLUSION Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.
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Affiliation(s)
- Patience Toyin-Thomas
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Paul Ikhurionan
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Efe E Omoyibo
- Department of Paediatrics, Federal Medical Centre, Asaba, Nigeria
| | - Chinelo Iwegim
- Fraser Health Authority, Surrey, British Columbia, Canada
| | - Avwebo O Ukueku
- Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Jermaine Okpere
- Department of Clinical Research, Alpha Research Clinic, Edmonton, Alberta, Canada
| | - Ukachi C Nnawuihe
- Department of Clinical Services, Intercountry Centre for Oral Health for Africa, Jos, Nigeria
| | - Josephine Atat
- Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Nigeria
| | - Uwaila Otakhoigbogie
- Department of Oral Pathology and Oral Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Franca Erhiawarie
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Uyoyo Odogu
- Department of Preventive Dentistry, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | | | - Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Asingei J, O'Flynn EP, O'Donovan DT, Masuka SC, Mashava D, Akello FV, Ulisubisya MM. The Specialist Anesthesiology Workforce in East, Central, and Southern Africa: A Cross-Sectional Study. Anesth Analg 2023; 136:230-237. [PMID: 35759411 DOI: 10.1213/ane.0000000000006134] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The populations of the East, Central, and Southern African regions receive only a fraction of the surgical procedures they require, and patients are more likely to die after surgery than the global average. An insufficient anesthetic workforce is a key barrier to safe surgery. The anesthetic workforce in this region includes anesthesiologists and nonphysician anesthesia providers. A detailed understanding of the anesthesiologist workforce in East, Central, and Southern Africa is required to devise strategies for the training, retention, and distribution of the workforce. METHODS A cross-sectional study of the anesthesiologist workforce of the 8 member countries of the College of Anaesthesiologists of East, Central, and Southern Africa (CANECSA) was undertaken. Data collection took place between May 2020 and September 2020 using existing databases and was validated through direct contact with anesthesiologists and other hospital staff. Primary outcomes were: total number of anesthesiologists in the region and their demographics, including gender, age, country of practice, current work location, country of origin, and country where they received their initial anesthesia qualification. RESULTS Within the CANECSA member countries, 411 qualified anesthesiologists were identified (0.19 per 100,000 population). The median age was 41 years, and one-third were women. The majority (67.5%) were based in urban areas with a population >1 million people, and most are used by government institutions (61.6%). Most anesthesiologists in the region were trained (89.1%) and currently work (95.1%) in their home country. CONCLUSIONS The numbers of anesthesiologists in CANECSA member countries are extremely low-about 5% of the minimum recommended figures-and poorly distributed relative to the population. Strategies are required to expand the anesthesia workforce and address maldistribution.
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Affiliation(s)
- Juventine Asingei
- From the Centre for Public Health, Institute for Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast United Kingdom
| | - Eric P O'Flynn
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Diarmuid T O'Donovan
- From the Centre for Public Health, Institute for Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast United Kingdom
| | - Sophia C Masuka
- College of Anaesthesiologists of East, Central, and Southern Africa, Arusha, Tanzania
| | - Doreen Mashava
- College of Anaesthesiologists of East, Central, and Southern Africa, Arusha, Tanzania
| | - Faith V Akello
- Association of Anesthesiologists of Uganda, Kampala, Uganda
| | - Mpoki M Ulisubisya
- College of Anaesthesiologists of East, Central, and Southern Africa, Arusha, Tanzania
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Zheng Q, Xiong L, Li H, Liu M, Xu J, Luo X. Demoralization: Where it stands-and where we can take it: A bibliometric analysis. Front Psychol 2022; 13:1016601. [DOI: 10.3389/fpsyg.2022.1016601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
ObjectivesThe purpose is to analyze existing studies related to the field of demoralization through bibliometrics.MethodologyRelevant literature on demoralization was searched from PubMed, Web of Science, the Cochrane Library, and CINAHL Complete. Bibliometric analysis was performed using GraphPad Prisma 8.2.1, VOSviewer 1.6.18 and R software. Research publication trends, author-country collaboration, research hotspots and future trends were explored by generating network relationship maps.ResultsA total of 1,035 publications related to the field of demoralization were identified. The earliest relevant studies have been published since 1974, and the studies have grown faster since 2000. Psyche-oncology and Psychother Psychosom had the highest number of publications (n = 25). The United States, Italy and Australia have made outstanding contributions to the field and there was an active collaboration among leading scholars. Major research hotspots include the multiple ways of assessing demoralization, the specificity of various demographics and psychological disorders in different disease contexts, and the association and distinction of diverse clinical psychological abnormalities. The impact of COVID-19 on demoralization and subsequent interventions and psychological care may become a future research direction.ConclusionThere has been a significant increase in research in the field of demoralization after 2000. The United States provided the most publications. There is overall active collaboration between authors, countries, and institutions. In future research, more attention will be paid to the effects of COVID-19 on demoralization and intervention care for this psychology.
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Alayande B, Chu KM, Jumbam DT, Kimto OE, Musa Danladi G, Niyukuri A, Anderson GA, El-Gabri D, Miranda E, Taye M, Tertong N, Yempabe T, Ntirenganya F, Byiringiro JC, Sule AZ, Kobusingye OC, Bekele A, Riviello RR. Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review. CURRENT TRAUMA REPORTS 2022; 8:66-94. [PMID: 35692507 PMCID: PMC9168359 DOI: 10.1007/s40719-022-00229-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action. Supplementary Information The online version contains supplementary material available at 10.1007/s40719-022-00229-1.
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Affiliation(s)
- Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Kathryn M. Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Alliance Niyukuri
- Hope Africa University, Bujumbura, Burundi
- Mercy Surgeons-Burundi, Research Department, Bujumbura, Burundi
- Mercy James Center for Paediatric Surgery and Intensive Care-Blantyre, Blantyre, Malawi
| | - Geoffrey A. Anderson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Deena El-Gabri
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Elizabeth Miranda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Mulat Taye
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ngyal Tertong
- International Fellow, Paediatric Orthopaedic Surgery Department of Orthopaedics, Sheffield Children’s Hospital, Sheffield, UK
| | - Tolgou Yempabe
- Orthopaedic and Trauma Unit, Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | - Faustin Ntirenganya
- University Teaching Hospital of Kigali, Kigali, Rwanda
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital of Kigali, Kigali, Rwanda
- NIHR Research Hub On Global Surgery, University of Rwanda, Kigali, Rwanda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Olive C. Kobusingye
- Makerere University School of Public Health, Kampala, Uganda
- George Institute for Global Health, Sydney, Australia
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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9
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Law TJ, Rose J, Gelb AW. Initiatives to support rural access to anesthesia. Can J Anaesth 2022; 69:790-791. [PMID: 35301698 DOI: 10.1007/s12630-022-02242-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tyler J Law
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
| | - John Rose
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Adrian W Gelb
- Center for Health Equity in Surgery & Anesthesia, University of California, San Francisco, CA, USA
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
- World Federation of Societies of Anaesthesiologists, London, United Kingdom
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10
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Garba DL, Fadalla T, Sarpong K, Suliman M, Rolle M, Ammar A, Hussein H, Park KB. Access to training in neurosurgery (Part 2): The costs of pursuing neurosurgical training. BRAIN AND SPINE 2022; 2:100927. [PMID: 36248162 PMCID: PMC9562254 DOI: 10.1016/j.bas.2022.100927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Deen L. Garba
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Tarig Fadalla
- Ribat NeuroSpine Center, Ribat University Hospital, The National Ribat University, Khartoum, Sudan
- Corresponding author.
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Mazin Suliman
- Ribat NeuroSpine Center, Ribat University Hospital, The National Ribat University, Khartoum, Sudan
| | - Myron Rolle
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Adam Ammar
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Haytham Hussein
- Ribat NeuroSpine Center, Ribat University Hospital, The National Ribat University, Khartoum, Sudan
| | - Kee B. Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Law TJ, Subhedar S, Bulamba F, O'Hara NN, Nabukenya MT, Sendagire C, Hewitt-Smith A, Lipnick MS, Tumukunde J. Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally. HUMAN RESOURCES FOR HEALTH 2021; 19:93. [PMID: 34321021 PMCID: PMC8320091 DOI: 10.1186/s12960-021-00634-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. METHODS A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May-June 2019. RESULTS No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). CONCLUSIONS No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.
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Affiliation(s)
- Tyler J Law
- Division of Global Health Equity, Department of Anesthesia & Perioperative Care, University of California San Francisco, 1001 Potrero Avenue, Building 5, Ward 3C, San Francisco, CA, 94110, United States of America.
| | - Shivani Subhedar
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, United States of America
| | - Fred Bulamba
- Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Nathan N O'Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Mary T Nabukenya
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Cornelius Sendagire
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Adam Hewitt-Smith
- Department of Anesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Tororo, Uganda
| | - Michael S Lipnick
- Division of Global Health Equity, Department of Anesthesia & Perioperative Care, University of California San Francisco, 1001 Potrero Avenue, Building 5, Ward 3C, San Francisco, CA, 94110, United States of America
| | - Janat Tumukunde
- Department of Anaesthesia, Makerere University, College of Health Sciences, Kampala, Uganda
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Workneh RS, Tuyishime E, Mumbwe M, Igaga EN, Bould MD. Not a "first world problem"-Care of the anesthetist in East and Southern Africa. Paediatr Anaesth 2021; 31:39-46. [PMID: 33124109 DOI: 10.1111/pan.14054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
Burnout and related concepts such as resilience, wellness, and taking care of healthcare professionals have become increasingly prevalent in the medical literature. Most of the work in this area comes from high-income countries, with the remainder from upper-middle-income countries, and very little from lower-middle-income or low-income countries. Sub-Saharan Africa is particularly poorly represented in this body of literature. Anglo-American concepts are often applied to different jurisdictions without consideration of cultural and societal differences. However, anesthesia providers in this region have unique challenges, with both the highest burden of "surgical" disease in the world and the least resources, both in terms of human resources for health and in terms of essential drugs and equipment. The effect of burnout on healthcare systems is also likely to be very different with the current human resources for the health crisis in East and Central Africa. According to the Joint Learning Initiative Managing for Performance framework, the three essential factors for building a workforce to effectively support a healthcare system are coverage, competence, and motivation. Current efforts to build capacity in anesthesia in East and Southern Africa focus largely on coverage and competence, but neglect motivation at the risk of failing to support a sustainable workforce. In this paper, we include a review of the relevant literature, as well as draw from personal experience living and working in East and Southern Africa, to describe the unique issues surrounding burnout, resilience, and wellness in this region.
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Affiliation(s)
| | | | - Mbangu Mumbwe
- Department of Anesthesia, Ndola Central Hospital, Ndola, Zambia
| | | | - M Dylan Bould
- Department of Anesthesia and Pain Medicine, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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