Challenges of Anesthesia in Low- and Middle-Income Countries: A Cross-Sectional Survey of Access to Safe Obstetric Anesthesia in East Africa

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Study Justification:
– The study aims to assess the capacity to provide safe anesthetic care for mothers in the main referral hospitals in East Africa.
– The United Nations 2015 Millennium Development Goals targeted a reduction in maternal mortality, and access to safe surgery, including cesarean delivery, is crucial in achieving this goal.
– Maternal deaths in Sub-Saharan Africa remain unacceptably high, and many of these deaths could be prevented with access to safe anesthesia.
Study Highlights:
– None of the respondents had all the necessary requirements available to provide safe obstetric anesthesia.
– Only 7% reported adequate anesthesia staffing.
– Availability of monitors was limited, and those that were available were often nonfunctional.
– Lack of local protocols and intensive care unit services contributed to poor maternal outcomes.
– There is a significant shortage of physician anesthetists and equipment needed for safe anesthetic care in East Africa.
Study Recommendations:
– Increase the number of physician anesthetists to address the shortage of personnel.
– Improve the training of nonphysician anesthesia providers to enhance the capacity for safe anesthesia.
– Develop management protocols for obstetric patients requiring anesthesia to improve outcomes.
– More funding is required for training physician anesthetists to reach the targeted specialist workforce density of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030.
Key Role Players:
– Ministry of Health in each country
– National Anesthesia Society of each country
– Referral hospitals in East Africa
– Anesthetists and healthcare providers
Cost Items for Planning Recommendations:
– Training programs for physician anesthetists
– Equipment procurement and maintenance
– Development of management protocols
– Capacity building for nonphysician anesthesia providers
– Infrastructure improvement for intensive care unit services
Please note that the provided information is based on the given description and may not include all details from the original study.

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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Based on the provided description, here are some potential innovations that could improve access to maternal health:

1. Increase the number of physician anesthetists: One innovation could be to implement programs that focus on training and increasing the number of physician anesthetists in East Africa. This would help address the shortage of personnel and improve access to safe obstetric anesthesia.

2. Improve training for nonphysician anesthesia providers: Another innovation could involve developing comprehensive training programs for nonphysician anesthesia providers, such as nurse anesthetists or clinical officers. This would help enhance their skills and knowledge in providing safe anesthesia care for obstetric patients.

3. Develop management protocols for obstetric patients requiring anesthesia: Creating standardized management protocols specifically for obstetric patients requiring anesthesia could help improve the quality and safety of anesthesia care. These protocols would provide clear guidelines for anesthetists and other healthcare providers, ensuring consistent and effective care for pregnant women.

4. Increase funding for training physician anesthetists: To achieve the targeted specialist workforce density of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030, more funding is required. Innovations could involve securing additional funding from international organizations, governments, and private donors to support the training of physician anesthetists in East Africa.

Overall, these innovations aim to address the challenges identified in the survey and improve access to safe obstetric anesthesia in East Africa, ultimately reducing maternal mortality rates.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health is to address the shortages of personnel and equipment needed to provide safe anesthetic care for obstetric surgical cases in East Africa. This can be achieved through the following steps:

1. Increase the number of physician anesthetists: There is a need to train and recruit more physician anesthetists in East Africa to address the shortage of skilled personnel. This can be done by establishing training programs and providing incentives to attract more medical professionals to specialize in anesthesiology.

2. Improve the training of nonphysician anesthesia providers: In addition to increasing the number of physician anesthetists, it is important to enhance the training of nonphysician anesthesia providers, such as nurse anesthetists or clinical officers. This will help expand the workforce and ensure that there are more skilled professionals available to provide safe anesthesia care.

3. Develop management protocols for obstetric patients requiring anesthesia: The lack of local protocols for managing obstetric patients requiring anesthesia contributes to poor maternal outcomes. It is crucial to develop standardized protocols that outline best practices for providing safe anesthesia during obstetric surgeries. These protocols should be based on international guidelines, such as the World Federation of the Societies of Anesthesiologists (WFSA) guidelines mentioned in the description.

4. Increase funding for training physician anesthetists: To achieve the targeted specialist workforce density of 20 surgical, anesthetic, and obstetric physicians per 100,000 population by 2030, as recommended by the Lancet Commission on Global Surgery, more funding is required. Governments, international organizations, and stakeholders should allocate resources to support the training of physician anesthetists in East Africa.

By implementing these recommendations, the capacity to provide safe anesthetic care for mothers in East Africa can be improved, leading to better maternal outcomes and reduced maternal mortality rates.
AI Innovations Methodology
Innovations for improving access to maternal health in low- and middle-income countries could include:

1. Task-shifting: Training and empowering non-physician healthcare providers, such as nurse anesthetists or midwives, to administer safe obstetric anesthesia under appropriate supervision. This can help alleviate the shortage of physician anesthetists and increase access to anesthesia services.

2. Telemedicine: Utilizing technology to provide remote consultations and guidance from experienced anesthetists to healthcare providers in underserved areas. This can help improve the quality of anesthesia care and ensure adherence to best practices.

3. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, guidelines, and decision support tools for healthcare providers involved in maternal health. These apps can enhance knowledge and skills, leading to improved anesthesia care.

4. Infrastructure development: Investing in the establishment or improvement of healthcare facilities, including operating theaters, recovery rooms, and intensive care units, to ensure the availability of necessary equipment and resources for safe obstetric anesthesia.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Baseline data collection: Gather information on the current state of access to maternal health services, including the availability of anesthesia providers, equipment, and protocols in the target areas.

2. Define indicators: Identify specific indicators that reflect the level of access to maternal health, such as the number of anesthesia providers per population, availability of functional monitors, or adherence to safe anesthesia guidelines.

3. Introduce interventions: Implement the recommended innovations, such as task-shifting, telemedicine, mHealth applications, and infrastructure development, in the target areas.

4. Data monitoring: Continuously collect data on the selected indicators to assess the impact of the interventions. This can be done through surveys, interviews, or monitoring systems.

5. Analysis and evaluation: Analyze the collected data to evaluate the changes in access to maternal health services after implementing the interventions. Compare the indicators before and after the interventions to measure the improvements.

6. Adjustments and scaling up: Based on the evaluation results, make necessary adjustments to the interventions and consider scaling them up to reach a larger population or replicate them in other similar settings.

By following this methodology, policymakers and healthcare providers can assess the effectiveness of the recommended innovations in improving access to maternal health and make informed decisions on implementing them on a larger scale.

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