Challenges of Anaesthesia in Developing Countries: A Survey of the Quality of Anaesthesia Care for Obstetric Patients in East Africa

Presenter: Isabella Epiu, University of California Global Health Institute

Background: The United Nations 2015 Millennium Development Goals focused significant resources toward reducing maternal mortality. However, the number of deaths per 100 000 live births remains unacceptably high across Sub-Saharan Africa (SSA), with a large percentage of mothers requiring surgical care. Access to safe surgery and anaesthesia is a basic human right for health. As safe anaesthesia and safe surgery are an essential but neglected element of good maternal outcomes, we set out to assess the capacity to provide safe anaesthetic care for mothers in the main referral hospitals in East Africa.

Methodology:  A cross-sectional survey was conducted at the main referral hospitals for five East African countries; Mulago- Uganda, Kenyatta- Kenya, Muhimbili- Tanzania, Center Hospitalier Universite de Kigali (CHUK) – Rwanda, and Centre Hospitalier Universitaire de Kamenge (CHUK) – Burundi. Local anaesthetists and Key Informants from the Ministry of Health and National Anaesthesia society were interviewed based on the World Federation of Societies of Anaesthesiologists (WFSA) international standards for safe anesthesia.

Results:  Survey results estimated the number of physician and non-physician in Uganda 30 and 400, Kenya 168 and 800, Tanzania 22 and 400, Rwanda 15 and 350, Burundi 2 and 328, respectively. Using the WFSA checklist as a guide, of the 85 anesthetists interviewed only four percent were able to provide safe obstetric anaesthesia. Essential supplies such as oxygen, basic airway equipment, electricity and running water were not always available, and none of the hospitals in the region reached World Health Organization standards for essential surgery.

Conclusion: Lack of access to quality surgical and anaesthetic care is pervasive in East Africa. The ongoing surgical disease crisis in the region is multifactorial and a result of inadequate workforce, infrastructure, and supplies. The lack of surgical capacity in the region contributes to unacceptably high death rates in mothers and babies.