Gastrointestinal endoscopy capacity in Eastern Africa
Journal – Endoscopy International Open
Article type – Journal research article – Clinical research
Publication date – Nov – 2021
Authors – Michael Mwachiro, Hillary M. Topazian‡, Violet Kayamba, Gift Mulima, Elly Ogutu, Mengistu Erkie, Gome Lenga, Thomas Mutie, Eva Mukhwana, Hailemichael Desalegn, Rezene Berhe, Berhane Redae Meshesha, Bongani Kaimila, Paul Kelly, David Fleischer, Sanford M. Dawsey, Mark D. Topazian
Keywords – eastern sub-Saharan Africa, Endoscopy capacity, gastrointestinal disease
Open access – Yes
Speciality – General surgery
World region Eastern Africa
Country: Ethiopia, Kenya, Malawi, Zambia
Language – English
Submitted to the One Surgery Index on November 20, 2021 at 3:52 am
Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity.
Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020.
Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services.
Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.
OSI Number – 21353