Anaesthesia facility evaluation: a Whatsapp survey of hospitals in Burundi

Background: Data regarding the capacity to provide safe anaesthesia is lacking in many low-income countries. With the increasing popularity of WhatsApp for both personal and professional communication in Africa, we sought to test the feasibility of using this platform to administer a brief survey of anaesthesia equipment availability in Burundi. The aims of the study were to survey a subset of anaesthesia equipment availability in Burundi and to assess the suitability of using a WhatsApp chat group to administer such a survey.

Methods: The survey was distributed via WhatsApp by ATSARPS (Agora des Techniciens Supérieurs Anesthésistes Réanimateurs pour la Promotion de la Santé), an association of anaesthesia providers in Burundi. The questions focused on the presence of five pieces of anaesthesia equipment recommended by the World Health Organization – World Federation of Societies of Anesthesiologists (WHO–WFSA) International Standards for a Safe Practice of Anesthesia, namely a Lifebox pulse oximeter, anaesthesia machine, capnograph, ECG and defibrillator. Questions were sent as free text, and responses were received as a reply or as a personal message to the president of ATSARPS who sent the survey.

Results: Responses received represented data from 55 (85%) of the 65 hospitals that offer anaesthesia care across Burundi. Eightynine per cent of hospitals had a Lifebox pulse oximeter, 91% had an anaesthesia machine, 16% had capnography, 24% had an ECG and 14% had a defibrillator. Among hospitals which responded to our survey, only 60% reported perfoming general endotracheal anaesthesia on a monthly basis.

Conclusion: Data collection in low- and middle-income countries (LMICs) can be challenging; therefore, simple, low-cost methods of data collection need to be developed. We have demonstrated the feasibility of using a WhatsApp chat group among a national society of anaesthesia providers in Burundi to perform an initial abbreviated audit of anaesthesia facilities. We have also identified significant deficits in anaesthesia equipment in Burundi.

Inequalities in caesarean section in Burundi: evidence from the Burundi Demographic and Health Surveys (2010–2016)

Background
Despite caesarean section (CS) being a lifesaving intervention, there is a noticeable gap in providing this service, when necessary, between different population groups within a country. In Burundi, there is little information about CS coverage inequality and the change in provision of this service over time. Using a high-quality equity analysis approach, we aimed to document both magnitude and change of inequality in CS coverage in Burundi over 7 years to investigate disparities.

Methods
For this study, data were extracted from the 2010 and 2016 Burundi Demographic and Health Surveys (BDHS) and analyzed through the recently updated Health Equity Assessment Toolkit (HEAT) of the World Health Organization. CS delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and sub-national region. For each equity stratifier, relative and absolute summary measures were calculated. We built a 95% uncertainty interval around the point estimate to determine statistical significance.

Main findings
Disparity in CS was present in both survey years and increased over time. The disparity systematically favored wealthy women (SII = 10.53, 95% UI; 8.97, 12.10), women who were more educated (PAR = 8.89, 95% UI; 8.51, 9.26), women living in urban areas (D = 12.32, 95% UI; 9.00, 15.63) and some regions such as Bujumbura (PAR = 11.27, 95% UI; 10.52, 12.02).

Conclusions
Burundi had not recorded any progress in ensuring equity regarding CS coverage between 2010 and 2016. It is important to launch interventions that promote justified use of CS among all subpopulations and discourage overuse among high income, more educated women and urban dwellers.