Key bottlenecks to the provision of safe obstetric anaesthesia in low- income countries; a cross-sectional survey of 64 hospitals in Uganda
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Date
2017
Authors
Epiu, Isabella
Wabule, Agnes
Kambugu, Andrew
Mayanja-Kizza, Harriet
Tindimwebwa, Jossy Verel Bahe
Dubowitz, Gerald
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health
facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope
effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these
countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral
hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of
Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of
Anesthesia in Low-and Middle-Income Countries. WFSA; 2014 http://wfsa.newsweaver.com/Newsletter/p8c8ta4ri7a1
wsacct9y3u?a=2&p=47730565&t=27996496). In spite of this evidence, factors contributing to maternal mortality related
to anaesthesia in LMICs and the magnitude of these issues have not been comprehensively studied. We therefore set
out to assess regional referral, district, private for profit and private not-for profit hospitals in Uganda.
Methods: We conducted a cross-sectional survey at 64 government and private hospitals in Uganda using pre-set
questionnaires to the anaesthetists and hospital directors. Access to the minimum requirements for safe obstetric
anaesthesia according to WFSA guidelines were also checked using a checklist for operating and recovery rooms.
Results: Response rate was 100% following personal interviews of anaesthetists, and hospital directors. Only 3 of the
64 (5%) of the hospitals had all requirements available to meet the WFSA International guidelines for safe anaesthesia.
Additionally, 54/64 (84%) did not have a trained physician anaesthetist and 5/64 (8%) had no trained providers for
anaesthesia at all. Frequent shortages of drugs were reported for regional/neuroaxial anaesthesia, and other essential
drugs were often lacking such as antacids and antihypertensives. We noted that many of the anaesthesia machines
present were obsolete models without functional safety alarms and/or mechanical ventilators. Continuous ECG was
only available in 3/64 (5%) of hospitals.
Conclusion: We conclude that there is a significant lack of essential equipment for the delivery of safe anaesthesia
across this region. This is compounded by the shortage of trained providers and inadequate supervision. It is therefore
essential to strengthen anaesthesia services by addressing these specific deficiencies. This will include improved
training of associate clinicians, training more physician anaesthetists and providing the basic equipment required to
provide safe and effective care. These services are key components of comprehensive emergency obstetric care and
anaesthetists are crucial in managing critically ill mothers and ensuring good surgical outcomes.
Description
Research Article
Keywords
Safe Anaesthesia, Obstetric Anaesthesia, Low-income countries, Caesarean section, Health system, Maternal mortality, Quality, Universal health care
Citation
Epiu et al. BMC Pregnancy and Childbirth (2017) 17:387 DOI 10.1186/s12884-017-1566-3