Anesthésie et recherche clinique
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Anesthesia Capacity in 22 Low and Middle Income Countries

Daniel Vo, Meena Nathan Cherian, Shannon Bianchi, Luc Noël, Ganbold Lundeg, Asadullah Taqdeer, Bakary Tijan Jargo, Margaret Okello-Nyeko, Athula Kahandaliyanage, Olive Sentumbwe-Mugisa, Andrew Ochroch E, David Okello, Jack Abdoulie, Olayinka O. Ayankogbe, Olaitan Alice Soyannwo, Patrick Hoekman, Paul Bossyn, Rachid Sani, Mary Thompson, Stephen Mwin

Objective: A high mortality rate is associated with anesthesia in low and middle income countries. The provision of basic and emergency surgical services in developing countries includes safe anesthetic care. We sought to determine the resources available to deliver anesthesia care in low and middle income countries. Methods: A standard World Health Organization tool was used to collect data from 34 Low and Middle-Income Countries (LMICs) regarding infrastructure and capacity of facilities. We then performed a database query to extract information on anesthesia-related capacity. Findings: Twelve countries were excluded for providing data on less than four facilities, leaving 22 countries in our results, with a total of 590 facilities surveyed. Thirty five percent of hospitals had no access to oxygen and 40% had no anaesthesia machines; despite this, 58.5% of hospitals offered general inhalational anesthesia. All facilities reported presence of an anaesthesia provider: a nurse or clinical assistant was present in all 590 facilities. Hospitals with > 200 beds reported a range of 2-10 providers; the average number of anesthesia physicians increased from one to four as the hospital size increased from less than to greater than 300 beds. The majority of facilities were district/rural/community hospitals (34.7%), followed by health centres (23.2%), private/NGO/missions hospitals (16.6%), provincial hospitals (11.7%), and general hospitals (13.1%). Conclusion: The delivery of anesthesia is limited by deficiencies in human resources, equipment availability and system capacity in many low and middle income countries.