Women Anesthesiologists in Sub-Saharan Africa in the Pre-COVID Era: A Multinational Demographic Study.

BACKGROUND: Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA. METHODS: Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant. RESULTS: Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%). CONCLUSIONS: On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

INTRODUCTION: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). METHODS: This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. RESULTS: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. CONCLUSION: Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.

Management of postoperative pain: experience of the Niamey National Hospital, Niger.

OBJECTIVE: The aim of this study was to evaluate the management of postoperative pain at the Niamey National Hospital. METHODS: A prospective study was conducted in the Department of Anesthesiology and Intensive Care at the Niamey National Hospital from March to June, 2009. Data collected included age, sex, literacy, American Society of Anesthesiologists (ASA) physical status classification, type of anesthesia, type of surgery, postoperative analgesics used, and the cost of analgesics. Three types of pain assessment scale were used depending on the patient's ability to describe his or her pain: the verbal rating scale (VRS), the numerical rating scale (NRS), or the visual analog scale (VAS). Patients were evaluated during the first 48 hours following surgery. RESULTS: The sample included 553 patients. The VRS was used for the evaluation of 72% of patients, the NRS for 14.4%, and the VAS for 13.6%. Of the VRS group, 33.9%, 8.3%, and 2.1% rated their pain as 3 or 4 out of 4 at 12, 24, and 48 hours postoperatively, respectively. For the NRS group, 33.8%, 8.8%, and 2.5% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. For the VAS group, 29.3%, 5.4%, and 0% rated their pain as greater than 7 out of 10 at 12, 24, and 48 hours postoperatively, respectively. CONCLUSION: Postoperative pain assessment and management in developing countries has not been well described. Poverty, illiteracy, and inadequate training of physicians and other health personnel contribute to the underutilization of postoperative analgesia. Analysis of the results gathered at the Niamey National Hospital gives baseline data that can be the impetus to increase training in pain management and to establish standardized protocols.