BACKGROUND: This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services. FINDINGS: Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non-physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith-based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric-specific operating theaters, and inadequate critical care services. SOLUTIONS: The lack of opportunities for sub-specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non-governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed.
The systemic challenges in providing safe anesthesia, including safe ventilation, to children in resource-constrained settings are many. For anesthesia providers caring for children, the lack of appropriate equipment, inadequate anesthesia workforce and deficiencies in postoperative care are especially difficult. The clinical decisions made by anesthesia providers around when and how to ventilate a child for surgery are influenced by all of these factors and can result in patient management which may vary significantly from that in a high-resource setting. This educational review considers the intraoperative ventilation of a small child in a resource-constrained setting and discusses specific challenges and context-sensitive solutions.
Anesthesia , Anesthesiology , Child , Developing Countries , Humans
Introduction : La gale humaine est une ectoparasitose due a Sarcoptes scabiei; parasite humain obligatoire. Son diagnostic est essentiellement clinique. Plusieurs auteurs ont recemment decrit sa recrudescence. Ainsi avons-nous voulu etablir un profil socio-demographique; ressortir la distribution lesionnelle et le type de lesions de la scabiose rencontree au cours de nos consultations de Dermatologie a Yaounde (Cameroun). Methodologie : Nous avons mene une etude descriptive et analytique a Yaounde pendant 12 mois (Octobre 2011 a Septembre 2012). Les patients avec un diagnostic de gale humaine pose durant la consultation initiale etaient inclus dans cette etude ouverte au tout venant. Les donnees recoltees prospectivement etaient saisies et analysees sous le logiciel Epi infos version 3.5.3. Resultats : 255 patients etaient retenus dont 158 (62) de sexe masculin et 97 (38) de sexe feminin. L'age variait de 0 a 80 ans avec une mediane de 18; 151 (59.2) etaient contamines par un proche ; 176 (69) signalaient une notion de contage et on notait 42 cas (16;5) de recidive. Une a huit personnes dans l'entourage avait un prurit. Les lesions siegeaient aux plis sous fessiers (71;8); aux poignets (70;2); aux plis inter fessiers (56;5). Les points crouteux (82;4); les papules (69;8) et les papulo-vesicules (68;6) etaient observes. Conclusion : La scabiose reste d'actualite et sa tendance a la propension necessite une sensibilisation aussi bien des populations que des praticiens au diagnostic precoce et a la prise en charge dans un bref delai
Pruritus , Recurrence , Scabies , Scabies/diagnosis
