Bidirectional needs assessment of otolaryngology-head and neck surgery short-term surgical trips in Zimbabwe.

Objectives: To describe findings from an otolaryngology-specific needs assessment tool in Zimbabwe. Methods: Surveys were developed and shared with Low-Middle Income Country (LMIC) hosting institutions in Zimbabwe and to High-Income Country surgical trip participants (HIC). Respondents were otolaryngologists identified online and through professional networks who had participated in a surgical trip. Results: The most common procedures Zimbabwe otolaryngologists reported treating were adenotonsillectomy (85.7%), chronic rhinosinusitis (71.4%), chronic otitis (57.1%), and head and neck tumor intervention (57.1%). The most common untreatable conditions that host physicians wanted to treat were skull base surgery (71.4%), flap reconstructions (57.1%), and laryngotracheal reconstruction (57.1%). The largest discrepancy between host desires and visiting team offerings were flap reconstruction (57.1%), nasal bone deformities (37.1%), and laryngotracheal reconstruction (17.1%). Perceptions of short-term surgical trips (STST) were recorded for host and visiting teams, and important differences between the public and private sectors of care in Zimbabwe were also identified. Conclusion: The surveys utilized in this study served as a bidirectional needs assessment of the requirements and care goals of host institutions and visiting teams in Zimbabwe. Differences between public and private sectors of care, particularly regarding infrastructure, resources, and surgical goals, were revealed, and the results can be utilized as part of efforts to maximize efforts within global surgical partnerships. Level of Evidence: VI.

Design and Usability of an Open-Source, Low-Cost Flexible Laryngoscope for Resource-Limited Settings.

Importance: Endoscopes are paramount to the practice of otolaryngology. To provide physicians in low-middle-income countries with adequate tools to treat otolaryngologic problems, it is necessary to create a low-cost sustainable option. Objective: To describe the design and usability of an open-source, low-cost flexible laryngoscope that addresses the lack of affordable and accessible methods for otolaryngologic visualization in resource-limited settings. Design, Setting, and Participants: This quality improvement study used a mixed-methods approach, including a technical description of device design as well as quantitative and qualitative survey evaluation of device usability. Engineering involved device design, sourcing or manufacturing individual components, fabricating a prototype, and iterative testing. Key assumptions and needs for the device were identified in collaboration with otolaryngologists in Zimbabwe, and designed and simulated by biomedical engineers in a US university laboratory. Board-certified otolaryngologists at a single US university hospital trialed a completed prototype on simulated airways between May 2023 and June 2023. Main Outcomes and Measures: Technical details on the design of the device are provided. Otolaryngologist gave feedback on device characteristics, maneuverability, and visualization using the System Usability Scale, a customized Likert-scale questionnaire (5-point scale), and semistructured interviews. Results: A functional prototype meeting requirements was completed consisting of a distal-chip camera, spring bending tip, handle housing the control mechanism and electronics, and flexible polyether block amide-coated silicone sheath housing the camera and control wires; an external monitor provided real-time visualization and ability to store data. A total of 14 otolaryngologists participated in the device review. The mean (SD) System Usability Scale score was 88.93 (10.08), suggesting excellent usability. The device was rated highly for ease of set up, physical attributes, image quality, and functionality. Conclusions and Relevance: This quality improvement study described the design of a novel open-source low-cost flexible laryngoscope that external review with otolaryngologists suggests was usable and feasible in various resource-limited environments. Future work is needed to translate the model into a clinical setting.

Prevalence and causes of paediatric hearing loss in a rural province of Zimbabwe: A cross-sectional study.

BACKGROUND: Hearing loss (HL) in childhood is a significant disability with severe consequences for educational, cognitive, and social-emotional success. Nevertheless, prevalence estimates for HL in Sub-Saharan Africa (SSA) are based on scarce data. Therefore, we aimed to estimate the prevalence of HL in a sample of primary school children from a rural province of Zimbabwe. METHODS: A cross-sectional study was performed on primary school children aged 4-13 years from a rural Zimbabwean province. In the quietest room available, participants underwent audiometry, video otoscopy, and tympanometry. Hearing loss was defined as a pure-tone average > 25 dB. Risk factors of hearing loss were evaluated via a questionnaire. Furthermore, to enable comparison with similar studies, HL prevalence was calculated according to two other commonly used definitions. RESULTS: A total of 451 pupils were included, of which 10.6% (95% CI 7.8-13.5) met the study criteria for HL. Conductive HL (95.1%) was nineteen times more prevalent than sensorineural HL (4.9%). Otitis media was the underlying cause in 40% of all cases of HL. The prevalence of clinically significant HL varied depending on the definition applied, i.e., 0.4% (95% CI -0.2-1.0) in the worst World Health Organisation category as opposed to 4.2% (95% CI 2.4-4.1) in the worst American Speech-Hearing Association category. CONCLUSIONS: Hearing loss was common in this sample of primary school children from a rural province in Zimbabwe.

Priority setting in otolaryngology practices in Zimbabwe.

PURPOSE OF REVIEW: This article describes priority setting in otorhinolaryngology healthcare services in Zimbabwe. It aims to initiate discussion on priority setting among otorhinolaryngologists working in African countries. RECENT FINDINGS: The WHO reports that most developed countries have formal processes in place for the collection and analysis of information that is used in priority setting in healthcare services. However, many resource-limited nations lack well-defined processes for priority setting. Information surrounding priority setting in otorhinolaryngology in particular is scarce. SUMMARY: Priority setting refers to the distribution of limited resources among competing programmes and patient or patient groups in an equitable and just manner. A dearth of information on priority setting in otorhinolaryngology exists. This silence is more pronounced in African settings. Despite the myriad of challenges facing many African countries, formal guidelines for priority setting are rare. Priority setting therefore is often haphazard and unplanned. We therefore recommend agility in bringing together otorhinolaryngology stakeholders in an effort to initiate dialogue and come up with formal processes that will collect information that will lead to provision of guidelines in priority setting.

Human papillomavirus types causing recurrent respiratory papillomatosis in Zimbabwe.

OBJECTIVE: Recurrent respiratory papillomatosis (RRP) caused by human papillomavirus (HPV) is preventable through vaccination. This study was motivated by the recent thrust of the Zimbabwean government to reduce incidence of HPV related cervical cancer in Zimbabwe through vaccination against HPV. We therefore set out to type HPV genotypes causing RRP in Zimbabwe. We also describe for the first time, the demographics of Zimbabwean RRP patients, the characteristics of patients with different HPV types and possible risk factors of HPV infection in our setting. METHODS: We conducted a prospective, hospital based study were patients were recruited from two national otorhinolaryngology hospitals in Zimbabwe. All patients diagnosed with RRP during a twenty four month period were included in the study. A questionnaire was administered per patient to collect both demographic and clinical variables. HPV DNA was extracted from formalin fixed paraffin embedded laryngeal tissue. The extracted HPV DNA was amplified using polymerase chain reaction and next generation sequencing was used to genotype the HPV types. RESULTS: A total of 52 patients all aged 14 years and under were recruited into the study. Only Juvenile onset RRP cases were observed over the two year period and 64% of the patients were HPV positive. HPV types 6 and 11 were the dominant types observed constituting 85% of all HPV types. The remaining 15% constituted of HPV 16 and HPV 18. 27% of the patients had coinfection with at least two different HPV types. There were no statistically significant differences between the characteristics of HPV positive and HPV negative patients. No statistically significant risk factors were observed. CONCLUSION: HPV types 6 and 11 were the predominant genotypes causing RRP in Zimbabwe. Thus the use of quadrivalent or even nonavalent HPV vaccines may play an important role in the prevention and management of RRP in Zimbabwe.