Surveying anesthesia care provision and deficiencies among the secondary public sector hospitals of rural Sindh, Pakistan.

Purpose

Provision of anesthesia care must go hand in hand with surgical care to equitably widen surgical coverage of underserved populations, especially the rural segments of low- and middle-income countries. The aim of this study was to assess the availability of key items and infrastructure needed for anesthesia care.

Methods

We conducted a cross-sectional survey at ten subdistrict or taluqa headquarter (THQ) hospitals and five district headquarter (DHQ) hospitals in six rural districts of the Sindh province of Pakistan using the Anesthesia Facility Assessment Tool. We assessed the domains of infrastructure, workforce, service delivery, conduct of anesthesia, equipment, and medications. We also scored these components and then compared the difference in mean scores.

Results

Three hospitals did not meet the minimum bed number required for a secondary hospital. Four hospitals had nonfunctioning operating rooms and conducted procedures elsewhere. Ten had full-time, certified anesthesiologists, while 11 had a postanesthesia care unit. There were only two hospitals with critical care units providing mechanical ventilation, and only one hospital conducting telemetry. Six hospitals did not have a dedicated anesthesia provider present at all times. Thirteen hospitals did not use the World Health Organization preoperative checklist before performing procedures. There were deficiencies in drugs such as hypnotics, opioids, and vasopressors.

Conclusion

There are many shortcomings in anesthesia care provision among these rural hospitals. Greater attention and investment are needed to safely conduct anesthesia in this setting.

References:

• Farmer PE, Kim JY. Surgery and global health: a view from beyond the OR. World J Surg 2008; 32: 533–6. https://doi.org/10.1007/s00268-008-9525-9
• Bath M, Bashford T, Fitzgerald JE. What is ‘global surgery’? Defining the multidisciplinary interface between surgery, anaesthesia and public health. BMJ Glob Health 2019; 4: e001808. https://doi.org/10.1136/bmjgh-2019-001808
• Meara JG, Leather AJ, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 2016; 25: 75–8. https://doi.org/10.1016/j.ijoa.2015.09.006
• Platt E, Doe M, Kim NE, et al. Economic impact of surgery on households and individuals in low income countries: a systematic review. Int J Surg 2021; 90: 105956. https://doi.org/10.1016/j.ijsu.2021.105956
• Nwanna–Nzewunwa O, Oke R, Agwang E, et al. The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study. BMC Health Serv Res 2021; 21: 568. https://doi.org/10.1186/s12913-021-06579-x