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Anesthesia Capacity in Ghana: A Teaching Hospital’s Resources, and the National Workforce and Education

Brouillette, Mark A. MD*; Aidoo, Alfred J. MBChB; Hondras, Maria A. DC, MPH, PhD*; Boateng, Nana A. MGCS, MBChB; Antwi-Kusi, Akwasi FGCS†‡; Addison, William FGCS, FWACS†‡; Hermanson, Alec R. BA*

doi: 10.1213/ANE.0000000000002487
Global Health: Original Clinical Research Report

BACKGROUND: Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital’s resources and the national workforce and education in this LMIC capacity report.

METHODS: A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016. Teaching hospital data were generated from observations of hospital facilities and patient care, review of archival records, and interviews with KATH personnel. National data were obtained from interviews with KATH personnel, correspondence with Ghana’s anesthesia society, and review of public records.

RESULTS: The practice of anesthesia at KATH incorporated preanesthesia clinics, intraoperative management, and critical care. However, there were not enough physicians to consistently supervise care, especially in postanesthesia care units (PACUs) and the critical care unit (CCU). Clean water and electricity were usually reliable in all 16 operating rooms (ORs) and throughout the hospital. Equipment and drugs were inventoried in detail. While much basic infrastructure, equipment, and medications were present in ORs, patient safety was hindered by hospital-wide oxygen supply failures and shortage of vital signs monitors and working ventilators in PACUs and the CCU. In 2015, there were 10,319 anesthetics administered, with obstetric and gynecologic, general, and orthopedic procedures comprising 62% of surgeries. From 2011 to 2015, all-cause perioperative mortality rate in ORs and PACUs was 0.65% or 1 death per 154 anesthetics, with 99% of deaths occurring in PACUs. Workforce and education data at KATH revealed 10 anesthesia attending physicians, 61 nurse anesthetists (NAs), and 7 anesthesia resident physicians in training. At the national level, 70 anesthesia attending physicians and 565 NAs cared for Ghana’s population of 27 million. Providers were heavily concentrated in urban areas, and NAs frequently practiced independently. Two teaching hospitals provided accredited postgraduate training modeled after European curricula to 22 anesthesia resident physicians.

CONCLUSIONS: While important limitations to capacity exist in Ghana, the overall situation is good compared to other LMICs. Many of the challenges encountered resulted from insufficient PACU and CCU provisions and few providers. Inadequate outcomes reporting made analysis and resolution of problem areas difficult. While many shortcomings stemmed from limited funding, strengthening physician commitment to overseeing care, ensuring oxygen supplies are uninterrupted, keeping ventilators in working order, and making vital signs monitors ubiquitously available are feasible ways to increase patient safety with the tools currently in place.

Published ahead of print September 14, 2017.

From the *Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas; Directorate of Anaesthesia and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana; and School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Published ahead of print September 14, 2017.

Accepted for publication August 14, 2017.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Mark A. Brouillette, MD, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas. Address e-mail to mark.brouillette@gmail.com.

© 2017 International Anesthesia Research Society