Endoscopic capacity in West Africa

Daniel Perl, Desmond Leddin, Damon Bizos, Andrew Veitch, James N’Dow, Stephanie Bush-Goddard, Ramou Njie, Maud Lemoine, Suzanne T. Anderson, John Igoe, Sharmila Anandasabapathy, Brijen Shah

Abstract

Background: Levels of endoscopic demand and capacity in West Africa are unclear.

Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-methods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses encountered.

Methods: In a three-day course, healthcare professionals were surveyed on endoscopic resources and capacity and were taught through active observation of live cases, case discussion, simulator experience and didactics. Before and after didactics, multiplechoice exams as well as questionnaires were administered to assess for course efficacy. Also, a case series of 23 patients needing upper GI endoscopy was done.

Results: In surveying physicians, less than half had resources to perform an EGD and none could perform an ERCP, while waiting time for emergency endoscopy in urban populations was at least one day. In assessing improvement in medical knowledge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI course with simulation and didactics improves gastrointestinal knowledge amongst participants.

Keywords: Endoscopic capacity, endoscopic demand, West Africa, training course