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Article ; Online: Developing the Anesthesia Workforce: The Impact of Training Nurse Anesthetists.

Vreede, Eric / Bulamba, Fred / Chikumba, Edson

2019 Volume 129, Issue 5, Page(s) 1199–1201

MeSH term(s)	Anesthesia ; Government ; Humans ; Kenya ; Nurse Anesthetists ; Workforce
Language	English
Publishing date	2019-10-15
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000004432
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Article ; Online: The Global Anesthesia Workforce Survey: Updates and Trends in the Anesthesia Workforce.

Law, Tyler J / Lipnick, Michael S / Morriss, Wayne / Gelb, Adrian W / Mellin-Olsen, Jannicke / Filipescu, Daniela / Rowles, Jackie / Rod, Pascal / Khan, Fauzia / Yazbeck, Patrica / Zoumenou, Eugene / Ibarra, Pedro / Ranatunga, Kumudini / Bulamba, Fred

Anesthesia and analgesia

2024

Abstract: Background: There is a large global deficit of anesthesia providers. In 2016, the World Federation of Societies of Anaesthesiologists (WFSA) conducted a survey to count the number of anesthesia providers worldwide. Much work has taken place since then ... ...

Abstract	Background: There is a large global deficit of anesthesia providers. In 2016, the World Federation of Societies of Anaesthesiologists (WFSA) conducted a survey to count the number of anesthesia providers worldwide. Much work has taken place since then to strengthen the anesthesia health workforce. This study updates the global count of anesthesia providers. Methods: Between 2021 and 2023, an electronic survey was sent to national professional societies of physician anesthesia providers (PAPs), nurse anesthetists, and other nonphysician anesthesia providers (NPAPs). Data included number of providers and trainees, proportion of females, and limited intensive care unit (ICU) capacity data. Descriptive statistics were calculated by country, World Bank income group, and World Health Organization (WHO) region. Provider density is reported as the number of providers per 100,000 population. Results: Responses were obtained for 172 of 193 United Nations (UN) member countries. The global provider density was 8.8 (PAP 6.6 NPAP 2.3). Seventy-six countries had a PAP density <5, whereas 66 countries had a total provider density <5. PAP density increased everywhere except for high- and low-income countries and the African region. Conclusions: The overall size of the global anesthesia workforce has increased over time, although some countries have experienced a decrease. Population growth and differences in which provider types that are counted can have an important impact on provider density. More work is needed to define appropriate metrics for measuring changes in density, to describe anesthesia cadres, and to improve workforce data collection processes. Effort to scale up anesthesia provider training must urgently continue.
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006836
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Article ; Online: A Cross-Sectional Survey of Anesthetic Airway Equipment and Airway Management Practices in Uganda.

Bulamba, Fred / Connelly, Stephanie / Richards, Sara / Lipnick, Michael S / Gelb, Adrian W / Igaga, Elizabeth N / Nabukenya, Mary T / Wabule, Agnes / Hewitt-Smith, Adam

Anesthesia and analgesia

2023 Volume 137, Issue 1, Page(s) 191–199

Abstract: Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant ... ...

Abstract	Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant contributor to perioperative morbidity and mortality. While existing data have highlighted the magnitude of airway management complications in LMICs, there are inadequate data to understand their root causes. This study aimed to pilot an airway management capacity tool that evaluates airway management resources, provider practices, and experiences with difficult airways in an attempt to better understand potential contributing factors to airway management challenges. Methods: We developed a novel airway management capacity assessment tool through a nonsystematic review of existing literature on anesthesia and airway management in LMICs, internationally recognized difficult airway algorithms, minimum standards for equipment, the safe practice of anesthesia, and the essential medicines and health supplies list of Uganda. We distributed the survey tool during conferences and workshops, to anesthesia care providers from across the spectrum of surgical care facilities in Uganda. The data were analyzed using descriptive methods. Results: Between May 2017 and May 2018, 89 of 93 surveys were returned (17% of anesthesia providers in the country) from all levels of health facilities that provide surgical services in Uganda. Equipment for routine airway management was available to all anesthesia providers surveyed, but with a limited range of sizes. Pediatric airway equipment was always available 54% of the time. There was limited availability of capnography (15%), video laryngoscopes (4%), cricothyroidotomy kits (6%), and fiber-optic bronchoscopes (7%). Twenty-one percent (18/87) of respondents reported experiencing a "can't intubate, can't ventilate" (CICV) scenario in the 12 months preceding the survey, while 63% (54/86) reported experiencing at least 1 CICV during their career. Eighty-five percent (74/87) of respondents reported witnessing a severe airway management complication during their career, with 21% (19/89) witnessing a death as a result of a CICV scenario. Conclusions: We have developed and implemented an airway management capacity tool that describes airway management practices in Uganda. Using this tool, we have identified significant gaps in access to airway management resources. Gaps identified by the survey, along with advocacy by the Association of Anesthesiologists of Uganda, in partnership with the Ugandan Ministry of Health, have led to some progress in closing these gaps. Expanding the availability of airway management resources further, providing more airway management training, and identifying opportunities to support skilled workforce expansion have the potential to improve perioperative safety in Uganda.
MeSH term(s)	Humans ; Child ; Uganda ; Cross-Sectional Studies ; Airway Management/adverse effects ; Anesthetics ; Anesthesiology
Chemical Substances	Anesthetics
Language	English
Publishing date	2023-04-28
Publishing country	United States
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006278
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Article ; Online: Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers' perspectives.

Edgcombe, Hilary / Baxter, Linden S / Kudsk-Iversen, Soren / Thwaites, Victoria / Bulamba, Fred

BMJ open

2019 Volume 9, Issue 3, Page(s) e026218

Abstract: Objectives: To explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries.: Design: This was a qualitative ... ...

Abstract	Objectives: To explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries. Design: This was a qualitative exploratory descriptive study. Semistructured interviews were conducted online, recorded, transcribed and analysed thematically using NVivo. Setting: Participants' homes or workplaces in Sierra Leone, Somaliland and Uganda. Participants: 15 NPAPs, physician anaesthetists and surgeons working in the countries concerned. Results: Three major themes were identified: (1) discrepancy between urban training and rural practice, (2) prominent development of attitudes outside the curricular set during training, including approaches to learning and clinical responsibility and (3) the importance of interprofessional relationships developed during training for later practice. Conclusions: Anaesthesia providers in different cadres and very different country contexts in sub-Saharan Africa describe common themes in training which appear to be significant for their later practice. Not all these issues are explicitly planned for in current training programmes, although they are important in the view of providers. Subsequent programme development should consider these themes with a view to enhancing the safety and quality of anaesthesia practice in this context.
MeSH term(s)	Adult ; Anesthesiology/education ; Anesthetists/education ; Attitude of Health Personnel ; Clinical Competence/standards ; Female ; Health Personnel/education ; Humans ; Male ; Middle Aged ; Qualitative Research ; Sierra Leone
Language	English
Publishing date	2019-03-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2044-6055 ; 2044-6055 ; 2053-3624
ISSN (online)	2044-6055
ISSN	2044-6055 ; 2053-3624
DOI	10.1136/bmjopen-2018-026218
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Article ; Online: The Need for a Global Perspective on Task-Sharing in Anesthesia.

Lipnick, Michael S / Bulamba, Fred / Ttendo, Stephen / Gelb, Adrian W

Anesthesia and analgesia

2017 Volume 125, Issue 3, Page(s) 1049–1052

Language	English
Publishing date	2017-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000001988
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Postoperative pain after cesarean section: assessment and management in a tertiary hospital in a low-income country.

Kintu, Andrew / Abdulla, Sadiq / Lubikire, Aggrey / Nabukenya, Mary T / Igaga, Elizabeth / Bulamba, Fred / Semakula, Daniel / Olufolabi, Adeyemi J

BMC health services research

2019 Volume 19, Issue 1, Page(s) 68

Abstract: Background: There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was ... ...

Abstract	Background: There is little information about the current management of pain after obstetric surgery at Mulago hospital in Uganda, one of the largest hospitals in Africa with approximately 32,000 deliveries per year. The primary goal of this study was to assess the severity of post cesarean section pain. Secondary objectives were to identify analgesic medications used to control post cesarean section pain and resultant patient satisfaction. Methods: We prospectively followed 333 women who underwent cesarean section under spinal anesthesia. Subjective assessment of the participants' pain was done using the Visual Analogue Scale (0 to 100) at 0, 6 and 24 h after surgery. Satisfaction with pain control was ascertained at 24 h after surgery using a 2-point scale (yes/no). Participants' charts were reviewed for records of analgesics administered. Results: Pain control medications used in the first 24 h following cesarean section at this hospital included diclofenac only, pethidine only, tramadol only and multiple pain medications. There were mothers who did not receive any analgesic medication. The highest pain scores were reported at 6 h (median: 37; (IQR:37.5). 68% of participants reported they were satisfied with their pain control. Conclusion: Adequate management of post-cesarean section pain remains a challenge at Mulago hospital. Greater inter-professional collaboration, self-administered analgesia, scheduled prescription orders and increasing availability of analgesic drugs may contribute to improved treatment of postoperative pain with better pain scores.
MeSH term(s)	Adolescent ; Adult ; Analgesics/therapeutic use ; Analgesics, Opioid/therapeutic use ; Anesthesia, Spinal/adverse effects ; Cesarean Section/adverse effects ; Cesarean Section/psychology ; Female ; Humans ; Pain Management/psychology ; Pain Measurement/methods ; Pain, Postoperative/prevention & control ; Pain, Postoperative/psychology ; Patient Satisfaction ; Pregnancy ; Prospective Studies ; Tertiary Care Centers ; Treatment Outcome ; Uganda ; Young Adult
Chemical Substances	Analgesics ; Analgesics, Opioid
Language	English
Publishing date	2019-01-25
Publishing country	England
Document type	Journal Article
ISSN	1472-6963
ISSN (online)	1472-6963
DOI	10.1186/s12913-019-3911-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally.

Law, Tyler J / Subhedar, Shivani / Bulamba, Fred / O'Hara, Nathan N / Nabukenya, Mary T / Sendagire, Cornelius / Hewitt-Smith, Adam / Lipnick, Michael S / Tumukunde, Janat

Human resources for health

2021 Volume 19, Issue 1, Page(s) 93

Abstract: Background: One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain ... ...

Abstract	Background: One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. Methods: A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May-June 2019. Results: No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). Conclusions: No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.
MeSH term(s)	Anesthesia ; Career Choice ; Humans ; Income ; Physicians ; Rural Health Services ; Uganda
Language	English
Publishing date	2021-07-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2126923-3
ISSN	1478-4491 ; 1478-4491
ISSN (online)	1478-4491
ISSN	1478-4491
DOI	10.1186/s12960-021-00634-8
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Article: Achieving the Recommended Endotracheal Tube Cuff Pressure: A Randomized Control Study Comparing Loss of Resistance Syringe to Pilot Balloon Palpation.

Bulamba, Fred / Kintu, Andrew / Ayupo, Nodreen / Kojjo, Charles / Ssemogerere, Lameck / Wabule, Agnes / Kwizera, Arthur

Anesthesiology research and practice

2017 Volume 2017, Page(s) 2032748

Abstract: Background: Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20-30 cmH: Methods: This was a randomized clinical trial. ... ...

Abstract	Background: Both under- and overinflation of endotracheal tube cuffs can result in significant harm to the patient. The optimal technique for establishing and maintaining safe cuff pressures (20-30 cmH Methods: This was a randomized clinical trial. We enrolled adult patients scheduled to undergo general anesthesia for elective surgery at Mulago Hospital, Uganda. Study participants were randomized to have their endotracheal cuff pressures estimated by either loss of resistance syringe or pilot balloon palpation. The pressures measured were recorded. Results: One hundred seventy-eight patients were analyzed. 66.3% (59/89) of patients in the loss of resistance group had cuff pressures in the recommended range compared with 22.5% (20/89) from the pilot balloon palpation method. This was statistically significant. Conclusion: The loss of resistance syringe method was superior to pilot balloon palpation at administering pressures in the recommended range. This method provides a viable option to cuff inflation.
Language	English
Publishing date	2017-12-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397574-X
ISSN	1687-6970 ; 1687-6962
ISSN (online)	1687-6970
ISSN	1687-6962
DOI	10.1155/2017/2032748
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Article ; Online: Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.

Bedwell, Gillian J / Dias, Priyanthi / Hahnle, Lina / Anaeli, Amani / Baker, Tim / Beane, Abi / Biccard, Bruce M / Bulamba, Fred / Delgado-Ramirez, Martha B / Dullewe, Nilmini P / Echeverri-Mallarino, Veronica / Haniffa, Rashan / Hewitt-Smith, Adam / Hoyos, Alejandra Sanin / Mboya, Erick A / Nanimambi, Juliana / Pearse, Rupert / Pratheepan, Anton Premadas / Sunguya, Bruno /

Tolppa, Timo / Uruthirakumar, Powsiga / Vengadasalam, Sutharshan / Vindrola-Padros, Cecilia / Stephens, Timothy J

Anesthesia and analgesia

2022 Volume 135, Issue 6, Page(s) 1217–1232

Abstract: Background: Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may ...

Abstract	Background: Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs). Methods: Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs. Results: We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care. Conclusions: We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
MeSH term(s)	Pregnancy ; Female ; Humans ; Developing Countries ; Quality of Health Care ; Delivery of Health Care ; Qualitative Research ; Perioperative Care
Language	English
Publishing date	2022-08-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006113
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Article: A Novel Multiplayer Screen-Based Simulation Experience for African Learners Improved Confidence in Management of Postpartum Hemorrhage.

Taekman, Jeffrey M / Foureman, Megan F / Bulamba, Fred / Steele, Michael / Comstock, Emily / Kintu, Andrew / Mauritz, Amy / Olufolabi, Adeyemi

Frontiers in public health

2017 Volume 5, Page(s) 248

Abstract: Introduction: Postpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often ... ...

Abstract	Introduction: Postpartum hemorrhage (PPH) remains a global challenge, affecting thirteen million women each year. In addition, PPH is a leading cause of maternal mortality in Asia and Africa. In the U.S.A., care of critically ill patients is often practiced using mannequin-based simulation. Mannequin-based simulation presents challenges in global health, particularly in low- or middle-income countries. We developed a novel multiplayer screen-based simulation in a virtual world enabling the practice of team coordination with PPH. We used this simulation with learners in Mulago, Uganda. We hypothesized that a multiplayer screen-based simulation experience would increase learner confidence in their ability to manage PPH. Methods: The study design was a simple pre- and a post-intervention survey. Forty-eight interprofessional subjects participated in one of nine 1-h simulation sessions using the PPH software. A fifteen-question self-assessment administered before and after the intervention was designed to probe the areas of learning as defined by Bloom and Krathwohl: affective, cognitive, and psychomotor. Results: Combined confidence scores increased significantly overall following the simulation experience and individually in each of the three categories of Bloom's Taxonomy: affective, cognitive, and psychomotor. Conclusion: We provide preliminary evidence that multiplayer screen-based simulation represents a scalable, distributable form of learning that may be used effectively in global health education and training. Interestingly, despite our intervention being screen-based, our subjects showed improved confidence in their ability to perform psychomotor tasks. Although there is precedent for mental rehearsal improving performance, further research is needed to understand this finding.
Language	English
Publishing date	2017-09-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2017.00248
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