Indications, Challenges, and Characteristics of Successful Implementation of Perioperative Registries in Low Resource Settings: : A Systematic Review

Acknowledgements The authors would like to thank Ms. Dilshaad Brey for her assistance during the database searches and in organising the search results. UCT Division of Global Surgery and Prof Maswime’s SA MRC Mid-career Scientist Award for partially funding this study. Funding Open access funding provided by University of Cape Town. This study was partially funded by the University of Cape Town Department of Global Surgery, and the Network for Perioperative and Critical Care (N4PCc).Peer reviewedPublisher PD

Intensive Care in Sub-Saharan Africa : A National Review of the Service Status in Ethiopia

Funding: This study was funded by the Ethiopian Ministry of Health Emergency and Critical Care Directorate. A.B. and R.H. are funded in whole, or in part, by the Wellcome Trust [220211] and UKRI GECO Grant MR/V030884/1 for their contribution to this study. ACKNOWLEDGMENTS The authors wish to thank all hospital CEO’s and medical directors for their honest and cooperative response, and data collectors and coordinators who visited facilities for their assistance with data col- lection. We thank Ermiyas Belay, MSc, from Wolkite University, Ethiopia, and Dilanthi Gamage from Network for Improving Critical Care Systems and Training (NICST), Sri Lanka for their assistance in analyzing the data. We are particularly grateful to Prof Bruce Biccard, PhD, from University of Cape Town for his assistance in presubmission manuscript review.Peer reviewedPublisher PD

Perioperative care capacity in East Africa : results of an Ethiopian national cross-sectional survey

Acknowledgments The authors thank all hospitals who participated in the survey, all anesthesia providers, surgeons, obstetricians, nurses, and hospi- tal management staff who provided data voluntarily, and those who helped coordinate the study in their area.Peer reviewedPublisher PD

Indications, challenges, and characteristics of successful implementation of perioperative registries in low resource settings: A systematic review

Background Data is central to healthcare system improvement. Perioperative registries can be utilised for quality improvement initiatives through tracking outcomes, developing risk prediction models, and supporting policymakers and health professionals in making evidence-based decisions and interventions. This is particularly desirable in low-resource settings, where there is an unmet surgical demand and patients have a mortality rate up to double that of high-income countries. To better understand and support initiatives to establish clinical registries, this study aimed to assess the indications, challenges, and characteristics of successful perioperative registries in low-resource settings from the available literature on perioperative registry implementations. Materials and Methods We conducted a librarian-assisted literature search of international research databases; PubMed, Scopus, Cochrane Library, Web of Science, and WHOLIS WHO Library Database of articles published between January 1969 to January 2021 using controlled subject headings and keywords. Studies were filtered using predefined criteria and responses to two Mixed Method Appraisal Tool screening questions. A Direct Content Analysis Method was used to synthesize data for eligible studies based on predefined criteria. Results The search identified 2793 abstracts, with ten studies included after removing duplicates and excluding studies that did not meet eligibility criteria. Three were conducted in South America, four in Africa, two in the Middle East, and one in Asia. The lack of context-specific data for determining and evaluating patient outcomes (n=7) was the major indication for implementing registries. Organizing local research teams and engaging stakeholders in the host country was associated with successful implementation. However, inadequate funding to hire data collectors and monitor data quality was identified as a major challenge (n=4). Conclusion The goal of a perioperative registry is to generate data to influence and support quality improvement, and national surgical policies. Efforts to establish perioperative registries must continue while adhering to local ethical practices and broader principles and should consider those characteristics associated with successful registry implementation identified in this review

A scoping review of Enhanced Recovery After Surgery (ERAS), protocol implementation, and its impact on surgical outcomes and healthcare systems in Africa

Abstract Background Enhanced Recovery After Surgery (ERAS) is a patient-centered approach to surgery designed to reduce stress responses and facilitate faster recovery. ERAS protocols have been widely adopted in high-income countries, supported by robust research demonstrating improved patient outcomes. However, in Africa, there is limited evidence regarding its implementation. This review aims to identify the existing literature on the implementation of ERAS principles in Africa, the reported clinical outcomes, and the challenges and recommendations for successful implementation. Methods We conducted a librarian-assisted literature search of electronic research databases between October and November 2023. Titles and abstracts were screened for eligibility, and duplicates were then removed, followed by full-text assessment of potentially eligible studies. We utilized the summative content analysis method to synthesize and group the data into fewer categories based on agreed-upon criteria. Descriptive statistics were used to describe the results. Results The search identified 342 potential studies resulting in 15 eligible studies for inclusion in the review. The publication years ranged from 2016 to 2023. The studies originated from three countries: Egypt (n = 10), South Africa (n = 4), and Uganda (n = 1). Successful implementation was associated with reduced hospital length of stay (n = 12), lower mortality rates (n = 3), and improved pain outcomes (n = 7). Challenges included protocol adherence (n = 5) and limitations of the research design to generate strong evidence (n = 3). Recommendations included formal adoption of ERAS principles (n = 5), the need for sustained research commitment, and exploration of the applicability of ERAS in diverse surgical contexts (n = 8). Large-scale implementation beyond individual institutions was encouraged to further validate its impact on patient outcomes and healthcare costs (n = 1). Conclusions Despite the limited number of studies on ERAS implementation in Africa, the available evidence suggests that it reduces the length of hospital stays and mortality rates. This is crucial for the region, given its higher mortality rates, necessitating more collaborative, methodically well-designed studies to establish stronger evidence for ERAS in lower-resource environments

Clinical profiles of individuals with orofacial clefts: Results from fourteen Eastern African countries.

Background: More than 100,000 cleft lip and palate patients have benefited from reconstructive surgeries in Africa because of surgical support from non-governmental organizations such as Smile Train. The Smile Train Express is the largest cleft-centered patient registry with over a million records of clinical records, globally. In this study, we reviewed data from the Eastern African patient registry to analyze and understand the clinical profiles of cleft lip and palate patients operated at Smile Train partner hospitals in East Africa. Method: A cross-sectional study design was undertaken through a retrospective database review in fourteen Eastern African countries. The study population included all patients who had cleft lip and palate surgeries recorded in the Smile Train database between 2001 and 2019. Findings: 86,683 patient records from 14 Eastern African countries were included in this study. The mean age was (8.8), the mean weight was 22.3 kg and 20.8 kg for males and females, respectively, and 61.9% of the surgeries were performed on male patients. Left cleft lip and palate (21,062, 24.62%) and left cleft lip only (17,155, 20.05%) were the most common types of clefts, with bilateral cleft lip only (3958, 4.63%) being the least frequent. complete left cleft lip with complete left alveolus was the most frequent cleft combination observed (n = 21,746) and Cleft lip to cleft lip and palate to cleft palate ratio (CL:CLP: CP) was 4.73:7.1:1. Unilateral primary lip-nose repairs were the most common surgeries (66%). General anesthesia was used for 74,783 (86.2%) of the procedures. Interpretation: Most children with cleft lip and/or palate were underweight, possibly due to malnutrition or related to socioeconomic status. There were more male patients compared to females, which could be related to gender disparities. Access to surgical care for children born with congenital defects needs to be improved, and inequities need to be addressed via more evidence-based collaborative intervention strategies. Funding: Non