Challenges Facing Otolaryngologists in Low- and Middle-Income Countries During the COVID-19 Pandemic

Author(s): Maxwell P. Kligerman ^a ^, ^∗ , Shaina Lamour ^b , Samuel Okerosi ^c ^, ¹ ^, ² , Members of the Global OHNS Initiative group who contributed to and approved of the production of this manuscript

Publication date (Electronic): 18 August 2020

Journal: International Journal of Pediatric Otorhinolaryngology

Publisher: Elsevier B.V.

Keywords: Global Health, COVID-19, Global Otolaryngology, Low- and Middle-income countries

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Abstract

The COVID-19 pandemic poses significant challenges for otolaryngologists practicing in low- and middle-income countries (LMICs). This commentary highlights some of the particular challenges in low resource settings, including limited testing, insufficient personal protective equipment, small numbers of surgeons, and competing socio-economic demands. The commentary focuses on specific examples from around the world to draw attention to these challenges and also highlight examples of success and innovation. Amidst the crisis an opportunity exists for otolaryngologists from around the world to share resources, ideas, and innovations to best serve patients and improve the health system globally for the future.

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Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

Marius Gilbert, Giulia Pullano, Francesco Pinotti … (2020)

Summary Background The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19. Methods We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk. Findings Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively. Interpretation Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. Funding EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.

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Managing COVID-19 in Low- and Middle-Income Countries

Joost Hopman, Benedetta Allegranzi, Shaheen Mehtar (2020)

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Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015

Wakisa Mulwafu, Robbert Ensink, Hannah Kuper … (2017)

ABSTRACT Background: A 2009 survey of ENT, audiology, and speech therapy services and training opportunities in 18 Sub-Saharan African countries reported that the availability of services was extremely poor, the distribution of services was very inequitable, and training opportunities were limited. Objective: We conducted a new survey to determine the current status of ear, nose, and throat (ENT), audiology, and speech therapy services in sub-Saharan Africa. Method: This study is a cross-sectional study. A questionnaire was distributed by email to an ad hoc group of ENT surgeons and audiologists in 30 sub-Saharan African countries. Data from the current survey were compared to those of a 2009 survey. The numbers of ENT surgeons, audiologists, and speech therapists/100,000 people were compared to the ratios in the United Kingdom. Results: A total of 22 countries responded to the questionnaire. When data of the 15 countries that responded in both 2009 and 2015 are compared, the number of ENT surgeons had increased by 43%, audiologists had increased by 2.5%, and speech therapists by 30%. When the 23% population growth is taken into account, the numbers of ENT surgeons, audiologists, and speech therapists per 100,000 people had declined in four countries, and there remains a severe shortfall of ENT surgeons, audiologists, and speech therapists when compared to the UK Respondents cited lack of availability of basic equipment as the most frequent limitation in providing ENT services. Other important factors causing limitations in daily practice were: lack of ENT training facilities and audiological rehabilitation, low awareness of the burden of ENT pathology, as well as poor human resources management. Conclusions: There has been a lack of progress in ENT, audiology, and speech therapy services and training opportunities in sub-Saharan Africa between 2009 and 2015. There is a need to look at increased collaboration with developed countries and non-governmental organisations, establishing new and improving existing training centres in Africa, and task-shifting of some ENT services to primary health workers.

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Author and article information

Contributors

Maxwell P. Kligerman

Journal

Journal ID (nlm-ta): Int J Pediatr Otorhinolaryngol

Journal ID (iso-abbrev): Int. J. Pediatr. Otorhinolaryngol

Title: International Journal of Pediatric Otorhinolaryngology

Publisher: Elsevier B.V.

ISSN (Print): 0165-5876

ISSN (Electronic): 1872-8464

Publication date PMC-release: 18 August 2020

Publication date (Electronic): 18 August 2020

Electronic Location Identifier: 110322

Affiliations

[a ]Department of Otolaryngology, Stanford University, Palo Alto, California, USA

[b ]Department of Otorhinolaryngology, Hopital de L’Universite D’Etat D’Haiti, Port-au-Prince, Haiti

[c ]Department of Otolaryngology, Machakos Level Five Hospital, Machakos County, Kenya

Author notes

[∗ ]Corresponding author. 801 Welch Road, Palo Alto, CA, 94304 Tel.: +954 854-4000 Maxwell3@ 123456stanford.edu

[1]

All authors contributed equally to this manuscript

[2]

On behalf of the Global Otolaryngology/Head and Nek Surgery Initiative

Article

Publisher ID: S0165-5876(20)30465-1 Publisher ID: 110322

DOI: 10.1016/j.ijporl.2020.110322

PMC ID: 7434320

PubMed ID: 32861979

SO-VID: a582141e-67be-430b-a325-dbb4b510727a

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Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Challenges Facing Otolaryngologists in Low- and Middle-Income Countries During the COVID-19 Pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 10

Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

Managing COVID-19 in Low- and Middle-Income Countries

Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015

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