CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1827-E1836
DOI: 10.1055/a-1551-3343
Original article

Gastrointestinal endoscopy capacity in Eastern Africa

Michael Mwachiro
 1   Department of Endoscopy and Surgery, Tenwek Hospital, Bomet, Kenya
Hillary M. Topazian
 2   Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Violet Kayamba
 3   University of Zambia School of Medicine, Lusaka, Zambia
Gift Mulima
 4   Kamuzu Central Hospital, Lilongwe Malawi
Elly Ogutu
 5   Department of Clinical Medicine & Therapeutics, University of Nairobi, Kenya
 6   World Gastroenterology Organization Training Centre, Nairobi, Kenya
Mengistu Erkie
 7   Division of Gastroenterology & Hepatology, Department of Internal Medicine, Addis Ababa University, College of Health Sciences, Ethiopia
Gome Lenga
 8   Department of Medical Services, Kenya Ports Authority
Thomas Mutie
 6   World Gastroenterology Organization Training Centre, Nairobi, Kenya
 9   Department of Gastroenterology, Nairobi Hospital
Eva Mukhwana
 6   World Gastroenterology Organization Training Centre, Nairobi, Kenya
Hailemichael Desalegn
10   Division of Gastroenterology and Hepatology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Rezene Berhe
11   Division of Gastroenterology & Hepatology, Department of Internal Medicine, Addis Ababa University, College of Health Sciences, Ethiopia
Berhane Redae Meshesha
12   Department of Surgery, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Bongani Kaimila
13   UNC Project, Lilongwe Malawi University
Paul Kelly
 3   University of Zambia School of Medicine, Lusaka, Zambia
David Fleischer
14   Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona
Sanford M. Dawsey
15   Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States
Mark D. Topazian
16   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations


Background and study aims Limited evidence suggests that endoscopy capacity in sub-Saharan Africa is insufficient to meet the levels of gastrointestinal disease. We aimed to quantify the human and material resources for endoscopy services in eastern African countries, and to identify barriers to expanding endoscopy capacity.

Patients and methods In partnership with national professional societies, digestive healthcare professionals in participating countries were invited to complete an online survey between August 2018 and August 2020.

Results Of 344 digestive healthcare professionals in Ethiopia, Kenya, Malawi, and Zambia, 87 (25.3 %) completed the survey, reporting data for 91 healthcare facilities and identifying 20 additional facilities. Most respondents (73.6 %) perform endoscopy and 59.8 % perform at least one therapeutic modality. Facilities have a median of two functioning gastroscopes and one functioning colonoscope each. Overall endoscopy capacity, adjusted for non-response and additional facilities, includes 0.12 endoscopists, 0.12 gastroscopes, and 0.09 colonoscopes per 100,000 population in the participating countries. Adjusted maximum upper gastrointestinal and lower gastrointestinal endoscopic capacity were 106 and 45 procedures per 100,000 persons per year, respectively. These values are 1 % to 10 % of those reported from resource-rich countries. Most respondents identified a lack of endoscopic equipment, lack of trained endoscopists and costs as barriers to provision of endoscopy services.

Conclusions Endoscopy capacity is severely limited in eastern sub-Saharan Africa, despite a high burden of gastrointestinal disease. Expanding capacity requires investment in additional human and material resources, and technological innovations that improve the cost and sustainability of endoscopic services.

Supplementary material

Publication History

Received: 06 May 2021

Accepted: 09 July 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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