RSS-Feed abonnieren

DOI: 10.1055/a-1942-7359
Starting gastrointestinal endoscopy in a lower middle-income country in Africa: Training, creating an endoscopy facility and developing telemedicine

Abstract
Background and study aims The prevalence of digestive diseases seems to be high in African countries. Nonetheless, the human and material resources are scarce. The aim of the Portuguese volunteering project described in this report was to develop the specialty of digestive endoscopy in Sao Tome and Principe, a lower-middle-income country in Africa.
Methods Beginning by assessing the local needs and available resources and managing immediate issues related to this field, we aimed to provide the tools necessary to improve gastroenterological and endoscopic care in the country. The first step included training of the local teams, through the development and accomplishment of an adapted curriculum for a 3-year medical gastroenterological fellowship and a short-term nursing fellowship, both in Portugal, and the organization of regular gastroenterological and endoscopic theoretical and practical sessions in Sao Tome and Principe. Second, the endoscopy facilities of the unit were significantly optimized. Third, a web platform was designed to provide telemedicine incorporating real-time endoscopic imaging available remotely.
Results Through these sequential steps achieved in collaboration with Portuguese and local teams, this 5-year project provided the basis for gastroenterology care in this country.
Conclusions At the present time, Sao Tome and Principe has an autonomous, efficient and skilled team and unit to provide care for patients with gastrointestinal diseases who need endoscopic procedures.
Publikationsverlauf
Eingereicht: 29. April 2022
Angenommen nach Revision: 05. September 2022
Accepted Manuscript online:
14. September 2022
Artikel online veröffentlicht:
15. November 2022
© 2022. 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. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 United Nations, Department of Economic and Social Affairs. World Population prospects – Population division. 2019 https://population.un.org/wpp/publications/files/wpp2019_highlights.pdf
- 2 Kelly P, Katema M, Amadi B. et al. Gastrointestinal pathology in the University Teaching Hospital, Lusaka, Zambia: review of endoscopic and pathology records. Trans R Soc Trop Med Hyg 2008; 102: 194-199
- 3 Mbengue M, Dia D, Diouf ML. et al. Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal). Med Trop (Mars) 2009; 69: 286-288
- 4 World Health Organization. A spatial database of health facilities managed by the public health sector in sub-Saharan Africa. 2019 https://www.who.int/publications/m/item/who-cds-gmp-2019-01
- 5 Ministério da Saúde, República Democrática de São Tomé e Príncipe. Anuário Estatístico da Saúde 2020. 2020 Anuario-Estatistico-da-Saude-2020.pdf
- 6 Instituto Nacional de Estatística, Portugal. Estatísticas da Saúde 2019. 2021 https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_publicacoes&PUBLICACOESpub_boui=257483090&PUBLICACOESmodo=2
- 7 Instituto Marquês de Valle Flôr. Saúde para Todos. 2021 https://www.imvf.org/wp-content/uploads/2021/06/documento-informativo-saude-2021.pdf
- 8 Beilenhoff U, Biering H, Blum R. et al. Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: Position Statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – Update 2018. Endoscopy 2018; 50: 1205-1234
- 9 Hassan C, Aabakken L, Ebigbo A. et al. Partnership with African Countries: European Society of Gastrointestinal Endoscopy (ESGE) – Position Statement. Endosc Int Open 2018; 06: E1247-E1255
- 10 Instituto Nacional de Estatística, São Tomé e Príncipe. Inquérito Demográfico e Sanitário 2008-2009. 2010 https://dhsprogram.com/pubs/pdf/FR233/FR233.pdf
- 11 Smith S, Fowora M, Pellicano R. Infections with Helicobacter pylori and challenges encountered in Africa. WJG 2019; 25: 3183-3195
- 12 Smith SI, Ajayi A, Jolaiya T. et al. Helicobacter pylori infection in Africa: update of the current situation and challenges. Dig Dis 2022; 40: 535-544
- 13 Habeebu MY, Salako O, Okediji PT. et al. The distribution, histologic profile and clinical presentation of gastrointestinal malignancies in Lagos, Nigeria. J West Afr Coll Surg 2017; 7: 9-31
- 14 Mbiine R, Nakanwagi C, Kituuka O. High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda. Endosc Int Open 2021; 09: E997-E1000
- 15 Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part i: overall and upper gastrointestinal diseases. Gastroenterology 2009; 136: 376-386
- 16 Le Moine O, Diouf M, Mbengue M. et al. Creation of a therapeutic digestive endoscopy suite in Senegal: renovation, training and university certification. Results of a Belgian-Senegalese inter-university project. Endoscopy 2012; 44: 177-185
- 17 Mwachiro M, Topazian HM, Kayamba V. et al. Gastrointestinal endoscopy capacity in Eastern Africa. Endosc Int Open 2021; 09: E1827-E1836
- 18 Wootton R. Recent advances: Telemedicine. BMJ 2001; 323: 557-560
- 19 Shimizu S, Itaba S, Yada S. et al. Significance of telemedicine for video image transmission of endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography procedures. J Hepato Biliary Pancreat Sci 2011; 18: 366-374
- 20 Tang Z, Dubois S, Soon C. et al. A model for the pandemic and beyond: Telemedicine for all outpatient gastroenterology referrals reduces unnecessary clinic visits. J Telemed Telecare 2020;
- 21 Påhlsson H, Groth K, Permert J. et al. Telemedicine: an important aid to perorm high-quality endoscopic retrograde cholangiopancreatography in low-volume centers. Endoscopy 2013; 45: 357-361
- 22 Brinne Roos J, Bergenzaun P, Groth K. et al. Telepresence-teleguidance to facilitate training and quality assurance in ERCP: a health economic modeling approach. Endosc Int Open 2020; 08: E326-E337