Asgedom, Brhanu H.

Background: Surgical registries have been widely adopted in high-income countries to improve patient outcomes. However, similar data-driven initiatives are still scarce in low- and middle-income countries (LMICs). Aims: This study aimed to address the challenges of implementing a perioperative registry for otolaryngology-head and neck surgery (OHNS) in Mekelle, Ethiopia, and to assess strategies for ensuring its long-term sustainability. Methods: The registry was developed using REDCap, through a collaborative effort between otolaryngologists in the United States and Ethiopia, ensuring its relevance to the local context. On-site training sessions were conducted for 13 OHNS residents and four senior surgeons to facilitate their use of the registry. A Wi-Fi router was installed in the operating room to enable real-time data entry. Continuous support was provided through remote communication between the local team and the U.S. research team. Sustainability strategies focused on fostering local ownership, integrating the registry into existing workflows, and maintaining continuous data monitoring. Results: Despite facing challenges like intermittent internet connectivity and issues with workflow integration, the local team successfully integrated the registry into routine clinical and surgical practices. Key strategies included providing dedicated Wi-Fi routers, modifying registry fields for improved efficiency, and emphasizing the registry’s value to the institution. Ongoing collaboration between the local team and the U.S. team enabled continuous optimization and data collection. Conclusion: The successful implementation of this perioperative registry underscores the importance of engaging local stakeholders and integrating sustainable workflows. This initiative serves as a model for other LMICs seeking to establish surgical registries that enhance data-driven decision-making at both the patient and institutional levels.

AbstractThis study compares delays in otolaryngologic care between patients in Mekelle, Ethiopia and Harare, Zimbabwe using the Three Delays model. Patient surveys conducted among 46 patients in Zimbabwe during October 2022 and 105 patients in Ethiopia during June 2023 revealed a significantly higher prevalence of delays in seeking and reaching care in Ethiopia. This was in the aftermath of the Tigray War, which damaged the region's health care infrastructure and diminished the trust of patients. In Zimbabwe, there was poor awareness among patients and nonotolaryngologist providers of otolaryngology disease and care capacity leading to delays in seeking and reaching care. Patients in both countries faced delays in receiving appropriate care due to resource limitations, with Ethiopia's constraints worsened by the recent war and Zimbabwe's by consistent health care underfunding. The longest delays were observed in head and neck oncology care. These findings provide a foundation for understanding otolaryngologic care delays in these low‐ and middle‐income countries.

AbstractObjectiveThis study aims to document and analyze the challenges and outcomes of performing complex airway surgery in a low‐resource, post‐war setting in Mekelle, Ethiopia.MethodsThis prospective case series examines clinical data from five patients who underwent airway reconstruction surgeries and one patient who underwent total laryngectomy at Ayder Comprehensive Specialized Hospital in Mekelle. Data included patient demographics, airway stenosis etiology and severity, operative details, postoperative outcomes, complications, and hospital length of stay. Ethical approval was obtained from institutional review boards at Mayo Clinic and Mekelle University.ResultsThe study included six patients aged 9–62 years, with surgeries comprising three cricotracheal resections, two tracheal resections, and one laryngectomy. Three reconstructions were for war‐related injuries. Challenges included power outages during surgeries, limitations in medical supplies and equipment, and inadequate perioperative care. Despite these, three patients requiring tracheostomies were successfully decannulated within a year. However, complications such as restenosis, infections, and the need for reintubation were common.ConclusionAirway surgeries in a low‐resource, post‐war setting face significant hurdles, including perioperative care quality, resource limitations, and infrastructure issues. Successful outcomes require multidisciplinary training tailored to local contexts, investments in hospital infrastructure and reliable electricity, and proper perioperative nutrition. This study highlights the need for comprehensive interventions to improve surgical care in such settings.Level of evidence: IV.

Abstract Background: The three delays model, identifies three key stages to delays in care that can contribute to adverse outcomes: decision-making to seek care, accessing healthcare facilities, and receiving appropriate medical care. However, the application of this model in otolaryngology-head and neck surgery (OHNS) and in a human conflict environment has not been examined. This study aims to explore the impact of each delay type within the OHNS population in post-war Mekelle, Ethiopia. By investigating these delays, the study seeks to uncover strategies for reducing delays and improving outcomes in the management of OHNS pathology for this and similar environments. Methods: This study was conducted during a 3-week short term OHNS surgical trip in Mekele, Ethiopia, following a 2 year war. A total of 105 patients attending the OHNS clinic were identified and given verbal interviews and semi-structured questionnaires. The three delays model was applied to analyze the data collected, focusing on the following aspects: 1) decision to seek care, 2) reaching care, and 3) receiving care. Results: A total of 105 patients were included in the analysis, with 100% (105/105) experiencing type 1 delays (decision to seek care), 75% experiencing type 2 delays (75/105) and an additional 77% (77/105) facing type 3 delays (receiving appropriate care after reaching health care facility). More than half of the patients encountered delays in all three types. Various factors contributed to type 3 delays, including multiple delays at the time of admission, drug shortages, non-availability of skilled staff, and incompetence. Cost of transportation emerged as the primary factor contributing to type 2 delays. Conclusion: The findings provide valuable insights into the specific delays experienced by patients seeking OHNS services in a post-war setting and inform potential strategies for improving healthcare delivery in similar contexts.