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Abstract
Introduction. Les pathologies oto-rhino-laryngologiques (ORL) figurent parmi les motifs fréquents de consultation en Afrique subsaharienne. Leur prise en charge repose sur un diagnostic clinique nécessitant des moyens adaptés, dont la disponibilité est mal documentée au Tchad. Cette étude a visé à évaluer la disponibilité des moyens diagnostiques ORL dans les hôpitaux de district de N'Djaména. Méthodologie. Une étude transversale descriptive a été menée du 1er avril au 31 juillet 2023 dans quatre hôpitaux de district de N'Djaména. Un échantillonnage exhaustif des praticiens non spécialistes impliqués dans la prise en charge ORL a été réalisé. Les données ont été recueillies par questionnaire structuré et analysées avec SPSS version 26.0. Résultats. Sur 229 praticiens recensés, 157 ont participé (taux de participation 68,6 %). L'âge moyen était de 36,0 ± 6,0 ans, avec une prédominance féminine (59,9 %). Les infirmiers représentaient 53,5 % des participants. Une source lumineuse de fortune (lampe torche, téléphone) était utilisée par 112 praticiens (71,3 %). L'otoscope était disponible chez 41 praticiens (26,1 %), et 61 praticiens (38,9 %) ne disposaient d'aucun matériel ORL spécifique. Plus d'un tiers des praticiens (36,9 %) déclaraient ne réaliser aucun examen clinique ORL, et 55,4 % rapportaient établir le diagnostic sans examen clinique complet. Conclusion. La disponibilité des moyens diagnostiques ORL dans les hôpitaux de district de N'Djaména est très insuffisante, conduisant à des pratiques de fortune et à des diagnostics incomplets. Un renforcement urgent des équipements de base et de la formation des praticiens non spécialistes est nécessaire pour améliorer la qualité des soins ORL en milieu périphérique tchadien.
ABSTRACT
Introduction. Otorhinolaryngological (ENT) conditions are frequent reasons for consultation in sub-Saharan Africa. Their management relies on clinical diagnosis requiring appropriate tools, the availability of which is poorly documented in Chad. This study aimed to assess the availability of ENT diagnostic tools in district hospitals of N'Djaména. Methods. A descriptive cross-sectional study was conducted from April 1 to July 31, 2023, in four district hospitals in N'Djaména. Exhaustive sampling of non-specialist practitioners involved in ENT care was performed. Data were collected using a structured questionnaire and analyzed with SPSS version 26.0. Results. Among 229 practitioners identified, 157 participated (participation rate 68.6%). Mean age was 36.0 ± 6.0 years, with female predominance (59.9%). Nurses represented 53.5% of participants. A makeshift light source (flashlight, mobile phone) was used by 112 practitioners (71.3%). An otoscope was available to 41 practitioners (26.1%), and 61 practitioners (38.9%) had no specific ENT equipment. Over one-third of practitioners (36.9%) reported performing no ENT clinical examination, and 55.4% reported making a diagnosis without a complete clinical examination. Conclusion. The availability of ENT diagnostic tools in district hospitals of N'Djaména is severely insufficient, leading to makeshift practices and incomplete diagnoses. Urgent strengthening of basic equipment and training of non-specialist practitioners is needed to improve the quality of ENT care in peripheral Chadian health facilities.
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References
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- 14. Graydon K, Waterworth C, Miller H, Gunasekera H. Global burden of hearing impairment and ear disease. J Laryngol Otol. 2019;133(1):18-25.
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- 16. Olusanya BO, Neumann KJ, Saunders JE. The global burden of disabling hearing impairment: a call to action. Bull World Health Organ. 2014;92(5):367-373.
- 17. Bhamjee A, le Roux T, Schlemmer K, Graham MA, Mahomed-Asmail F. Audiologists’ Perceptions of Hearing Healthcare Resources and Services in South Africa’s Public Healthcare System. Health Services Insights. 2022;15.
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References
1. World Health Organization. Deafness and hearing loss. Geneva: WHO; 2021.
2. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One. 2012;7(4):e36226.
3. Fagan JJ, Jacobs M. Survey of ENT services in Africa: need for a comprehensive intervention. Glob Health Action. 2009;2.
4. Bluestone CD, Klein JO. Otitis media in infants and children. 4th ed. BC Decker; 2007.
5. Mulwafu W, Ensink R, Kuper H, Fagan J. Survey of ENT services in sub-Saharan Africa: little progress between 2009 and 2015. Glob Health Action. 2017;10(1):1289736.
6. Chadha S, Cieza A. Promoting global action on hearing loss: World hearing day. Int J Audiol. 2017;56(3):145-147.
7. Ghebreyesus TA. Strengthening our resolve for primary health care. Bull World Health Organ. 2020;98(11):726-726A.
8. Lukama L, Kalinda C, Aldous C. Africa's challenged ENT services: highlighting challenges in Zambia. BMC Health Serv Res. 2019;19(1):443.
9. Ministère de la Santé Publique et de la Prévention du Tchad. Annuaire statistique sanitaire 2023. N’Djaména: MSPP; 2024.
10. Leach AJ, Homøe P, Chidziva C, Gunasekera H, Kong K, Bhutta MF, Jensen R, Tamir SO, Das SK, Morris P. Panel 6: Otitis media and associated hearing loss among disadvantaged populations and low to middle-income countries. Int J Pediatr Otorhinolaryngol. 2020;130 Suppl 1(Suppl 1):109857.
11. Lukama L, Aldous C, Michelo C, Kalinda C. Ear, Nose and Throat (ENT) disease diagnostic error in low-resource health care: Observations from a hospital-based cross-sectional study. PLoS One. 2023;18(2): e0281686.
12. Fasunla AJ, Samdi M, Nwaorgu OG. An audit of ear, nose and throat diseases in a tertiary institution in Southwestern Nigeria. Pan Afr Med J. 2013;14:1.
13. Waterworth, C. J., Marella, M., O’Donovan, J., Bright, T., Dowell, R., & Bhutta, M. F.. Barriers to access to ear and hearing care services in low- and middle- income countries: A scoping review. Global Public Health. 2022;17(12), 3869–3893.
14. Graydon K, Waterworth C, Miller H, Gunasekera H. Global burden of hearing impairment and ear disease. J Laryngol Otol. 2019;133(1):18-25.
15. World Health Organization. World Report on Hearing. Geneva: WHO; 2021.
16. Olusanya BO, Neumann KJ, Saunders JE. The global burden of disabling hearing impairment: a call to action. Bull World Health Organ. 2014;92(5):367-373.
17. Bhamjee A, le Roux T, Schlemmer K, Graham MA, Mahomed-Asmail F. Audiologists’ Perceptions of Hearing Healthcare Resources and Services in South Africa’s Public Healthcare System. Health Services Insights. 2022;15.
18. Swanepoel de W, Hall JW 3rd. A systematic review of telehealth applications in audiology. Telemed J E Health. 2010;16(2):181-200.