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Abstract
RÉSUMÉ
Introduction. Les pathologies oto-rhino-laryngologiques (ORL) sont fréquentes dans les structures périphériques d'Afrique subsaharienne, où elles sont prises en charge par des praticiens non spécialistes. Leur niveau de formation pratique conditionne la qualité des soins, mais reste mal documenté. Cette étude avait pour but de décrire le profil des praticiens non spécialistes impliqués dans la prise en charge ORL dans les hôpitaux de district de N'Djaména et à analyser les facteurs liés à leur formation pratique en ORL. Méthodologie. Une étude transversale descriptive a été menée de façon prospective du 1er avril au 31 juillet 2023 dans quatre hôpitaux de district de N'Djaména. Tous les praticiens non spécialistes (médecins généralistes, infirmiers, sages-femmes, techniciens supérieurs) impliqués dans la prise en charge ORL ont été sollicités. Les données ont été recueillies par questionnaire structuré et analysées avec SPSS version 26.0, avec analyses descriptive et bivariée (test du χ²). 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 diplômés d'État représentaient 53,5 % des participants, suivis des sage-femmes (17,8 %) et des médecins généralistes (16,6 %). Seuls 25 praticiens (15,9 %) avaient effectué un stage pratique en ORL, dont 18 médecins généralistes (69,2 % des stagiaires). La réalisation d'un stage était significativement associée à la qualification professionnelle (p < 0,001) et à l'ancienneté (p < 0,001). Conclusion. La prise en charge ORL dans les hôpitaux de district de N'Djaména repose sur des praticiens non spécialistes très majoritairement dépourvus de formation pratique en ORL, à l'exception des médecins généralistes les plus anciens. Ces résultats appellent à intégrer des modules obligatoires de formation pratique en ORL dans les cursus de base et à organiser des stages de renforcement des compétences pour les personnels en poste.
ABSTRACT
Introduction. Otorhinolaryngological (ENT) conditions are common in peripheral health facilities in sub-Saharan Africa, where they are managed by non-specialist practitioners. Their level of practical training determines care quality but remains poorly documented. This study aimed to describe the profile of non-specialist practitioners involved in ENT care in district hospitals of N'Djaména and analyze factors associated with their practical ENT training. Methods. A descriptive cross-sectional study was conducted prospectively from April 1 to July 31, 2023, in four district hospitals in N'Djaména. All non-specialist practitioners (general practitioners, nurses, midwives, senior technicians) involved in ENT care were invited. Data were collected using a structured questionnaire and analyzed with SPSS version 26.0, with descriptive and bivariate analysis (χ² test). Results. Among 229 practitioners identified, 157 participated (participation rate 68.6%). Mean age was 36.0 ± 6.0 years, with female predominance (59.9%). State-registered nurses represented 53.5% of participants, followed by midwives (17.8%) and general practitioners (16.6%). Only 25 practitioners (15.9%) had completed a practical ENT rotation, including 18 general practitioners (69.2% of trainees). Completing a rotation was significantly associated with professional qualification (p < 0.001) and seniority (p < 0.001). Conclusion. ENT care in N'Djaména's district hospitals relies on non-specialist practitioners overwhelmingly lacking practical ENT training, except for senior general practitioners. These findings call for integrating mandatory practical ENT modules into basic curricula and organizing competency-strengthening rotations for current staff.
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References
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References
1. World Health Organization. Primary ear and hearing care training resource. Geneva: WHO; 2006.
2. Marom T, Tan A, Wilkinson GS, Pierson KS, Freeman JL, Chonmaitree T. Trends in otitis media–related health care use in the United States, 2001–2011. JAMA Pediatr. 2014;168(1):68–75.
3. Fasunla AJ, Samdi M, Nwaorgu OGB. An audit of ear, nose and throat diseases in a tertiary health institution in Nigeria. Afr J Med Med Sci. 2013;42(1):1–6.
4. Bluestone CD, Klein JO. Otitis media in infants and children. 4th ed. Hamilton (ON): BC Decker; 2007.
5. Schilder AGM, Chonmaitree T, Cripps AW, Rosenfeld RM, Casselbrant ML, Haggard MP, et al. Otitis media. Nat Rev Dis Primers. 2016;2:16063.
6. World Health Organization. World report on hearing. Geneva: WHO; 2021.
7. 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.
8. World Health Organization. Strengthening primary health care to improve health outcomes. Geneva: WHO; 2019.
9. Fagan JJ, Jacobs M. Survey of ENT services in Africa: need for a comprehensive intervention. Otolaryngol Head Neck Surg. 2009;140(6):722–725.
10. Naidoo Y, Mulwafu W, Ensink R, Fagan J. Otolaryngology services in Africa: workforce challenges and solutions. Int J Health Plann Manage. 2018;33(3):658–667.
11. Ministère de la Santé Publique du Tchad. Annuaire statistique sanitaire 2021. N’Djaména: MSP; 2022.
12. Kolo ES, Ramalan MA. Pattern of ear, nose and throat diseases in a Nigerian teaching hospital. Niger J Clin Pract. 2012;15(1):98–101.
13. Adoga AA, Nimkur TL, Manasseh AN. Pattern of ENT diseases in Jos, Nigeria. Pan Afr Med J. 2013;15:1–6.
14. Ologe FE, Nwawolo CC. Prevalence of ear, nose and throat diseases in a Nigerian population. Afr Health Sci. 2005;5(1):1–6.
15. McPherson B, Brouillette R. Audiology and otolaryngology services in developing countries. Int J Audiol. 2011;50(2):82–88.
16. Brouillette M, Kesser BW. Training non-specialist health workers in ear and hearing care. Glob Health Action. 2016;9:29808.
17. Kiringoda R, Lustig LR. A meta-analysis of surgical and nonsurgical interventions for chronic otitis media in low-income settings. J Laryngol Otol. 2018;132(2):1–6.
18. Mulwafu W, Kuper H, Ensink R. Training and capacity building in ENT care in low-income countries. Trop Med Int Health. 2014;19(12):1429–1436.
19. Saunders JE, Rankin Z, Noonan KY. Otologic and audiologic care in developing countries. Otolaryngol Clin North Am. 2018;51(3):585–597.
20. World Health Organization. Package of essential noncommunicable disease interventions for primary health care (PEN). Geneva: WHO; 2020.
21. Mulwafu W, Fagan JJ, Ibekwe TS. ENT outreach in Africa: rules of engagement. OTO Open. 2018;2(2):2473974X18777220.
22. World Health Organization. Primary ear and hearing care: training manual. Geneva: WHO; 2017.
23. Ministère de la Santé Publique du Tchad. Plan national de développement sanitaire 2022–2026. N’Djaména: MSP; 2022.
