Excessive fasting times: still an underaddressed challenge for African pediatrics and anesthesia?
Gregor Pollach,1,2 Rose Kapenda,2 Beauty Anusa,2 Ethel Waluza,2 Felix Namboya1,2
1Department of Anaesthesia and Intensive Care, College of Medicine, University of Malawi, 2Queen Elizabeth Central Hospital, Blantyre, Malawi, Central Africa
Background: Children are starved before surgery following international preoperative guidelines. Extreme fasting is still reported, but data for Africa are scarce. Starving in hot climates leads to challenges arising from dehydration, hypotension, metabolic disturbances, and complications during induction of anesthesia. The purpose of this study was to evaluate the scope of the problem, identify possible reasons for this, and propose realistic solutions.
Methods: We performed eleven prospective audits between 2008 and 2013 in Malawi to improve our preoperative fasting times. In total, 631 children (aged 3 days to 13 years) were monitored. Training was provided, and the results were measured using a visual analog scale.
Results: In 2008, the baseline audit showed a mean fasting time (MFT) of 13.48 hours (31 patients). Training reduced the MFT to 8.77 hours (73 patients) and 3.2 hours (35 patients) in 2009. Without training, the MFT increased to 4.6 hours (35 patients) in 2010 and to 10.2 hours (50 patients) in 2011. A low level of training decreased the MFT to 8.13 hours (139 patients, in spring 2012). Educational activity brought the MFT down further to 7.86 hours (36 patients, in summer 2012). Lack of training in autumn 2012 increased MFT to 9.32 hours (151 patients), which then improved to 8.04 hours (27 patients) as a result of renewed educational activity. In 2013, MFT increased to 9.8 hours (37 patients) despite training. In June 2013, more education achieved a reduction in MFT to 6.52 hours (17 patients). The MFT across all audits (2008–2013) was 8.48 hours. Education reduces MFT, but only in the short term. Factors responsible for changes in MFT were identified.
Conclusion: Excessive preoperative fasting is an underaddressed problem in Africa. Reduction is difficult, so it has to be accepted as an ongoing task.
Keywords: child, infant, fluid, education, developing countries, Africa, fasting
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