The role of ENT Surgery in Global Health

January 11, 2021: Posted by Shirwa Sheik-Ali

Authors: Mr Shirwa Sheik Ali, Mr Sharaf Sheik Ali 

It has been reported that the poorest third of the world’s population obtain only 3.5% of surgical operations conducted globally and that 5 billion people do not have access to safe, affordable surgical care when required (1,2). Shortfalls in infrastructure, trained personnel and political priority partly account for this (3,4).

Non-communicable diseases, including those of ear, nose and throat (ENT) conditions, have a low profile in the field of global health. Despite this, hearing impairment that is disabling is the most common disability internationally (5). Indeed, over 5% of the world’s population – or 466 million people – have disabling hearing loss (6). These figures are set to rise, with one in every ten people predicted to have disabling hearing loss by 2050 (6). 

The World Health Organisation (WHO) defines disabling hearing loss as someone with hearing loss thresholds greater than 40 decibels (dB) in the better hearing ear in adults and a hearing loss greater than 30 dB for children. (6). The majority of people with disabling hearing loss live in low- and middle-income countries. (7). Despite this, the disability is widely misunderstood and neglected. 

Disabling hearing impairment can result in damaging consequences to multiple aspects of someone’s life – from communication, mental well-being, quality of life and economic achievement (8,9). For children, in particular, disabling hearing loss can hinder speech and language development, with ensuing effects on education and vocational fulfilment (10). In adulthood, disabling hearing impairment can lead to social isolation, stigmatization, prejudice and relatively low earnings (11). Disabling hearing loss has harmful consequences on all aspects of a sufferer’s life – whether this be functional, social or economical.

ENT resources in many low- and middle-income countries are often limited. The high ENT disease burden has not received the required resources for treatment. It has been reported that, excluding South Africa, the number of ENT surgeons per 100,000 population in 18 sub-saharan African countries was five times lower than in the United kingdom (12). A further cross-sectional study of Zambia’s ENT services revealed deficiencies in all aspect of hospital care – from infrastructure to human resources and hospital equipment. (13). Indeed, studies consistently report under resourced, under staffed and poor ENT, audiology and speech and language therapy services in many low income countries (13).

What can be done?

There are several steps forward to support equity in ENT services globally. These are namely: advocacy, preventative public health measures, education and training and governmental priority. 

International ENT organisations, including the ENT UK Global Health ENT group, can highlight the critical nature of tackling ENT disease globally. 

Preventative public health measures can limit up to half of all cases of hearing loss (6). The World Health Organisation has suggested simple strategies for such prevention – namely immunisation programmes against childhood diseases attributable for hearing loss, including immunising children against measles, meningitis, rubella and mumps. Other public health measures to prevent hearing loss include: reducing occupational and recreational exposure to loud sounds; avoiding otototoxic drugs and strengthening maternal and child health programmes, amongst others (6). 

Governmental priority in low- and middle-income countries for reducing morbidity and mortality associated with ENT services is critical. This includes rolling out National Health Strategic Plans to recognise ENT disorders, upscaling dedicated ENT training programmes and increasing infrastructure and equipment for ENT services.  

The global ENT disease burden is significant and steps can be taken forward to acknowledge, address and support them. 

 

References:

  1. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–144.
  2. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624. 
  3. Vo D, Cherian MN, Anesthesia Bianchi S. Anesthesia Capacity in 22 Low and Middle Income Countries. J Anesth Clin Res. 2012;3:4.
  4. Farmer PE, Kim JY. Surgery and Global Health: a view from beyond the OR. World J Surg. 2008;32:533–536. doi: 10.1007/s00268-008-9525-9
  5. Ta NH. ENT in the context of global health. Ann R Coll Surg Engl 2019; 101:93-96
  6. World Health Organization. Deafness and hearing loss. 2020 https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss (accessed December 2020).
  7. World Health Organization. Millions of People in the World have Hearing Loss that can be Treated or Prevented. Geneva. WHO; 2013. 
  8. Mason A, Mason M. Psychologic impact of deafness on the child and adolescent. Prim Care. 2007;34:407–26.
  9. Kotby MN, Tawfik S, Aziz A, Taha H. Public health impact of hearing impairment and disability. Folia Phoniatr Logop. 2008;60:58–63.
  10. Karchmer MA, Allen TE. The functional assessment of deaf and hard of hearing students. Am Ann Deaf. 1999;144:68–77
  11. Ruben RJ. Redefining the survival of the fittest: communication disorders in the 21st century. Laryngoscope. 2000;110:241–5
  12. Fagan J, Jacobs M. Surgery of ENT servies in Africa: need for a comprehensive intervention. Glob Health Action 2009; 2(1).
  13. Lukama L, Kalinda C, Aldous C. Africa’s challenged ENT services: highlighting challenges in Zambia. BMC Health Services Research (2019) 19:443

About Shirwa Sheik-Ali – United Kingdom

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