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Pediatric procedural sedation in African clinical settings: A mixed methods study of African providers' sedation
Megan L Schultz1, Andrew Melby2, Rebecca Gray3
1Department of Pediatrics, Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Insights
Pediatric procedural sedation in Africa is critical but faces barriers. Improving training, resources, and guidelines can enhance safe pediatric sedation practices for children in resource-limited settings.
Area of Science:
- Pediatric Emergency Medicine
- Global Health
- Anesthesiology
Background:
- Pediatric procedural sedation is vital for emergency care in Africa, yet its practice is poorly understood.
- This study examines clinical experiences, indications, medications, adverse events, training, and guidelines for pediatric sedation in African resource-limited settings.
Purpose of the Study:
- To describe current pediatric procedural sedation practices among African medical providers.
- To identify barriers and challenges to providing safe pediatric sedation in resource-limited African environments.
Main Methods:
- A mixed-methods approach utilizing semi-structured interviews with key informants across Africa.
- Purposive sampling ensured representation from diverse geographic, economic, and professional backgrounds in 19 countries.
- Qualitative and quantitative data were collected on provider practices, barriers, and suggestions for improvement.
Main Results:
- Thirty-eight key informants reported imaging as the most common indication (42%) and ketamine as the most frequent medication (92%).
- Hypoxia was the most common adverse event (61%), and only half of providers felt adequately trained.
- Key barriers identified were lack of resources, insufficient education, and lack of standardization.
Conclusions:
- Specialized training for pediatric sedation teams is recommended.
- Developing portable sedation kits and locally relevant guidelines can mitigate barriers.
- These interventions aim to improve the safety and accessibility of pediatric procedural sedation in resource-limited African settings.
Background:
Little is known about the practice of pediatric procedural sedation in Africa, despite being incredibly useful to the emergency care of children. This study describes the clinical experiences of African medical providers who use pediatric procedural sedation, including clinical indications, medications, adverse events, training, clinical guideline use, and comfort level. The goals of this study are to describe pediatric sedation practices in resource-limited settings in Africa and identify potential barriers to the provision of safe pediatric sedation.
Methods:
This mixed methods study describes the pediatric procedural sedation practices of African providers using semi-structured interviews. Purposive sampling was used to identify key informants working in African resource-limited settings across a broad geographic, economic, and professional range. Quantitative data about provider background and sedation practices were collected concurrently with qualitative data about perceived barriers to pediatric procedural sedation and suggestions to improve the practice of pediatric sedation in their settings. All interviews were transcribed, coded, and analyzed for major themes.
Results:
Thirty-eight key informants participated, representing 19 countries and the specialties of Anesthesia, Surgery, Pediatrics, Critical Care, Emergency Medicine, and General Practice. The most common indication for pediatric sedation was imaging (42%), the most common medication used was ketamine (92%), and hypoxia was the most common adverse event (61%). Despite 92% of key informants stating that pediatric procedural sedation was critical to their practice, only half reported feeling adequately trained. The three major qualitative themes regarding barriers to safe pediatric sedation in their settings were: lack of resources, lack of education, and lack of standardization across sites and providers.
Conclusions:
The results of this study suggest that training specialized pediatric sedation teams, creating portable "pediatric sedation kits," and producing locally relevant pediatric sedation guidelines may help reduce current barriers to the provision of safe pediatric sedation in resource-limited African settings.
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