Endoscopy capacity in Nigeria: a national needs assessment and recommendations

Gastrointestinal (GI) disease is increasing globally, particularly in low-and-middle-income countries (LMICs), where mortality rates are higher compared to high-income countries. This disparity is due to late presentation, as advanced stages of disease result in limited treatment options, leading to increased morbidity and mortality. Endoscopy is essential in diagnosing GI disease and plays a key role in early detection programs for cancers, which aim to identify cancers at earlier treatable stages. The extent of endoscopic capacity in LMICS and in sub-Saharan Africa, especially in countries like Nigeria, remains largely unknown.

We conducted a qualitative needs assessment study, interviewing 32 physician endoscopists representing 36 states in Nigeria and Federal Capital Territory Abuja regarding endoscopy capacity and recommendations on mitigating barriers to endoscopy services. They provided information on endoscopy facilities, the healthcare workforce, costs, volume, and clinical practices. Geographic Information System mapping was used to estimate travel time to the nearest endoscopy facility.

There are 198 available facilities for endoscopy services. Facilities were private (138) and public (60); functional (170), partially functional (7), nonfunctional (19), and 2 had unknown functionality. There are 207 physicians performing endoscopies with a range of 2-75 upper endoscopies and 1-60 colonoscopies performed monthly. Physicians believe barriers to endoscopy include lack of community awareness, insufficient referral systems, and costs. A scarcity of a trained workforce, limited access to equipment, and the inability to repair damaged endoscopes locally have led to difficulty in performing endoscopies.

Endoscopy is feasible in Nigeria, yet capacity and procedural volume are low. Nigerian physicians recommend implementing awareness campaigns to community members and primary care physicians on the symptoms of GI disease, standardize training, and build facilities to repair scopes locally. While endoscopic capacity is limited in Nigeria, we offer solutions, and these strategies can be adopted in other resource-limited countries globally.