Assessing Otolaryngology Capacity in Sub-Saharan Africa: Flexible Laryngoscope Availability and Use

Flexible laryngoscopy is an essential tool for diagnosis within otolaryngology yet remains underutilized in many low-and-middle-income countries (LMICs), including those in Sub-Saharan Africa. This study aims to (1) characterize barriers to flexible laryngoscope access and use in Sub-Saharan Africa and (2) assess the perceived utility of the ZimScope, a low-cost, reusable flexible laryngoscope that was designed for such contexts.

We conducted a mixed-methods study involving semistructured video interviews and structured surveys with 13 practicing otolaryngologists and one resident from eight Sub-Saharan African countries. Participants were recruited via snowball sampling. Video interviews were recorded, transcribed, and thematically analyzed. Surveys captured complementary data on equipment availability, procurement challenges, and desired flexible laryngoscope features.

Four central themes emerged: (1) equipment scarcity, (2) financial and procurement barriers, (3) disparities in patient access and practice capacity, and (4) laryngoscope design needs. Many respondents (85.7%) rated their current laryngoscopes as expensive or very expensive, and 64.3% described access to scopes as a major or significant challenge. Public-sector providers reported greater shortages, with 76.9% citing current or past access issues. Additionally, 35.7% reported insufficient training in laryngoscopy, and 50% noted a lack of trained personnel to assist. Preferred device features included improved imaging, greater ergonomics, and portability.

Persistent structural and logistical challenges hinder access to flexible laryngoscopes in Sub-Saharan Africa. Low-cost alternatives like the ZimScope shows promise as a cost-conscious solution, but broader efforts addressing procurement, training, and infrastructure will be key for equitable otolaryngology care delivery.

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