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Anaesthetic research in low‐ and middle‐income countries’

Last post 30 Jan 2019, 11:35 AM by Priya Ranganathan. 0 replies.
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  •  30 Jan 2019, 11:35 AM 2725

    Anaesthetic research in low‐ and middle‐income countries’

    In their editorial on ‘Anaesthetic research in low‐ and middle‐income countries’, Bashford and Vercueil make a strong case for fostering research in low- and middle-income countries (LMICs). The authors have summarized the human, financial and institutional barriers to research in these countries [1]

    Data from the World Federation of Societies of Anaesthesiologists (WFSA) shows that against the recommended workforce of 20 specialist anaesthesia providers per 100,000 population, the density can be less than 3 per 100,000 in many low‐ and middle‐income countries (LMICs) [2,3]. Even this meagre taskforce is not uniformly distributed, but is concentrated in pockets. Obviously, with these staggering clinical workloads, research does not take priority.

    The paradox here is that these same countries which are unable to carry out research are the ones who need them the most. Studies carried out in high-and-middle income countries (HMICs) may have questions which are not pertinent, interventions which are not affordable and results which are not applicable in resource-constrained situations. LMICs need to invest in research which is locally relevant, and can identify innovative cost-effective solutions to improve the quality and outcomes of anaesthesia in their settings.

    Bashford and Vercueil have identified several methods in which international societies and journals can encourage research in LMICs [1]. In addition, it is important to remember that with the lack of funding and research infrastructure, resource-intensive clinical trials may not be feasible. A well-performed observational study can provide important information and must be considered as an appropriate alternative. Also, standards of care differ between LMICs and HMICs and we must accept that a comparator arm which may be considered ‘unethical’ in a HMIC may well be the current standard of care in a LMIC.

    P. Ranganathan

    Tata Memorial Hospital

    Mumbai, India.

    Email: drpriyaranganathan@gmail.com


    No external funding and no conflicts of interest declared.



    1. Bashford T, Vercueil A. Anaesthetic research in low- and middle-income countries. Anaesthesia 2019; 74: 143-6.
    2. Meara JG, Greenberg SL. The Lancet Commission on Global surgery 2030: Evidence and solutions for achieving health, welfare and economic development. Surgery 2015; 157: 834-5.
    3. Kempthorne P, Morriss WW, Mellin-Olsen J, Gore-Booth J. The WFSA Global Anesthesia workforce survey. Anesthesia and Analgesia 2017; 125: 981-90.
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