The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews

Gaby I Ooms; Mohammed A Usman; Tim Reed; Hendrika A van den Ham; Aukje K Mantel-Teeuwisse

doi:10.1186/s12913-024-11040-w

The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews

BMC Health Serv Res. 2024 May 7;24(1):598. doi: 10.1186/s12913-024-11040-w.

Authors

Gaby I Ooms^{1

2}, Mohammed A Usman^{3

4}, Tim Reed⁵, Hendrika A van den Ham⁶, Aukje K Mantel-Teeuwisse⁶

Affiliations

¹ Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands. gaby@haiweb.org.
² Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands. gaby@haiweb.org.
³ Federal University of Dutse, Dutse, Jigawa State, Nigeria.
⁴ Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria.
⁵ Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands.
⁶ Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.

Abstract

Background: Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled.

Methods: This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach.

Results: The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants.

Conclusion: Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.

Keywords: Access; Anaesthesia care; Drug policy; Ketamine; Sub-saharan Africa.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Africa South of the Sahara
Anesthesia / methods
Anesthetics, Dissociative / administration & dosage
Controlled Substances
Cross-Sectional Studies
Health Services Accessibility
Humans
Interviews as Topic
Ketamine*
Qualitative Research
Rwanda

Substances

Ketamine
Anesthetics, Dissociative
Controlled Substances