Pratique de l'anesthésie chez l'enfant en Afrique francophone subsaharienne. État des lieux et perspectives d'amélioration

We describe the practice of anaesthesia in children in sub-Saharan French-speaking Africa. With a ratio of 1.5 anaesthetists by million of inhabitants, the demography of anaesthetists in the region is hundred times lower than that observed in France. Only 10 anaesthetists out of the 368 registered have had a specific clinical training of more than six months in paediatric anaesthesia and only 7 obtained a university degree in paediatric anaesthesia. Most of the children are operated in hospitals dedicated to adult patients and having neither a specific department of paediatric surgery nor a specific department of paediatric anaesthesia and intensive care. General anaesthesia is the most frequent technique using inhalational induction with halothane. The use of regional anaesthesia is rare and consists essentially in spinal anaesthesia. This anaesthetic practice carries an unacceptably high level of severe perioperative morbidity and increased mortality in children. We encourage specific training courses in paediatric anaesthesia for physician and nurse anaesthetists taking care of children. Moreover, the development of paediatric hospitals with specific surgical anaesthetic activities will improve the competence of anaesthetists and security of anaesthetized children through an exclusive and regular practice of paediatric anaesthesia.