Otolaryngology burden of disease and surgical case triage in resource‐limited settings: An example from Cameroon

Windon, Melina J.; Faniriko, Marco B. A.; Bogale, Mesele; Acha, Everistus; Koch, Wayne

OBJECTIVES: Otolaryngology services worldwide faced an unprecedented demand for case triage during the SARS‐CoV‐2 pandemic. We propose and apply a novel case‐leveling schema in a resource‐limited setting. Describing the surgical burden of otolaryngologic disease in this setting may critically inform resource planning to address global surgical disparities. METHODS: This is a retrospective study of otolaryngology cases performed over a 28‐month period (1/2016‐4/2018) at a hospital in rural Cameroon. Case details were collated and categorized as a surrogate measure of otolaryngologic disease in resource‐limited settings. A case‐levelling schema based on temporal urgency and anticipated impact on health was proposed and applied. RESULTS: 1277 cases took place during the study. The largest proportion of cases were head and neck (517, 40%), followed by pediatrics (316, 25%). A four‐tiered leveling system was generated: level 1 cases were immediately life‐saving; level 2 cases were expected to result in a significant return to functions of daily living, or would prevent future death from cancer; level 3 cases aimed to significantly improve quality of life; level 4 cases were purely elective. Upon application of the schema, most cases were deemed to be level 2 (661, 52%). CONCLUSION: We use our experience in a resource‐limited setting to generate and apply a novel schema to be used for otolaryngology case triage in services facing unprecedented states of emergency such as the SARS‐CoV‐2 pandemic. This is the first study describing the surgical otolaryngologic disease burden in a resource‐limited setting, data which may be used for future resource allocation. LEVEL OF EVIDENCE: 4.