Addressing gastrointestinal disorders in rural Ethiopia: Success of a weekend outreach colonoscopy service

Abstract

BACKGROUND

Colonoscopy is essential for screening, diagnosing, and treating lower gastrointestinal diseases; however, access is limited in resource-constrained areas. Barriers to endoscopy services include a shortage of trained specialists and inadequate equipment and infrastructure. Most gastroenterologists in Ethiopia work in major cities, leaving the 80% rural population with limited access to endoscopy due to economic and logistical challenges. Such inequitable access negatively impacts optimal patient care and outcomes and potentially skews data on disease prevalence. To address these issues we implemented weekend outreach endoscopy program in Southwest Ethiopia where such services were previously unavailable. Findings were documented electronically and stored safely.

AIM

To evaluate the findings, success, and impact of weekend outreach colonoscopy services in predominantly rural Southwest Ethiopia.

METHODS

In partnership with Jimma Awetu Hospital, a senior gastroenterologist from Addis Ababa University established an outreach endoscopy service in 2019, training local nursing staff as coordinators. Physicians selected and referred patients for colonoscopy, and informed consent was obtained before the procedure. A total of 1612 procedures were performed using a portable Fujinon EPX-2500-HD system, and findings were documented electronically. Data were analyzed using descriptive statistics on Statistical Package for the Social Sciences 29.

RESULTS

From 2019 to 2024 1612 colonoscopy procedures were performed, achieving an 83.0% diagnostic yield. The cohort was predominantly male (70.6%) with a mean age of 44 years; 61% were under 50. Ninety-one percent of patients were referred by 21 hospitals across three regions. Primary indications included abdominal pain (26.8%) and lower gastrointestinal bleeding (25.3%). Abnormal findings included inflammation (39.5%), colorectal masses (13.2%), and hemorrhoid (11.8%). Histology confirmed inflammatory bowel disease in 11.5%, cancers in 11.0%, and polyps in 10.0%. In this study half of colorectal cancer cases occurred in patients under 50 with prevalence rates of 18.8% in females and 10.8% in males, challenging the global trend that shows this disease predominantly affects older individuals and males.

CONCLUSION

This weekend outreach colonoscopy service implemented standard diagnostics, improved the existing service, and generated vital evidence on local disease patterns with the potential to positively impact clinical practice and policy-making.

Keywords: Colonoscopy; Colorectal cancer; Feasibility; Inflammatory bowel disease; Outreach; Resource-limited; Ethiopia

Core Tip: Over the past 6 years, we have performed over 6000 endoscopy procedures at an outreach site in southwest Ethiopia, a region lacking a functional endoscopy unit. Among the 1612 colonoscopy findings, the most common were nonspecific inflammation, colorectal masses, inflammatory bowel disease, and polyps. Notably, half of the colorectal cancer cases in this study occurred in patients under 50 with a prevalence of 18.8% in females and 10.8% in males. This contradicts the global trend in which the disease predominantly affects males and older individuals. Less than 5.0% of all patients underwent colonoscopy for screening or suspected colorectal cancer.