Characterizing Baseline Prevalence and Causes of Complications of Tracheostomy and Gastrostomy Tubes Among Cancer Patients at Muhimbili National Hospital in Tanzania

PURPOSE Tracheostomy and gastrostomy tube interventions are common procedures for patients with head and neck and esophageal cancer, which are both highly prevalent at Muhimbili National Hospital (MNH), the largest referral hospital in Tanzania. Reported complications lead to unplanned hospital readmissions and increased disease burden, negatively impacting patient outcomes. While there are described approaches to quality improvement for complications in these procedures, these have mostly been in high-income countries. We aimed to study patients at MNH in Tanzania to tailor interventions to low-middle-income country (LMIC) settings. This project is part of the pre-intervention phase of a longitudinal multifaceted implementation science study with the MNH Global Cancer Program. METHODS Two patient surveys aimed to study indications for, and complications of tracheostomy and gastrostomy tubes were created. The surveys, created in English but translated to the local language Swahili, inform on the patient's social drivers of health, clinical characteristics, caregiver support, complication and readmission rates, and quality of life. Survey administration was piloted and optimized for data entry to REDCap while minimizing clinical burden in a resource-constrained healthcare system. An automated study tracker was also created to facilitate follow-up for the enrolled patients. RESULTS The surveys enable the collection of important patient data that will ultimately determine the direction of the multifaceted intervention to address complication rates with tracheostomy and gastrostomy tube care at MNH in Tanzania. These surveys, the REDCap database, and the study tracker were all created in a context-appropriate manner to promote independent sustainability of data collection and maintenance for the team at MNH. Additionally, stakeholder meetings were held with the General Surgery and Otolaryngology Departments to ensure partnership with the healthcare teams at MNH. These highlighted important areas to refine the proposed interventions to fit the local context. Data collection has begun and is expected to continue in the coming months. CONCLUSION This project, to our knowledge, will be the first to apply an implementation science framework to adopt quality improvement strategies for tracheostomy and gastrostomy tube care in an LMIC setting. The tools developed and this multifaceted approach can be adopted regionally and by other LMICs.