Impact of the COVID-19 pandemic on gastrointestinal endoscopy in Africa
Authors: Alanna Ebigbo, John Gásdal Karstensen, Purnima Bhat, Uche Ijoma, Chukwuemeka Osuagwu, Hailemichael Desalegn, Ganiyat K. Oyeleke, Rezene B. Gebru, Claire Guy, Giulio Antonelli, Peter Vilmann, Lars Aabakken, Cesare Hassan
Background and study aims: As with all other fields of medical practice, gastrointestinal endoscopy has been impacted by the COVID-19 pandemic. However, data on the impact of the pandemic in Africa, especially sub-Saharan Africa are lacking.
Methods: A web-based survey was conducted by the Inter-national Working Group of the European Society for Gastrointestinal Endoscopy and the World Endoscopy Organization to determine the impact and effects the COVID-19pandemic has had on endoscopists in African countries.
Results: Thirty-one gastroenterologists from 14 countries in north, central, and sub-Saharan Africa responded to the survey. The majority of respondents reduced their endoscopy volume considerably. Personal protective equipment including FFP-2 masks were available in almost all participating centers. Pre-endoscopy screening was performed as well.
Conclusion: The COVID-19 pandemic has had a substantial impact on gastrointestinal endoscopy in most African countries; however, the impact may not have been as devastating as expected.
The novel coronavirus disease (COVID-19), which first appeared in Wuhan, China in December 2019, has had a global impact of historically unprecedented scale [1,2]. Medical institutions all over the world have been challenged not only with severely afflicted patients but also with restructuring and reorganization of medical practice to accommodate the influx of patients as well as for reasons of infection protection and control [3,4].
In central and sub-Saharan Africa, disease epidemics have been easily spread and sustained, primarily due to socioeconomic, regulatory, and demographic factors . Weak and poorly resourced health-care systems in African countries have led to concerns about the possible devastating effects that a rapidly spreading Coronavirus could have in these countries [6–8]. At the time of writing, the World Health Organization has reported 83,913 cases of COVID-19 and 2,287 deaths in Africa . Nevertheless, many African countries have made quick and timely efforts to prepare their medical systems for the pandemic . Also, the experience of many African countries with past epidemics, including the Ebola virus disease epidemic of2014, may prove advantageous in the current situation. In addition to this, infrastructure from previous global initiatives in dealing with HIV, malaria, and tuberculosis could also have a positive effect in facing the current pandemic 
As with all other fields of medical practice, the COVID-19 pandemic has impacted gastrointestinal endoscopy, especially with regards to triage and prioritization of patients and procedures, cleaning and disinfection of equipment as well as protection of health care workers (HCW) [11,12]. A survey from northern Italy showed a dramatic burden of the pandemic on endoscopy units . However, data on the effects of the pandemic on gastrointestinal endoscopy in central and sub-Saharan Africa (SSA) are lacking. Possible underreporting of disease burden, unavailability of test kits, and scarcity of personal protective equipment (PPE) may have had a greater impact on endoscopy practice in SSA than in other parts of the world.
In this study, we report the results of an Africa-wide survey of the impact of the COVID-19 pandemic on endoscopy practice in central Africa and SSA. The survey was developed by the International Affairs Working Group (IAWG) of the European Society of Gastrointestinal Endoscopy (ESGE) and the World Endoscopy Organization (WEO) and conducted between the13 and 27 May, 2020.