Pre-operative management of acute typhoid peritonitis in a resource-limited setting: a qualitative study on the experience and autonomy of anaesthesia and resuscitation technicians in Matadi (DRC)

Abstract

Introduction: Acute diffuse peritonitis (ADP) is a medical and surgical emergency associated with high morbidity and mortality in resource-limited settings. In Matadi, Anaesthesia and Resuscitation Technicians (ARTs) are responsible for pre-operative preparation (POP), often without specialist doctors or adequate equipment. This study aimed to explore their practices and the constraints influencing the POP of patients with ADP.

Methods. This descriptive qualitative study was conducted in three general referral hospitals located in the city of Matadi (DRC). Purposive sampling was used to select ARTs who had recent experience of pre-operative preparation (POP). Empirical data saturation, achieved during the 8th interview, was corroborated by conducting three additional interviews within a restricted target population of 15 inpatients, excluding two who were on leave, resulting in an effective recruitment pool of 13 inpatients. The data, collected through semi-structured interviews based on the Theory of Planned Behaviour, were subjected to a thematic analysis incorporating dual coding and a verification procedure with the participants.

Results. Eight participants (5 women) with between 3 and 27 years’ experience described patients admitted in a state of septic shock and advanced malnutrition. Resuscitation relied exclusively on crystalloids administered ‘ad libitum’, guided by rudimentary clinical monitoring (blood pressure measured with a cuff, skin fold thickness, urine output, level of consciousness). Faced with shortages and financial constraints, the TARs develop coping strategies (‘resourcefulness’, personal donations) whilst exercising quasi-medical decision-making autonomy, which generates stress and ethical distress.

Conclusion. Pre-operative preparation (POP) for patients with acute diffuse peritonitis (ADP) of typhoid origin in Matadi is compromised by systemic constraints that the ingenuity of Anaesthesia and Resuscitation Technicians (ARTs) cannot compensate for in the long term; consequently, this situation warrants the development of context-specific protocols as well as urgent provision of emergency kits.

Keywords: Typhoid peritonitis; pre-operative preparation; Anaesthesia and Resuscitation Technician; limited resources; DRC.

Received Date: June 19, 2026

Accepted Date: July 10, 2026

Published Date: August 01, 2026

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/858