Stoma care research in low- and middle-income countries: update from the NIHR global health research unit on global surgery.

Dear Editor

We read the letter from Schaps and Alvarez with interest, and thank them for their important insights. Literature around global practices in stoma formation is limited, and their work in El Salvador represents an important contribution to understanding of potential differences in training and practice.

As highlighted by the Patient Viewpoint from Ms Azmina Verjee published alongside our BJS Open analysis, stoma care represents a significant challenge to many patients in low–middle income countries (LMICs), with limited access to stoma appliances, sanitation, and support from specialists. Although stomas often represent a lifesaving or life-improving intervention, technical care at the point of stoma formation and equitable access to stoma-care supplies and supporting services are essential to safe and high-quality global surgical care.

To extend understanding of this prioritized topic, the National Institute for Health Research Global Health Unit on Global Surgery has been undertaking multicountry work led from network leaders in the Philippines. The SToma cARe For Improvement reSearcH (STARFISH) study is using mixed-methodology research to explore another potential area of disparity between high-income countries and LMICs: the support that patients with a stoma receive, the challenges they experience, and their access to services and supplies to care for their stoma.

STARFISH has three major objectives: to describe rates of early stoma-related complications in an international retrospective cohort study; to explore the experiences, priorities, challenges, and coping strategies for people with stomas in LMICs; and to co-develop a patient-reported questionnaire with patients from LMICs to inform future research and quality improvement efforts. Community engagement and involvement (CEI) methods have been used to co-design the study protocol, interview topic schedule, and interpretation of results, ensuring that patients’ interests are represented at the heart of research delivery. This global CEI case is available at https://globalsurg.org/community-engagement-involvement/cei-starfish-case-study/.

We hope that STARFISH will go some way to enriching understanding of stoma quality and patient experience in a global setting.

Disclosure. The authors declare no conflict of interest.