1
|
Shool S, Piri SM, Ghodsi Z, Tabrizi R, Amirzade-Iranaq MH, Mashayekhi M, Dabbagh Ohadi MA, Mojtabavi K, Abbasnezhad R, Vasighi K, Atlasi R, Ansari-Moghaddam A, Taghi Heydari S, Sharif-Alhoseini M, Shafieian M, O'Reilly G, Rahimi-Movaghar V. The prevalence of helmet use in motorcyclists around the world: a systematic review and meta-analysis of 5,006,476 participants. Int J Inj Contr Saf Promot 2024; 31:431-469. [PMID: 38628097 DOI: 10.1080/17457300.2024.2335509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/13/2024] [Accepted: 03/23/2024] [Indexed: 08/25/2024]
Abstract
Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden.
Collapse
Affiliation(s)
- Sina Shool
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Tabrizi
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Hosein Amirzade-Iranaq
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Universal Network of Interdisciplinary Research in Oral and Maxillofacial Surgery (UNIROMS), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mahdieh Mashayekhi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kurosh Mojtabavi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhane Abbasnezhad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Vasighi
- Department of Occupational Therapy, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Rasha Atlasi
- Evidence based Practice Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Gerard O'Reilly
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
- National Trauma and Research Institute, Alfred Health, Melbourne, Australia
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| |
Collapse
|
2
|
Anand A, Ajayi AO, Ansari A, Mustapha MJ, Verma A, Adinoyi SA, Uthman U, Usman A, Mofatteh M, Khatib MN, Zahiruddin QS, Gaidhane S, Sharma RK, Rustagi S, Satapathy P, Ajibade AA, Oluwamayowa O, Obanife HO, Ahmad KI, Ogunleye OO. Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review. World Neurosurg 2024; 189:108-117. [PMID: 38851629 DOI: 10.1016/j.wneu.2024.05.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.
Collapse
Affiliation(s)
- Ayush Anand
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal; MediSurg Research, Darbhanga, India; Global Consortium of Medical Education and Research, Pune, India
| | | | - Ayesha Ansari
- Global Consortium of Medical Education and Research, Pune, India; Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), India
| | | | - Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | | | | | - Abubakar Usman
- Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Division of Evidence Synthesis, South Asia Infant Feeding Research Network (SAIFRN), Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Rakesh Kumar Sharma
- Graphic Era (Deemed to be University), Dehradun, India; Graphic Era Hill University, Dehradun, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Iraq
| | | | | | | | | | | |
Collapse
|
3
|
Ukachukwu AEK, Nischal SA, Trillo-Ordonez Y, Nwaribe EE, Abu-Bonsrah N, Malomo TA, Oyemolade TA, Badejo OA, Deng DD, Still MEH, Oboh EC, Okere OE, Asemota I, Oboh EN, Ogundeji OD, Ugorji C, Rahman R, Reddy P, Seas A, Waguia-Kouam R, von Isenburg M, Fuller AT, Haglund MM, Adeleye AO. Epidemiological Burden of Neurotrauma in Nigeria: A Systematic Review and Pooled Analysis of 45,763 Patients. World Neurosurg 2024; 185:e99-e142. [PMID: 38741332 DOI: 10.1016/j.wneu.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE Neurotrauma is a significant cause of morbidity and mortality in Nigeria. We conducted this systematic review to generate nationally generalizable reference data for the country. METHODS Four research databases and gray literature sources were electronically searched. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions and Cochrane's risk of bias tools. Descriptive analysis, narrative synthesis, and statistical analysis (via paired t-tests and χ2 independence tests) were performed on relevant article metrics (α = 0.05). RESULTS We identified a cohort of 45,763 patients from 254 articles. The overall risk of bias was moderate to high. Most articles employed retrospective cohort study designs (37.4%) and were published during the last 2 decades (81.89%). The cohort's average age was 32.5 years (standard deviation, 20.2) with a gender split of ∼3 males per female. Almost 90% of subjects were diagnosed with traumatic brain injury, with road traffic accidents (68.6%) being the greatest cause. Altered consciousness (48.4%) was the most commonly reported clinical feature. Computed tomography (53.5%) was the most commonly used imaging modality, with skull (25.7%) and vertebral fracture (14.1%) being the most common radiological findings for traumatic brain injury and traumatic spinal injury, respectively. Two-thirds of patients were treated nonoperatively. Outcomes were favorable in 63.7% of traumatic brain injury patients, but in only 20.9% of traumatic spinal injury patients. Pressure sores, infection, and motor deficits were the most commonly reported complications in the latter. CONCLUSIONS This systematic review and pooled analysis demonstrate the significant burden of neurotrauma across Nigeria.
Collapse
Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Yesel Trillo-Ordonez
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | | | - Isaac Asemota
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Olaniyi D Ogundeji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Raphia Rahman
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Padmavathi Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
4
|
Usman B, Ajulo A, Abubakar A. Impact of a visiting consultant neurosurgeon: The Nigerian experience. World Neurosurg X 2023; 18:100161. [PMID: 36851941 PMCID: PMC9958471 DOI: 10.1016/j.wnsx.2023.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Objective To study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon. Methods This is a 5-year retrospective study of neurosurgical conditions and their management outcomes by a visiting consultant neurosurgeon in a Nigerian Tertiary institution from January 2016 to December 2020. Results Thousand two hundred and four (1,204) patients were reviewed. Patients' ages were between 1 h and to 86-year-olds, with a mean of 23 years and a mode of 32 ± 4 years. Children were 423 (35.1%), with 781(64.9%) adults. Males were 862 (71.6%), and Females were 342 (28.4%), with a Male to Female ratio of 5:2. Congenital problems were 170 (14.1% of 1204): meningocoeles (38, 22.4%), myelomeningocoeles (61, 35.9%), encephalocoeles (24, 14.1%), anencephaly (6, 3.5%), and hydrocephalus (41, 24.1%). Acquired conditions were 1034 (85.9% of 1204): Head injuries (486, 47%), spinal cord injuries (51, 5%), Pyogenic brain Abscess (3, 0.3%), Pott's disease (2, 0.2%), Hydrocephalus (63, 6.1%), brain tumour (5, 0.5%), degenerative spine (421, 40.7%), vascular (3, 0.3%). Surgery was indicated in 348(28.9%) patients. Two hundred and twenty-six (18.8% of 1204) had surgeries, while 978 (81.2% of 1204) had no surgeries. Referred to other facilities were 122 (10.1%). Overall, surgical intervention was 64.9% (226 of 348), with mortality of 13.5% (18 patients) among those who had surgical interventions. Conclusions In countries with very few medical specialists, particularly neurosurgeons, such a regular visit can impact the care of neurosurgical patients in their environment.
Collapse
Affiliation(s)
- B. Usman
- Neurosurgery Unit, Surgery Department, University of Maiduguri Teaching Hospital and the University of Maiduguri, Borno State, Nigeria
- Visiting Neurosurgeon to the Surgery Department, Federal Medical Centre Yola, Adamawa State, Nigeria
| | - A. Ajulo
- Surgery Department, Federal Medical Centre Yola, Adamawa State, Nigeria
| | - A.M. Abubakar
- Surgery Department, Federal Medical Centre Yola, Adamawa State, Nigeria
| |
Collapse
|
5
|
Barki MT, Filza F, Khattak AF, Khalid OB, Qazi M, Gilani H, Ayub S, Farooq M. A Survey of Traumatic Brain Injuries from Road Traffic Collisions in a Lower Middle-Income Country. Cureus 2023; 15:e36892. [PMID: 37128537 PMCID: PMC10147992 DOI: 10.7759/cureus.36892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/03/2023] Open
Abstract
The burden of traumatic brain injury (TBI) from road traffic collisions (RTCs) is great in low-and middle-income countries (LMICs) due to shortfalls in preventative measures, and the lack of relevant, accurate data collection. To address this gap, we sought to study the epidemiology of TBI from RTCs in two LMIC neurosurgical centres in order to identify factors amenable to preventative strategies. A prospective survey of all adult and paediatric cases of TBI from RTCs admitted to Northwest General Hospital (NWGH) and Hayatabad Medical Complex (HMC) over a four-week period was carried out. Data on patient demographics, risk factors, injury details, pre-hospitalisation details, admission details and post-acute care was collected and analysed. A total of 68 patients were included in the study. 18 (26%) of the patients were male and in the 30 to 39 age group. Fifty-two percent were two-wheeler riders and/or passengers. 51 (75%) of the RTCs occurred between 12 noon and 12 midnight and in rural areas (66.2%). The most commonly documented risk factor that led to the RTC was speeding (35.3%). Pre-hospital care was either absent or undocumented. Up to two-thirds of patients were not direct transfers, and most were transported in private vehicles (48.5%) arriving later than an hour after injury (94.1%). Less than half with documented disabilities were referred for rehabilitation (38.5%). There are still gaps in the prevention of TBI from RTCs and in relevant data collection. Data collection systems must be strengthened, and further exploratory research carried out in order to improve the prevention of TBI from RTCs.
Collapse
Affiliation(s)
| | - Faiqa Filza
- Neurosurgery, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | - Osama Bin Khalid
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Humaira Gilani
- Dermatology, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Shahid Ayub
- Neurosurgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
- Neurosurgery, Khyber Girls Medical College, Peshawar, PAK
| | - Muhammad Farooq
- Neurosurgery, Afridi Medical Complex and Teaching Hospital, Peshawar, PAK
| |
Collapse
|
6
|
Oyemolade TA, Adeleye AO, Ehinola BA, Olusola AJ, Ekanem IN, Adesola DJ. Neurotrauma: a burgeoning, yet understudied disease of rural areas in developing countries. J Neurosurg 2022; 138:1069-1076. [PMID: 36057116 DOI: 10.3171/2022.7.jns22996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a paucity of data-driven reports on neurotrauma from the rural areas of developing countries, despite a disproportionally higher and burgeoning disease burden from those areas. This study aims to define the burden of neurotrauma in a new rural neurosurgical practice of a developing sub-Saharan country in Africa (Nigeria). METHODS The authors conducted a prospective observational study of all neurotrauma patients managed at their center over a 36-month period beginning in August 2018. RESULTS There were 1067 patients, 816 (76.5%) of them male, accounting for 79% of all the neurosurgical patients seen at the authors' center during the study period. The peak incidence of neurotrauma was in the 20- to 29-year age group. The median trauma duration was 9 hours before presentation. The neurotrauma involved only head injury (HI) in 78% of the patients and only the spine in 4%. HIs were predominantly mild in severity (79%). Spinal cord injuries were largely incomplete (86%) and cervical in location (72%). Road traffic accidents caused approximately 79% (845/1067) of this neurotrauma burden, mostly from motorcycle crashes (69%, 581/845). Fifty-three patients (5%) were managed surgically. The median time from trauma to surgery for the operated patients was 82 hours. Treatment outcome was good in 81.2% of the patients. CONCLUSIONS Neurotrauma, mostly caused by motorcycle crashes and other road accidents, accounts for the bulk of the neurosurgical workload in this rural neurosurgical center. Although late presentation and delayed surgical interventions were prominent features of this level of care, the in-hospital outcome was fortuitously good in the majority of patients.
Collapse
Affiliation(s)
- Toyin A Oyemolade
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Amos O Adeleye
- 2Department of Neurological Surgery, University College Hospital, Ibadan, Oyo State.,3Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Oyo State; and
| | - Busayo A Ehinola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Ayodele J Olusola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Inwonoabasi N Ekanem
- 4Department of Accident and Emergency, Federal Medical Center, Owo, Ondo State, Nigeria
| | - Damilola J Adesola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| |
Collapse
|
7
|
Oyemolade TA, Adeleye AO, Olusola AJ, Ehinola BA, Aikhomu EP, Iroko AA. Burden of pediatric neurosurgical disease in a rural developing country: perspectives from southwest Nigeria. J Neurosurg Pediatr 2022; 29:162-167. [PMID: 34678780 DOI: 10.3171/2021.6.peds21179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The proportion of the global burden of neurosurgical disease represented by pediatric neurosurgical pathology is unknown, especially in lower-middle income countries (LMICs) where there exists no known data-driven literature on the subject. In this study, the authors aimed to quantify the pediatric neurosurgical disease profile in a rural area of a developing country. METHODS This was a prospective observational study of all pediatric neurosurgical patients managed at a single center over a 30-month period. RESULTS Overall, 226 pediatric patients were included in the study (150 males and 76 females, male/female ratio 2:1), accounting for 20.4% of the total patient population during the study period. The modal age distribution was the 0- to 4-year-old group (32.3%), and head injury was the most common presentation, occurring alone in 157 patients (69.5%). Hydrocephalus alone was seen in 21 patients (9.3%) and in combination with myelomeningocele in 4 patients (1.8%). Brain tumors were found in 6 patients (2.7%), infective lesions in 6 patients (2.7%), and encephaloceles in 2 patients (0.9%). The treatment outcome was good in 170 patients (75.2%). Fourteen patients (6.2%) were referred to more advanced health facilities for specialized care; 29 patients (12.8%) were discharged against medical advice, mostly because of financial constraints; and 8 patients (3.5%) died. Several surgical cases could not be performed because of sundry logistical constraints. CONCLUSIONS Pediatric neurosurgical disease accounted for one-fifth of the neurosurgical workload at a tertiary health facility in southwest Nigeria. Trauma was the most common presentation, and optimal in-hospital treatment, including surgery, was hampered by severe logistical constraints in a significant proportion of the cases.
Collapse
Affiliation(s)
- Toyin A Oyemolade
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Amos O Adeleye
- 2Department of Neurological Surgery, University College Hospital, Ibadan, Oyo State; and
- 3Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ayodele J Olusola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Busayo A Ehinola
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Ebosetale P Aikhomu
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| | - Anita A Iroko
- 1Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Ondo State
| |
Collapse
|
8
|
Oyemolade TA, Balogun JA, Akinkunmi MA, Ogunyileka OC, Arogundade FM, Olusola AJ. The Burden of Neurosurgical Diseases in a Rural Southwestern Nigeria Setting. World Neurosurg 2020; 140:e148-e152. [PMID: 32387403 DOI: 10.1016/j.wneu.2020.04.205] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most of the few neurosurgeons in Nigeria are clustered in the urban centers. Consequently, a large proportion of the population who live in the rural areas have no direct access to neurosurgical care. This study aims to describe the burden of neurosurgical diseases in a rural neurosurgical service in Nigeria. METHODS This was a prospective observational study of all neurosurgical patients managed at our center between August 2018 and July 2019. Data were analyzed with SPSS version 20 (IBM, Armonk, New York, USA). RESULTS The study cohort comprised 379 patients, including 267 males and 112 females (male:female ratio 2.4:1). The mean age was 35.71 ± 20.08 years (range, 35 hours to 100 years). More than one-half of the patients (55.6%) were age 20-49 years. Head injury was the most common presentation, occurring alone in 256 patients (67.55%) and in combination with spinal cord injury in 30 patients (7.92%). Brain tumors were present in 19 patients (5.01%), spinal cord injury in 15 patients (3.96%), degenerative spine disease in 9 patients (2.38%), and hydrocephalus in 5 patients (1.32%). Surgical intervention was performed in 21 patients (5.54%). The outcome of treatment was good in 251 patients (66.22%); 34 patients (8.97%) were referred to other facilities, 43 patients (11.35%) were discharged against medical advice, mostly because of economic reasons and poor medical insight, and 31 patients (8.18%) died. CONCLUSIONS Trauma is the most common indication for neurosurgical care in our service. Poverty and poor medical insight remain formidable obstacles to maximizing the benefits of available neurosurgical care in developing countries.
Collapse
Affiliation(s)
- Toyin Ayofe Oyemolade
- Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Nigeria.
| | - James Ayokunle Balogun
- Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan and Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | | | | | | | - Ayodele Joy Olusola
- Division of Neurosurgery, Department of Surgery, Federal Medical Center, Owo, Nigeria
| |
Collapse
|
9
|
Abstract
Background: Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria. Objectives: This report details our initial experiences and the profile of neurosurgical admissions in our center. Methods: A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed. Results: A total of 249 males (75.2%) and 82 females (24.8%) were managed. The median age was 37 years (range: Day of birth – 94 years). Trauma was the leading cause of presentation with 225 (68.0%) and 35 (10.6%) having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%). Twenty-four (7.2%) patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4%) had satisfactory outcome while 30 (9.1%) died. Conclusion: Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities.
Collapse
Affiliation(s)
- Taopheeq Bamidele Rabiu
- Department of Surgery, Division of Neurological Surgery, Federal Medical Centre, Ido-Ekiti, Nigeria; Department of Surgery, Division of Neurological Surgery, Lautech Teaching Hospital, Osogbo, Nigeria
| | - Edward Oluwole Komolafe
- Department of Surgery, Division of Neurological Surgery, Federal Medical Centre, Ido-Ekiti, Nigeria; Department of Surgery, Division of Neurological Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
10
|
Balhara KS, Bustamante ND, Selvam A, Winders WT, Coker A, Trehan I, Becker TK, Levine AC. Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions. PREHOSP EMERG CARE 2018; 23:389-410. [PMID: 30141702 DOI: 10.1080/10903127.2018.1513104] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Lack of organized prehospital care may contribute to the disproportionate burden of trauma-related deaths in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends bystander training in basic principles of first aid and victim transport; however, prevalence of bystander or layperson assistance to trauma victims in LMICs has not been well-described, and organized reviews of existing evidence for bystander training are lacking. This systematic review aims to 1) describe the prevalence of bystander or layperson aid or transport for trauma victims in the prehospital setting in LMICs and 2) ascertain impacts of bystander training interventions in these settings. METHODS A systematic search of OVID Medline, Cochrane Library, and relevant gray literature was conducted. We included 1) all studies detailing prevalence of bystander-administered aid or transport for trauma victims in LMICs and 2) all randomized controlled trials and observational studies evaluating bystander training interventions. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS Sixty-two studies detailed prevalence of bystander transport and aid. Family members, police, and bus or taxi drivers commonly transported patients; a majority of patients, up to >94%, received aid from bystanders. Twenty-four studies examined impacts of training interventions. Only one study looked at transport interventions; the remainder addressed first aid training. Interventions varied in content, duration, and target learners. Evidence was generally of low quality, but all studies demonstrated improvements in layperson knowledge and skills. Five studies reported a mortality reduction. CONCLUSIONS Heterogeneity in data reporting and outcomes limited formal meta-analysis. However, this review shows high rates of bystander involvement in prehospital trauma care and transport in LMICs and highlights the need for bystander training. Bystander training in these settings is feasible and may have an important impact on meaningful outcomes such as mortality. Categories of involved bystanders varied by region and training interventions should be targeted at relevant groups. "Train the trainer" models appear promising in securing community engagement and maximizing participation. Further research is needed to examine the value of bystander transport networks in trauma.
Collapse
|
11
|
Mehmood A, Zia N, Hoe C, Kobusingye O, Ssenyojo H, Hyder AA. Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes. BMC Res Notes 2018; 11:299. [PMID: 29764476 PMCID: PMC5952367 DOI: 10.1186/s13104-018-3419-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/09/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Lack of data on traumatic brain injuries (TBI) hinders the appreciation of the true magnitude of the TBI burden. This paper describes a scientific approach for hospital based systematic data collection in a low-income country. The registry is based on the evaluation framework for injury surveillance systems which comprises a four-step approach: (1) identifying characteristics that assess a surveillance system, (2) review of the identified variables based on adopted specific, measurable, assignable, realistic, and time-related criteria, (3) assessment of the proposed variables and system characteristics by an expert panel, and (4) development and application of a rating system. Results The electronic hospital-based TBI registry is designed through a collaborative approach to capture comprehensive, yet context specific, information on each TBI case, from the time of injury until death or discharge from the hospital. It includes patients’ demographics, pre-hospital and hospital assessment and care, TBI causes, injury severity, and patient outcomes. The registry in Uganda will open the opportunity to replicate the process in other similar context and contribute to a better understanding of TBI in these settings, and feed into the global agenda of reducing deaths and disabilities from TBI in low-and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s13104-018-3419-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Connie Hoe
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
12
|
Adeleye AO, Ogun MI. Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era. Front Neurol 2017; 8:695. [PMID: 29326652 PMCID: PMC5736536 DOI: 10.3389/fneur.2017.00695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives Africa and other Asian low middle-income countries account for the greatest burden of the global road-traffic injury (RTI)-related head injury (HI). This study set out to describe the incidence, causation, and severity of RTI-related HI and associated injuries in a Nigerian academic neurosurgical practice. Methods This is a retrospective cross-sectional analysis of RTI-related HI from a prospective HI registry in an academic neurosurgery practice in Nigeria. Results All-terrain RTI accounted for 80.6% (833/1,034) of HI over a 7-year study period. All age groups were involved, mean 33.06 years (SD 18.30), mode 21–30, 231/833 (27.7%). The male:female ratio was 631:202, ≈3:1. The road trauma occurred exclusively from motorcycle-and motor-vehicle crash (MCC/MVC), MCC caused 56.8% (473/833) of these; the victims were vulnerable road users (VRU) in 74%, and >90% belong in the low socioeconomic class. Using the Glasgow Coma Scale grading, the HI was moderate/severe in 52%; loss of consciousness occurred in 93%, the Abbreviated Injury Severity-head > 3 in 74%, and computed tomography (CT) Rotterdam score > 3 in 52%. Significant extracranial injuries occurred in many organ systems, 421/833 (50.5%) having Injury Severity Score (ISS) > 25. Surgical lesions included extensive brain contusions in 157 (18.8%); acute extradural hematoma in 34 (4.1%); acute subdural hematoma in 32 (3.8%); and traumatic intracerebral hemorrhage in 27 (3.2%), but only 97 (11.6%) received operative care for various logistic reasons. The in-hospital outcome was good in 71.3% and poor in 28.7%; the statistically significant (p < 0.001) determinants of this outcome profile were the severity of the HI, the CT Rotterdam score, and the ISS. Conclusion In this study from Nigeria, RTI-related HI emanates from significant trauma to vulnerable road users and are caused exclusively by motorcycles and motor vehicles.
Collapse
Affiliation(s)
- Amos O Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Neurological Surgery, University College Hospital (UCH), Ibadan, Nigeria
| | - Millicent I Ogun
- Clinical Nursing Department, University College Hospital (UCH), Ibadan, Nigeria
| |
Collapse
|
13
|
Vissoci JRN, Shogilev DJ, Krebs E, de Andrade L, Vieira IF, Toomey N, Batilana AP, Haglund M, Staton CA. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. TRAFFIC INJURY PREVENTION 2017; 18:767-773. [PMID: 28448753 PMCID: PMC6350910 DOI: 10.1080/15389588.2017.1314470] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate, through a systematic review of hospital-based studies, the proportion of road traffic injuries and fatalities in sub-Saharan Africa (SSA). METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology guidelines, we searched the following electronic databases: PubMed, Embase, Africa-Wide Information, Global Health, and Web of Science. Articles were eligible if they measured proportion of road traffic injuries (RTIs) in SSA by using hospital-based studies. In addition, a reference and citation analysis was conducted as well as a data quality assessment. RESULTS Up to 2015, there were a total of 83 hospital-based epidemiologic studies, including 310,660 trauma patients and 99,751 RTI cases, in 13 SSA countries. The median proportion of RTIs among trauma patients was 32% (4 to 91%), of which the median proportion of death for the included articles was 5% (0.3 to 41%). CONCLUSION The number of studies evaluating RTI proportions and fatalities in SSA countries is increasing but without the exponential rise expected from World Health Organization calls for research during the Decade of Action for Road Traffic Injuries. Further research infrastructure including standardization of taxonomy, definitions, and data reporting measures, as well as funding, would allow for improved cross-country comparisons.
Collapse
Affiliation(s)
- João Ricardo N. Vissoci
- Division of Emergency Medicine, Department of Surgery, Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham USA,
| | | | | | | | | | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, USA,
| | | | - Michael Haglund
- Duke School of Medicine, Duke Global Health Institute, Duke University, Durham USA,
| | | |
Collapse
|
14
|
Folkerth RD, Zaharie D, Adesina AM. The Practice of Neuropathology in Africa: Our Time Has Come. J Neuropathol Exp Neurol 2016; 75:1005-1007. [PMID: 31952373 DOI: 10.1093/jnen/nlw086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rebecca D Folkerth
- Brigham and Women's Hospital Boston Children's Hospital and Harvard Medical School Boston, MA
| | - Dan Zaharie
- Department of Anatomical Pathology Tygerberg Hospital and University of Stellenbosch Western Province, Tygerberg, Republic of South Africa
| | | |
Collapse
|
15
|
Idowu OE, Akinbo O. Neurotrauma burden in a tropical urban conurbation level I trauma centre. Injury 2014; 45:1717-21. [PMID: 25034962 DOI: 10.1016/j.injury.2014.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/07/2014] [Accepted: 05/22/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neurotrauma is a preventable public health problem whose quantum is said to be increasing in Third-World countries. This evaluation was performed to collate data which is needed to guide in designing, implementing, and evaluating public health prevention programmes with respect to neurotrauma. METHODS A single institution prospective study was carried out. Data was collected at the surgical emergency (SE) room over a year period (1st October 2012-30th September 2013). These included patients' demographics, cause of injury, region of the body involved, Glasgow coma scale score, and outcome. The patients were further divided into patients with traumatic brain (TBI) and spine injury (TSI). Analysis of the variables was by simple proportion, percentages, Chi-square and analysis of variance was used to determine the differences between group means. A probability (p) of less than 0.05 was considered statistically significant. RESULTS A total of 2149 neurotrauma cases (38.8%) out of a total of 5541 surgical trauma cases were seen within the study period at our SE unit. Of the neurotrauma cases, 1621 were males, giving a male:female ratio of 3.1:1. The mean age was 31 years (median 30 years). The most common age group was 20-29 (29.6%) and 30-39 years (29.6%). Assault was the cause of neurotrauma in 903 patients (42%), closely followed by road traffic injury in 744 patients (34.6%). Brain and spine injury separately occurred in 93.2% and 5.3% of cases, respectively. Five hundred patients (23.3%) were resuscitated and referred to other centres due to lack of bed space. Forty (1.9%) patients were dead on arrival, while twenty-six (1.2%) died while on treatment at the emergency room. CONCLUSION Neurotrauma is one of the most common form of trauma at our surgical emergency. Assault and road traffic injury (RTI) were the most common cause of TBI and TSI respectively, with RTI being the most common cause of moderate and severe TBI. The incidence and aetiology of TBI varies according to age and gender.
Collapse
Affiliation(s)
- O E Idowu
- Neurosurgery Division, Department of Surgery, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria; Neurosurgery Division, Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
| | - O Akinbo
- Neurosurgery Division, Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| |
Collapse
|