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Mediratta S, Lippa L, Venturini S, Demetriades AK, El-Ouahabi A, Gandía-González ML, Harkness W, Hutchinson P, Park KB, Rabiei K, Rosseau G, Schaller K, Servadei F, Lafuente J, Kolias AG. Current state of global neurosurgery activity amongst European neurosurgeons. J Neurosurg Sci 2024; 68:371-378. [PMID: 35147400 DOI: 10.23736/s0390-5616.21.05447-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The expanding field of global neurosurgery calls for a committed neurosurgical community to advocate for universal access to timely, safe, and affordable neurosurgical care for everyone, everywhere. The aim of this study was to assess the current state of global neurosurgery activity amongst European neurosurgeons and to identify barriers to involvement in global neurosurgery initiatives. METHODS Cross-sectional study through dissemination of a web-based survey, from September 2019 to January 2020, to collect data from European neurosurgeons at various career stages. Descriptive analysis was conducted on respondent data. RESULTS Three hundred and ten neurosurgeons from 40 European countries responded: 53.5% regularly follow global neurosurgery developments, and 29.4% had travelled abroad with a global neurosurgery collaborative, with 23.2% planning a future trip. Respondents from high income European countries predominantly travelled to Africa (41.6%) or Asia (34.4%), whereas respondents from middle income European countries frequently traversed Europe (63.2%) and North America (47.4%). Cost implications (66.5%) were the most common barrier to global neurosurgery activity, followed by interference with current practice (45.8%), family duties (35.2%), difficulties obtaining humanitarian leave (27.7%) and lack of international partners (27.4%). 86.8% would incorporate a global neurosurgery period within training programmes. CONCLUSIONS European neurosurgeons are interested in engaging in global neurosurgery partnerships, and several sustainable programs focused on local capacity building, education and research have been established over the last decade. However, individual and system barriers to engagement persist. We provided insight into these to allow development of tailored mechanisms to overcome such barriers, enabling European neurosurgeons to advocate for the Global Surgery 2030 goals.
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Affiliation(s)
- Saniya Mediratta
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK -
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK -
| | - Laura Lippa
- Department of Neurosurgery, Ospedali Riuniti, Livorno, Italy
| | - Sara Venturini
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | | | | | - Maria L Gandía-González
- Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain
- CranioSPain Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | | | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
| | - Kee B Park
- Harvard Medical School, Department of Global Health and Social Medicine, Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Boston, MA, USA
| | - Katrin Rabiei
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gail Rosseau
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Karl Schaller
- Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Franco Servadei
- IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jesus Lafuente
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
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Laeke T, Kalleklev L, Tirsit A, Moen BE, Lund-Johansen M, Sundstrøm T. Surgical treatment and outcome of chronic subdural hematoma: a comparative study between Ethiopia and Norway. Acta Neurochir (Wien) 2023; 165:49-59. [PMID: 36495322 DOI: 10.1007/s00701-022-05435-z] [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: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Here, we studied differences in demographics, treatment, and outcome for CSDH patients in low-income (Ethiopia) and high-income (Norway) countries and assessed potential outcome determinants. METHODS We included patients from Addis Ababa University Hospitals (AAUH) and Haukeland University Hospital (HUH) who had surgery for CSDH (2013-2017). Patients were included prospectively in Ethiopia and retrospectively in Norway. RESULTS We enrolled 314 patients from AAUH and 284 patients from HUH, with a median age of 60 and 75 years, respectively. Trauma history was more common in AAUH (72%) than in HUH patients (64.1%). More patients at HUH (45.1%) used anticoagulants/antiplatelets than at AAUH (3.2%). Comorbidities were more frequent in HUH (77.5%) than in AAUH patients (30.3%). Burr hole craniostomy under local anesthesia and postoperative drainage was the standard treatment in both countries. Postoperative CT scanning was more common at HUH (99.3%) than at AAUH (5.2%). Reoperations were more frequent at HUH (10.9%) than at AAUH (6.1%), and in both countries, mostly due to hematoma recurrence. Medical complications were more common at HUH (6.7%) than at AAUH (1.3%). The 1-year mortality rate at HUH was 7% and at AAUH 3.5%. At the end of follow-up (> 3 years), the Glasgow Outcome Scale Extended (GOSE) score was 8 in 82.9% of AAUH and 46.8% of HUH patients. CONCLUSION The surgical treatment was similar at AAUH and HUH. The poorer outcome in Norway could largely be explained by age, comorbidity, medication, and complication rates.
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Affiliation(s)
- Tsegazeab Laeke
- Neurosurgery Division, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Line Kalleklev
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Abenezer Tirsit
- Neurosurgery Division, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Center for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Muacevic A, Adler JR, Tadele A, Mesfin FB. A Comparison of Thoracolumbar Injury Classification in Spine Trauma Patients Among Neurosurgeons in East Africa Versus North America. Cureus 2022; 14:e31761. [PMID: 36569733 PMCID: PMC9774996 DOI: 10.7759/cureus.31761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background In January 2021, we published findings evaluating the validity of thoracolumbar injury classification and biomechanical approach in the clinical outcome of operative and non-operative treatments. A notable result in our study was patients with unstable burst fractures received an Arbeitsgemeinschaft für Osteosynthesefragen System (AO) score that recommended conservative treatment compared to a Thoracolumbar Injury Classification and Severity Scale (TLICS) score that recommended surgical intervention. We designed a survey to determine reported differences in thoracolumbar injury classification, including the percentage of thoracolumbar spine fractures, type of classification system(s) used, use of classification system by board-certified neurosurgeons and neurosurgical residents, reliance on classification system to guide management, use of MRI in the evaluation of the posterior ligamentous complex, and readmission rate < 90 days at treating facilities. This study aims to determine which areas of neurosurgical practice in spine trauma patients differ among surgeons in North America and East Africa, including Ethiopia, Kenya, and Sudan. Multiple classification systems have been proposed to describe thoracolumbar spine injuries. We hypothesized that there would be marked variability in the classification systems used to evaluate thoracolumbar spine injury among neurosurgeons in North America and East Africa. Methods The survey consisted of seven questions and was sent to 440 neurosurgeons practicing on the continents of North America and East Africa. Results A total of 67 surgeons responded, 50 from North America and 17 from East Africa, including Ethiopia, Kenya, and Sudan. A significant percentage of African respondents reported a higher thoracolumbar spine fracture rate than respondents in North America (53% and 30%, respectively). Regarding the classification system used, 65% of surgeons in East Africa reported using TLICS, whereas 62% of surgeons in North America reported using Denis 3-column classification. For patients with spine trauma, surgeons in East Africa and North America reported a similar percentage of readmission <90 days (47% and 52%, respectively). Conclusion Our findings vary in spine trauma classification for American and East African patients and still highlight crucial areas for improvement due to patient load, education, and resource accessibility.
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Balak N, Shrestha P, Agboola K. The crucial role of ethical hospital administration in neurosurgery education. FRONTIERS IN HEALTH SERVICES 2022; 2:860266. [PMID: 36925839 PMCID: PMC10012789 DOI: 10.3389/frhs.2022.860266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Hospital, Istanbul, Turkey
| | | | - Kayode Agboola
- Department of Neurosurgery, Institute of Neurosurgery, A.P. Romodanov, National Academy of Medical Sciences (NAMS) of Ukraine, Kiev, Ukraine
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Holmaas G, Abate A, Woldetsadik A, Hevrøy O. Establishing a sustainable training programme in anaesthesia in Ethiopia. Acta Anaesthesiol Scand 2022; 66:1016-1023. [PMID: 35749233 PMCID: PMC9541354 DOI: 10.1111/aas.14106] [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: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Background Lack of qualified staff is a major hindrance for quality and safety improvements in anaesthesia and critical care in many low‐income countries. Support in specialist training may enhance perioperative treatment and have a positive downstream impact on other hospital services, which may improve the overall standard of care. Methods Between 2011 and 2019, consultant anaesthetists from Haukeland University Hospital in Norway supported a postgraduate anaesthesia‐training programme at Addis Ababa University/Tikur Anbessa Specialised Hospital in Ethiopia. The aim of the programme was to build a self‐sustainable work force of anaesthetists across the country who could perform high quality anaesthesia within the confinement of limited local resources. Over the course of 10 years, an almost continuous rotation of experienced anaesthetists and intensivists assisted training of Ethiopian residents in anaesthesia and critical care. Local specialists organised the programme; however, external support was necessary during this period to establish a sustainable training programme. Results Since the programme's commencement at Addis Ababa University in 2011, 159 residents have entered the programme and 71 have graduated. As the number of qualified anaesthetists increased, Ethiopian specialists gradually obtained responsibility for the programme. Candidates are recruited from various regions and from neighbouring countries. Five other Ethiopian training sites have been established. To date (May 2022), 112 residents have completed their training in Ethiopia, and 195 residents expect to graduate within 3 years. Conclusion Nearly 11 years after establishment of the programme, locally trained highly qualified anaesthetists work in Ethiopia's major hospitals throughout the country.
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Affiliation(s)
- Gunhild Holmaas
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | - Ananya Abate
- Department of Anesthesiology, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | | | - Olav Hevrøy
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
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Abdi H, Wang Z, Ham EI, Laeke T, Park KB, Negida A, Bizuneh Y, Tirsit A. Neurosurgery Research Output in Ethiopia: A Scoping Review. World Neurosurg 2022; 164:291-297. [PMID: 35609725 DOI: 10.1016/j.wneu.2022.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurosurgery-specific research plays a critical role in improving outcomes in patients with neurosurgical diseases. Despite the high burden of neurosurgical diseases in Ethiopia, little is known about types of neurosurgical research from Ethiopia. The goal of this scoping review is to assess the quantity and types of neurosurgical research published in peer-reviewed journals by authors from Ethiopia. METHODS PubMed, CINAHL, Embase, and Scopus were searched for Ethiopian neurosurgery literature published from 2001 to 2021. We selected articles based on the following criteria: articles must 1) discuss topics within neurosurgery and 2) focus on clinical practice and/or public health in Ethiopia. We collected data on research originality, study designs, and clinical versus public health research. The frequencies and percentages of categorical variables were reported. All analyses were conducted using Jamovi software. RESULTS Of the 362 results, 89 neurosurgical research articles were included in the final analysis. Of the 89 articles, case reports/series were most common (28.7%), followed by retrospective cohort (20.7%) and prospective cohort studies (18.4%). There were 8 literature reviews (9.2%) and 1 systematic review and meta-analysis (1.1%). No randomized controlled trial was found. Of all articles, 66 (75.9%) focused on clinical practice, and 21 (23.6%) were related to the public health aspect of neurosurgery. Forty-two articles (48.3%) included authors only from Ethiopia; 37 articles (42.5%) involved collaboration between Ethiopian and authors from another country, and 8 articles (9.2%) did not have Ethiopian authors. CONCLUSIONS Neurosurgery research from Ethiopia is lacking, despite its high disease burden. Case reports/series and cohort studies remain the mainstay, with few systematic reviews and no randomized controlled trial. International collaboration accounts for approximately half of Ethiopian neurosurgery research output. Further research support and infrastructure should be developed to encourage neurosurgery articles from Ethiopia.
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Affiliation(s)
- Hodan Abdi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Zhe Wang
- Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Edward I Ham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Tsegazeab Laeke
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed Negida
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Yemisirach Bizuneh
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenezer Tirsit
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Boever J, Weber T, Krause EA, Mussa JA, Demissie YG, Gebremdihen AT, Mesfin FB. Neurosurgical Patients’ Experiences and Surgical Outcomes Among Single Tertiary Hospitals in Ethiopia and the United States. Cureus 2022; 14:e22035. [PMID: 35340506 PMCID: PMC8913517 DOI: 10.7759/cureus.22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background In 2020, we published findings on reported outcomes of anterior cervical decompression and fusion surgery among neurosurgeons in Africa and North America. We found more similarities in outcomes than expected, however, differences still existed. Most notable was the length of stay of patients postoperatively in Africa compared to North America. We sought to examine the neurosurgical practices more closely at a single hospital in Ethiopia and compare it to our own institution, the University of Missouri in Columbia (UMC). Methods Two authors spent one week at Aabet Hospital (AH) in Ethiopia. Throughout the week, one author rotated in the clinic and OR gathering the information. Data collection for patients at UMC was collected through retrospective chart review over one week. Results A total of eight elective surgeries and four emergency procedures occurred at AH and 18 clinic patients were included in the study. The intraoperative data was collected during the elective procedures at AH. At UMC there were 99 clinic patients, and 29 elective surgeries and one emergency procedure were performed. Procedures at both institutions included cranial, spinal, vascular, and implantable/other cases. Distance travelled by patients to UMC was an average of 57 miles compared to 85 miles at AH. The median pre-op and post-op stays at AH were 2.5 and 6 days compared to 0.2 and 2.1 at UMC, respectively. Blood loss was greater at AH with a median blood loss of 175 mL. Median blood loss at UMC was 50 mL. Conclusion We found notable differences among neurosurgical practice and patient demographics at AH compared to UMC. This information will serve as the cornerstone for gathering more information about neurosurgical practice in Ethiopia where electronic medical records are unavailable.
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Wubie AB, Teshome GS, Ayele WE, Abebe F, Nigussie TM, Alemu YB, Mekonnen MS. Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia. Int J Neurosci 2021:1-9. [PMID: 34643151 DOI: 10.1080/00207454.2021.1986492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Despite the increase in ventriculoperitoneal shunt surgeries performed for children with hydrocephalus, the potential complications and survival of patients after the procedure remains the major challenge for both clinical and public health aspects. This study intends to assess the survival status and scrutinize the predictive factors of mortality among children after a ventriculoperitoneal shunt.Methods: A retrospective cohort study was employed by reviewing charts of 337 systematically selected children who have undergone a ventriculoperitoneal shunt from 2016 to 2018 in Addis Ababa. The extraction tool was used for data collection, Epi-data version 4.4.2 for data entry, and Stata version-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, and life table were used to describe the data. Cox proportional hazard regression model was used for analysis. Any variable at p < 0.25 in the bi-variable analysis was fitted to multivariate analysis, and significance was declared at p ≤ 0.05. Then, AHR with 95% CI was used to report the association and test the statistical significance. Finally, texts and tables were used to present the results.Results and Conclusion: The incidence rate of mortality was 58.4 per 1000 child-months of observation with a median survival time of 12 months (95%CI: 9.04-14.96). Communicative hydrocephalus (AHR: 1.99, 95% CI: 1.18-3.36), post-traumatic brain injury (AHR: 7.43, 95% CI: 3.21-16.88), emergency surgery (AHR: 1.86, 95% CI: 1.17-3.13) as well as revised shunt procedure (AHR: 8.01, 95% CI: 6.12-13.43) were independent predictors of death. Besides, sunset eye (ARH: 2.01; 95% CI: 1.17-3.47), rapidly increased head size (ARH: 2.05, 95% CI: 1.14-3.37), prolonged antibiotics treatment (AHR: 2.46, 95% CI: 1.82-7.37), and gram-negative infections (AHR: 1.95, 95% CI: 1.60-12.64) were also significantly associated. Hence, health professionals ought to give special attention to patients with identified predictors.
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Affiliation(s)
- Azene Bantie Wubie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Mangat HS, Wu X, Gerber LM, Shabani HK, Lazaro A, Leidinger A, Santos MM, McClelland PH, Schenck H, Joackim P, Ngerageza JG, Schmidt F, Stieg PE, Hartl R. Severe traumatic brain injury management in Tanzania: analysis of a prospective cohort. J Neurosurg 2021; 135:1190-1202. [PMID: 33482641 PMCID: PMC8295409 DOI: 10.3171/2020.8.jns201243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania. METHODS A neurotrauma registry was established at Muhimbili Orthopaedic Institute, Dar-es-Salaam, and patients with severe TBI admitted within 24 hours of injury were included. Detailed emergency department and subsequent medical and surgical management of patients was recorded. Two-week mortality was measured and compared with estimates of predicted mortality computed with admission clinical variables using the Corticoid Randomisation After Significant Head Injury (CRASH) core model. RESULTS In total, 462 patients (mean age 33.9 years) with severe TBI were enrolled over 4.5 years; 89% of patients were male. The mean time to arrival to the hospital after injury was 8 hours; 48.7% of patients had advanced airway management in the emergency department, 55% underwent cranial CT scanning, and 19.9% underwent surgical intervention. Tiered medical therapies for intracranial hypertension were used in less than 50% of patients. The observed 2-week mortality was 67%, which was 24% higher than expected based on the CRASH core model. CONCLUSIONS The 2-week mortality from severe TBI at a tertiary referral center in Tanzania was 67%, which was significantly higher than the predicted estimates. The higher mortality was related to gaps in the continuum of care of patients with severe TBI, including cardiorespiratory monitoring, resuscitation, neuroimaging, and surgical rates, along with lower rates of utilization of available medical therapies. In ongoing work, the authors are attempting to identify reasons associated with the gaps in care to implement programmatic improvements. Capacity building by twinning provides an avenue for acquiring data to accurately estimate local needs and direct programmatic education and interventions to reduce excess in-hospital mortality from TBI.
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Affiliation(s)
- Halinder S. Mangat
- Department of Neurology, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Xian Wu
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
| | - Hamisi K. Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Andreas Leidinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Maria M. Santos
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Paul H. McClelland
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | | | - Pascal Joackim
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Japhet G. Ngerageza
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute, Dar-es-Salaam, Tanzania
| | - Franziska Schmidt
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Philip E. Stieg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
| | - Roger Hartl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, New York
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Voss M, Swart O, Abel L, Mahtani K. Capacity-building partnerships for surgical post-graduate training in low- and middle-income countries: a scoping review of the literature with exploratory thematic synthesis. Health Policy Plan 2021; 35:1385-1412. [PMID: 33159525 DOI: 10.1093/heapol/czaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
In recent years, international surgical programmes have moved away from vertical service delivery and towards collaborative, capacity-building partnerships. The aim of this review was to provide a map of the current literature on international surgical training partnerships together with an exploration of factors influencing their implementation. Three bibliographic databases were searched for peer-reviewed reports of surgical training partnerships between organizations in high- and low or middle-income countries to July 2018. Reports were sorted in an iterative fashion into groups of similar programmes, and data were extracted to record the intervention strategies, context, financing, reported results and themes around implementation. Eighty-six reports were grouped into five types of programme: full residency training, bi-institutional twinning partnerships, diagonal/sub-specialist programmes, focused interventions or courses and programmes using remote support. Few articles were written from the perspective of the low-middle income partner. Full residency programmes and some diagonal/sub-specialist programmes report numbers trained while twinning partnerships and focused interventions tend to focus on process, partners' reactions to the programme and learning metrics. Two thematic networks emerged from the thematic synthesis. The first made explicit the mechanisms by which partnerships are expected to contribute to improved access to surgical care and a second identified the importance of in-country leadership in determining programme results. Training partnerships are assumed to improve access to surgical care by a number of routes. A candidate programme theory is proposed together with some more focused theories that could inform future research. Supporting the development of the surgical leadership in low- and middle-income countries is key.
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Affiliation(s)
- Miranda Voss
- Harris Manchester College, Savile Road Oxford, Oxford OX1 3TZ, UK
| | - Oostewalt Swart
- Department of Surgery, Worcester Hospital, Murray Street, Worcester 6840, South Africa
| | - Lucy Abel
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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State of Neurosurgical Education in Africa: A Narrative Review. World Neurosurg 2021; 151:172-181. [PMID: 34058355 DOI: 10.1016/j.wneu.2021.05.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is no comprehensive report of neurosurgery postgraduate education in Africa. This narrative review aimed to map out the landscape of neurosurgery training in Africa and highlight similarities and differences in training. METHODS The keywords "neurosurgery," "education," and "Africa" were searched on PubMed and Google Scholar from inception to January 17, 2021. Next, a complementary hand search was conducted on Google using the keywords "neurosurgery," "residency," and the individual African countries in English and official languages. The relevant data were extracted and compiled into a narrative review. RESULTS A total of 76 African training programs that recruit more than 168 trainees each year were identified. Less than half (40.7%, n = 22) of African countries have at least 1 neurosurgery training program. Egypt (n = 15), Algeria (n = 14), and Nigeria (n = 10) have the highest number of training programs, whereas Algeria (0.33), Egypt (0.15), and Libya (0.15) have the highest number of training programs per 1 million inhabitants. The College of Surgeons of East, Central, and Southern Africa has 16 programs in 8 countries, whereas the West African College of Surgeons has 17 accredited programs in 3 countries. The duration of training varies between 4 and 8 years. There is limited information available in the public domain and academic literature about subspecialty fellowships in Africa. CONCLUSIONS This review provides prospective applicants and African and global neurosurgery stakeholders with information to advocate for increased investment in African neurosurgery training programs.
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Asfaw ZK, Tirsit A, Barthélemy EJ, Mesfin E, Wondafrash M, Yohannes D, Ashagre Y, Park K, Laeke T. Neurosurgery in Ethiopia: A New Chapter and Future Prospects. World Neurosurg 2021; 152:e175-e183. [PMID: 34052452 DOI: 10.1016/j.wneu.2021.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inequitable access to surgical care is most conspicuous in low-income countries (LICs), such as Ethiopia, where infectious diseases, malnutrition, and other maladies consume the lion's share of the available health resources. The aim of this article was to provide an update on the current state of neurosurgery in Ethiopia and identify targets for future development of surgical capacity as a universal health coverage component in this East African nation. METHODS Publicly available data included in this report were gathered from resources published by international organizations. A PubMed search was used for a preliminary bibliometric analysis of scholarly output of neurosurgeons in Ethiopia and other low-income countries. Statistical analysis was used to determine the correlation between the number of neurosurgeons and academic productivity. RESULTS Neurosurgeon density has increased >20-fold from 0.0022 to 0.045 neurosurgeons per 100,000 population between 2006 and 2020. The increase in neurosurgeons was strongly correlated with an increase in total publications (P < 0.001) and the number of new publications per year (P = 0.003). Despite recent progress, the availability of neuroimaging equipment remains inadequate, with 38 computed tomography scanners and 11 magnetic resonance imaging machines for a population of 112.07 million. The geographic distribution of neurosurgical facilities is limited to 12 urban centers. CONCLUSIONS Ethiopian neurosurgery exemplifies the profound effect of international partnerships for training local surgeons on progress in low-income countries toward improved neurosurgical capacity. Collaborations that focus on increasing the neurosurgical workforce should synchronize with efforts to enhance the availability of diagnostic and surgical equipment necessary for basic neurosurgical care.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Abenezer Tirsit
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elam Mesfin
- Department of Neurosurgery, Mekelle University, Mekelle, Ethiopia
| | - Mulualem Wondafrash
- Department of Neurosurgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yordanos Ashagre
- Department of Neurosurgery, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kee Park
- Program in Global Surgery and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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Laeke T, Tirsit A, Kassahun A, Sahlu A, Yesehak B, Getahun S, Zenebe E, Deyassa N, Moen BE, Lund-Johansen M, Sundstrøm T. Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Surgical Procedures, Complications, and Postoperative Outcomes. World Neurosurg 2021; 150:e316-e323. [PMID: 33706016 DOI: 10.1016/j.wneu.2021.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is an important cause of trauma-related mortality and morbidity in Ethiopia. There are significant resource limitations along the entire continuum of care, and little is known about the neurosurgical activity and patient outcomes. METHODS All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia were prospectively registered from October 2012 to December 2016. Data registration included surgical procedures, complications, reoperations, discharge outcomes, and mortality. RESULTS A total of 1087 patients were included. The most common procedures were elevation of depressed skull fractures (49.5%) and craniotomies (47.9%). Epidural hematoma was the most frequent indication for a craniotomy (74.7%). Most (77.7%) patients were operated within 24 hours of admission. The median hospital stay for depressed skull fracture operations or craniotomies was 4 days. Decompressive craniectomy was only done in 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cerebrospinal fluid leak was the most common complication (7.9%). The overall mortality was 8.2%. Diagnosis, admission Glasgow Coma Scale (GCS) score, surgical procedure, and complications were significant predictors of discharge GCS score (P < 0.01). Age, admission GCS score, and length of hospital stay were significantly associated with mortality (P ≤ 0.005). CONCLUSIONS The injury panorama, surgical activity, and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services benefit a large number of patients in the greater Addis region and are qualitatively comparable with reports from high-income countries.
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Affiliation(s)
- Tsegazeab Laeke
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Abenezer Tirsit
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Azarias Kassahun
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Abat Sahlu
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Betelehem Yesehak
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Samuel Getahun
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Eyob Zenebe
- Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Negussie Deyassa
- School of Public Health, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Bente E Moen
- Department of Global Public Health and Primary Care, Center for International Health, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Laeke T, Tirsit A, Kassahun A, Sahlu A, Debebe T, Yesehak B, Masresha S, Deyassa N, Moen BE, Lund-Johansen M, Sundstrøm T. Prospective Study of Surgery for Traumatic Brain Injury in Addis Ababa, Ethiopia: Trauma Causes, Injury Types, and Clinical Presentation. World Neurosurg 2021; 149:e460-e468. [PMID: 33567370 DOI: 10.1016/j.wneu.2021.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a public health problem in Ethiopia. More knowledge about the epidemiology and neurosurgical management of TBI patients is needed to identify possible focus areas for quality improvement and preventive efforts. METHODS This prospective cross-sectional study (2012-2016) was performed at the 4 teaching hospitals in Addis Ababa, Ethiopia. All surgically treated TBI patients were included, and data on clinical presentation, injury types, and trauma causes were collected. RESULTS We included 1087 patients (mean age 29 years; 8.7% females; 17.1% <18 years old). Only 15.5% of TBIs were classified as severe (Glasgow Coma Scale score 3-8). Depressed skull fracture (44.9%) and epidural hematoma (39%) were the most frequent injuries. Very few patients had polytrauma (3.1%). Assault was the most common injury mechanism (69.9%) followed by road traffic accidents (15.8%) and falls (8.1%). More than 80% of patients came from within 200 km of the hospitals, but the median time to admission was 24 hours. Most assault victims (80.4%) were injured >50 km from the hospitals, whereas 46% of road traffic accident victims came from the urban area. Delayed admission was associated with higher Glasgow Coma Scale scores and nonsevere TBI (P < 0.01). CONCLUSIONS The injury panorama, delayed admission, and small number of operations performed for severe TBI are linked to a substantial patient selection bias both before and after hospital admission. Our results also suggest that there should be a geographical framework for tailored guidelines, preventive efforts, and development of prehospital and hospital services.
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Affiliation(s)
- Tsegazeab Laeke
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Abenezer Tirsit
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Azarias Kassahun
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abat Sahlu
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tequam Debebe
- Department of Radiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betelehem Yesehak
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samuel Masresha
- Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyassa
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bente E Moen
- Center for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Terje Sundstrøm
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Boever J, Mesfin F. A Comparison of Reported Outcomes of Anterior Cervical Spinal Surgery Among Neurosurgeons in Africa and North America. World Neurosurg 2020; 146:e1097-e1102. [PMID: 33248307 DOI: 10.1016/j.wneu.2020.11.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical practice in some African countries has significant differences in patient load and resource availability compared with North America. We designed a survey to determine reported differences in outcome of anterior cervical decompression and fusion surgery, including blood loss, length of stay, and follow-up time, among physicians on different continents. We expected outcomes in all categories to be pronounced between respondents in Africa compared with North America due to a multitude of factors. METHODS The survey consisted of 7 questions and was sent to 352 neurosurgeons practicing on the continents of North America, Africa, or Other. RESULTS A total of 62 surgeons responded, 44 from Africa, 15 from North America, and 3 from Other. A greater percentage of respondents in Africa reported an average follow-up time within 2 weeks compared with respondents practicing in North America (63.6% and 40%, respectively). On blood loss, 56% of surgeons in Africa reported >50 mL of intraoperative blood loss compared with 6.67% for respondents in North America. Over 90% reported length of stay of 2 or more days in Africa, compared with 6.67% in North America. CONCLUSIONS Our findings demonstrate greater advances in reported surgical outcomes for patients in Africa than we expected, but still highlight key areas for improvement, almost certainly due to lack of resources.
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Affiliation(s)
- Justus Boever
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA.
| | - Fassil Mesfin
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
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Uche EO, Ryttlefors M, Tisell M. Scaling Up Global Collaborations for Neurosurgical Education and Care Capacity Development in West Africa: Are There Low-Hanging Fruits Where It Tolls? World Neurosurg 2020; 139:512-518. [DOI: 10.1016/j.wneu.2020.04.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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Reynolds RA, Stack L, Bonfield CM. How to Take a Good Neurosurgical Photograph with a Mobile Phone Camera. World Neurosurg 2020; 137:469-471. [PMID: 32365433 DOI: 10.1016/j.wneu.2020.02.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rebecca A Reynolds
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Lawrence Stack
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Uche EO, Mezue WC, Ajuzieogu O, Amah CC, Onyia E, Iloabachie I, Ryttlefors M, Tisell M. Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration. Acta Neurochir (Wien) 2020; 162:973-981. [PMID: 31902003 DOI: 10.1007/s00701-019-04207-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The unmet need for neurosurgery in sub-Saharan Africa is staggering. Resolving this requires strategies that synergize salient local resources with tailored foreign help. This study is a trial of a twinning model adopted by the Swedish African Neurosurgical Collaboration (SANC). METHODS A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), developed through a collaboration between African and Swedish neurosurgical teams was adopted for a neurosurgical mission in March 2019. The pioneering steps are evaluated together with data of treated patients prospectively acquired using SPSS Chicago Inc., Version 23. Associations were analyzed using chi-square tests, while inferences were evaluated at 95% level of significance. RESULTS The SANC global neurosurgery mission targeted microsurgical brain tumor resection. Fifty-five patients were operated on during the mission and subsequent 3 months. Patients' ages ranged from 3 months to 69 years with a mean of 30.6 ± 2.1 years 95% CL. Seven cases were performed during the first mission, while 48 were performed after the mission. Compared to 3 months before SANC when only 9 brain tumors were resected, more tumors were resected (n = 25) within the 3 consecutive months from the mission (X2 = 14.2, DF = 1, P = 0.000). Thirty-day mortality following tumor resection was also lower, X2 = 4.8, DF = 1, P = 0.028. CONCLUSION Improvements in capacity and short-term outcome define our initial pioneering application of a neurosurgical twinning paradigm pioneered by SANC.
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Affiliation(s)
- Enoch O Uche
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria.
- University of Nigeria Teaching Hospital , Ituku/Ozalla Enugu, 40001, Nigeria.
| | - Wilfred C Mezue
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Obinna Ajuzieogu
- Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus , Enugu, Nigeria
| | - Christopher C Amah
- University of Nigeria Teaching Hospital , Ituku/Ozalla Enugu, 40001, Nigeria
| | - Ephraim Onyia
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Izuchukwu Iloabachie
- Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, 751.85, Uppsala, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
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Henderson F, Abdifatah K, Qureshi M, Perry A, Graffeo CS, Haglund MM, Olunya DO, Mogere E, Okanga B, Copeland WR. The College of Surgeons of East, Central, and Southern Africa: Successes and Challenges in Standardizing Neurosurgical Training. World Neurosurg 2020; 136:172-177. [PMID: 31958592 DOI: 10.1016/j.wneu.2020.01.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The College of Surgeons of East, Central, and Southern Africa (COSECSA) is a regional accrediting body for general and specialty surgical training programs that has recently expanded to include neurosurgery. As neurosurgical services expand in sub-Saharan Africa, the structure of training and accreditation has become a vital issue. METHODS We review the founding and current structures of COSECSA neurosurgical training, identifying accomplishments and challenges facing the expansion of neurosurgical training in this region. RESULTS The COSECSA model has succeeded in several countries to graduate qualified neurosurgeons, but challenges remain. Programs must balance the long duration of training required to promote surgical excellence against an overwhelming clinical need that seeks immediate solutions. CONCLUSION Harnessing global collaboration, rapidly expanding local infrastructure, and a robust multinational training curriculum, COSECSA has emerged as a leader in the effort to train neurosurgeons and is anticipated to dramatically improve on the markedly unmet need for neurosurgical care in sub-Saharan Africa.
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Affiliation(s)
- Fraser Henderson
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Khalif Abdifatah
- Department of Surgery, Neurosurgery Section, Aga Khan University Hospital, Nairobi, Kenya
| | - Mahmood Qureshi
- Department of Surgery, Neurosurgery Section, Aga Khan University Hospital, Nairobi, Kenya; NED Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, New York, USA
| | | | - Michael M Haglund
- Department of Neurosurgery, Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - David Oluoch Olunya
- Department of Surgery, Neurosurgery Section, Aga Khan University Hospital, Nairobi, Kenya
| | - Edwin Mogere
- Department of Surgery, Neurosurgery Section, Aga Khan University Hospital, Nairobi, Kenya
| | - Ben Okanga
- Coast Province General Hospital, Department of Neurosurgery, Mombasa, Kenya
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Schucht P, Zubak I, Kuhlen D, Abu-Isa J, Murek M, Raabe A, Soe ZW, Aung K, Soe Myint AT, Thu M. Assisted Education for Specialized Medicine: A Sustainable Development Plan for Neurosurgery in Myanmar. World Neurosurg 2019; 130:e854-e861. [DOI: 10.1016/j.wneu.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
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21
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Servadei F, Tropeano MP, Spaggiari R, Cannizzaro D, Al Fauzi A, Bajamal AH, Khan T, Kolias AG, Hutchinson PJ. Footprint of Reports From Low- and Low- to Middle-Income Countries in the Neurosurgical Data: A Study From 2015 to 2017. World Neurosurg 2019; 130:e822-e830. [DOI: 10.1016/j.wneu.2019.06.230] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 11/26/2022]
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Fieggen AG. ISPN presidential address 2018. Paediatric neurosurgery: Africa is our future. Childs Nerv Syst 2019; 35:1637-1647. [PMID: 31432223 DOI: 10.1007/s00381-019-04337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anthony Graham Fieggen
- Neuroscience Institute, Division of Neurosurgery & Department of Surgery, University of Cape Town, H53 Old Main Building, Groote Schuur Hospital, Cape Town, Western Cape, 7925, South Africa.
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One Hundred Skull Base Meningiomas Operated at Black Lion Specialized Hospital, Addis Ababa, Ethiopia. World Neurosurg 2019; 126:e1321-e1329. [DOI: 10.1016/j.wneu.2019.03.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/18/2022]
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Akhaddar A. African Contribution to the World Neurosurgical Literature During the Past Two Decades (1999-2018) Using PubMed Database. World Neurosurg 2019; 126:314-321. [PMID: 30898744 DOI: 10.1016/j.wneu.2019.03.095] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND To the best of our knowledge, no previous study has assessed the neurosurgical publications from Africa. A bibliometric analysis was performed in the present study to evaluate the contribution of African authors in neurosurgical journals worldwide and to discuss the approaches that could be used to enhance the quantity and quality of publications on this issue. METHODS A literature search of neurosurgical publications by African investigators was performed using the PubMed database from 1999 to 2018. The total number of articles per country was tabulated and normalized by the number of neurosurgeons in each country. RESULTS A total of 974 articles reported from 1999 to 2018 from 31 African countries were identified and analyzed. The number of African neurosurgical publications have increased remarkably during the past decade. However, a wide disparity exists in the productivity among the countries, especially when normalized by the number of neurosurgeons. Most of the research publications have been case series and case reports, with very few clinical trials, meta-analyses, or international collaborations. According to the neurosurgical research areas, the most representative subspecialties were the spine, intracranial tumor, hydrocephalus, and head injury. CONCLUSIONS African neurosurgeons will be able to meet the challenges of the new century with the appropriate use of its resources and staff, regardless of the difficulties they face. However, African neurosurgical research could be improved by teaching research methods and medical writing and should focus more on modern neurosurgical topics by highlighting continental particularities. African neurosurgeons should collaborate with each other (locally, regionally, and abroad) and with foreign centers for better quality research and international visibility.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University, Rabat, Morocco; Laboratory of Biostatistics Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
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Practical Challenges and Perspectives for the Development of Neurosurgery in a Peripheral East African Hospital During a One-Volunteer Midterm Mission. World Neurosurg 2017; 111:326-334. [PMID: 29294401 DOI: 10.1016/j.wneu.2017.12.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Several strategies have been proposed for developing and spreading surgical specialties in Sub-Saharan East Africa. Regarding neurosurgery, improvements are coming from the cooperation between Western and African institutes by means of the World Federation of Neurological Surgeons and independent organizations but, far from big cities and more equipped hospitals, shortcomings in the delivery of services persist. METHODS Through the application of 1 formally trained neurosurgeon volunteer, the Foundation for International Education in Neurological Surgery and Neurocirugía, Educación y Desarrollo coordinated a 2-month neurosurgical project at Mathari Consolata Hospital in Nyeri (Kenya), designed to analyze critical points and to find suggestions for initiating and developing a neurosurgical service, providing in the meantime clinical and surgical care for patients. RESULTS During the mission, general and local issues limiting the neurosurgical activities at the hospital were studied. They were discussed with the hospital board and the project supervisors, thereby ensuring short-term and medium-term solutions and possible future cooperation with the hospital. The volunteer also carried out clinics and surgery for neuro cases and neurosurgical training for nurses and doctors. CONCLUSIONS The model proposed should be considered a preliminary and immersive survey to evaluate the eligibility of a decentralized East African hospital to interface with neurosurgical activities, through the support of experienced local institutes and Western organizations. Host hospitals would also have the chance to enhance clinical services currently lacking and to train its personnel at low cost. The program may represent a rewarding personal and professional opportunity for young trained neurosurgeons, which also addresses the contemporary shortage of local specialists.
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