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Lippa L, Cadieux M, Barthélemy EJ, Baticulon RE, Ghotme KA, Shlobin NA, Piquer J, Härtl R, Lafuente J, Uche E, Young PH, Copeland WR, Henderson F, Sims-Williams HP, Garcia RM, Rosseau G, Qureshi MM. Clinical Capacity Building Through Partnerships: Boots on the Ground in Global Neurosurgery. Neurosurgery 2024; 95:728-739. [PMID: 39185894 DOI: 10.1227/neu.0000000000003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 06/29/2024] [Indexed: 08/27/2024] Open
Abstract
Global neurosurgery seeks to provide quality neurosurgical health care worldwide and faces challenges because of historical, socioeconomic, and political factors. To address the shortfall of essential neurosurgical procedures worldwide, dyads between established neurosurgical and developing centers have been established. Concerns have been raised about their effectiveness and ability to sustain capacity development. Successful partnerships involve multiple stakeholders, extended timelines, and twinning programs. This article outlines current initiatives and challenges within the neurosurgical community. This narrative review aims to provide a practical tool for colleagues embarking on clinical partnerships, the Engagements and assets, Capacity, Operative autonomy, Sustainability, and scalability (ECOSystem) of care. To create the ECOSystem of care in global neurosurgery, the authors had multiple online discussions regarding important points in the practical tool. All developed tiers were expanded based on logistics, clinical, and educational aspects. An online search was performed from August to November 2023 to highlight global neurosurgery partnerships and link them to tiers of the ECOSystem. The ECOSystem of care involves 5 tiers: Tiers 0 (foundation), 1 (essential), 2 (complexity), 3 (autonomy), and 4 (final). A nonexhaustive list of 16 neurosurgical partnerships was created and serves as a reference for using the ECOSystem. Personal experiences from the authors through their partnerships were also captured. We propose a tiered approach for capacity building that provides structured guidance for establishing neurosurgical partnerships with the ECOSystem of care. Clinical partnerships in global neurosurgery aim to build autonomy, enabling independent provision of quality healthcare services.
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Affiliation(s)
- Laura Lippa
- Neurosurgery Unit, Department of Neurosciences, ASST Grande Ospedale Metropolitano Niguarda, Milan , Italy
- Sezione di Traumatologia Cranica, Società Italiana di Neurochirurgia (SINCh), Padua , Italy
| | - Magalie Cadieux
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
- Division of Neurosurgery, Muhimbili Orthopaedic Hospital, Dar Es Salaam , Tanzania
- Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center, New York , New York , USA
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn , New York , USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila , Philippines
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, School of Medicine, Universidad de La Sabana, Chia , Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota , Colombia
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - José Piquer
- Chair VIU-NED Foundation, Hospital de la Ribera, Alzira , Valencia , Spain
| | - Roger Härtl
- Division of Neurosurgery, Muhimbili Orthopaedic Hospital, Dar Es Salaam , Tanzania
- Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center, New York , New York , USA
| | | | - Enoch Uche
- Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu , Nigeria
- Division of Neurosurgery, College of Medicine, University of Nigeria Nsukka, Ituku/Ozalla Campus, Enugu , Nigeria
| | - Paul H Young
- Section of Neurosurgery, Department of Surgery, St. Louis University, St. Louis , Missouri , USA
| | | | - Fraser Henderson
- Division of Neurosurgery, Tenwek Hospital, Bomet , Kenya
- Department of Neurosurgery, Loma Linda University, Loma Linda , California , USA
| | | | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
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Omer M, Härtl R. Urgent Call for International Support and Research Focus on Neurosurgery in Conflict-Affected Sudan. World Neurosurg 2024; 189:291-295. [PMID: 38909754 DOI: 10.1016/j.wneu.2024.06.089] [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: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/25/2024]
Abstract
Neurosurgical services and educational processes in Sudan have been severely disrupted by the ongoing armed conflict. The destruction of neurosurgical infrastructure and the continuous exodus of trained neurosurgeons from an already strained system have intensified the humanitarian crisis. The situation is further compounded by several factors, including attacks on medical professionals, partial suspension of neurosurgical training program, loss of communication tools, shortages of essential instruments, and disruptions in partnerships with regional and international neurosurgical associations. The re-establishment of international partnerships and the reconstruction of damaged neurosurgical infrastructure are advocated, coupled with the utilization of advanced research to address these critical issues. A staged recovery strategy is called for, and support from the global neurosurgical community is urged, highlighting the crucial role of academic platforms like "World Neurosurgery" in fostering global collaboration and disseminating research from conflict-affected regions.
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Affiliation(s)
- Mazin Omer
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany.
| | - Roger Härtl
- Department of Neurological Surgery, New York-Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York, USA
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Mukumbya B, Kitya D, Trillo-Ordonez Y, Sun K, Obiga O, Deng DD, Stewart KA, Ukachukwu AEK, Haglund MM, Fuller AT. The feasibility, appropriateness, and usability of mobile neuro clinics in addressing the neurosurgical and neurological demand in Uganda. PLoS One 2024; 19:e0305382. [PMID: 38913633 PMCID: PMC11195962 DOI: 10.1371/journal.pone.0305382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations. METHODS Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants. RESULTS Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable. CONCLUSION The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.
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Affiliation(s)
- Benjamin Mukumbya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David Kitya
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yesel Trillo-Ordonez
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Keying Sun
- Duke Global Health Institute, Durham, NC, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Oscar Obiga
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Di D. Deng
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
| | | | - Alvan-Emeka K. Ukachukwu
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Michael M. Haglund
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Neurosurgery, Duke University Health System, Durham, NC, United States of America
| | - Anthony T. Fuller
- Duke Global Neurosurgery and Neurology, Durham, NC, United States of America
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Waterkeyn F, Ikwuegbuenyi CA, Woodfield J, Sommer F, Magogo J, Cheserem B, Schupper AJ, Shabani HK, Hussain I, Ahmad AA, Balsano M, Mangat H, Härtl R. Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa. World Neurosurg 2023; 180:e550-e559. [PMID: 37778623 DOI: 10.1016/j.wneu.2023.09.109] [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: 06/06/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. METHODS We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. RESULTS The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. CONCLUSIONS To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.
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Affiliation(s)
- François Waterkeyn
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium.
| | - Chibuikem A Ikwuegbuenyi
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Julie Woodfield
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Fabian Sommer
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Juma Magogo
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Beverly Cheserem
- Department of Neurological Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Alexander J Schupper
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
| | - Ibrahim Hussain
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA
| | - Alaaeldin Azmi Ahmad
- Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Halinder Mangat
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New-York Presbyterian, Och Spine, New York, New York, USA; Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salam, Tanzania
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Shayo CS, Woodfield J, Shabhay ZA, Ikwuegbuenyi CA, Mtei J, Yonah B, Ndossi MY, Massawe SL, Magawa DG, Mndeme H, Kwelukilwa D, Bureta CA, Ngeregeza J, Hoffman C, Mangat HS, Mchome LL, Härtl R, Shabani HK. Neurosurgical Education in Tanzania: The Dar es Salaam Global Neurosurgery Course. World Neurosurg 2023; 180:42-51. [PMID: 37659749 DOI: 10.1016/j.wneu.2023.08.111] [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: 07/14/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Postgraduate neurosurgical training is essential to develop a neurosurgical workforce with the skills and knowledge to address patient needs for neurosurgical care. In Tanzania, the number of neurosurgeons and neurosurgical services offered have expanded in the past 40 years. Training opportunities within the country, however, are not sufficient to meet the needs of residents, specialists, and nurses in neurosurgery, forcing many to train outside the country incurring associated costs and burdens. We report on the Dar es Salaam Global Neurosurgery Course, which aims to provide local training to neurosurgical health care providers in Tanzania and surrounding countries. METHODS We report the experience of the Global Neurosurgery Course held in March 2023 in Dar es Salaam, Tanzania. We describe the funding, planning, organization, and teaching methods along with participant and faculty feedback. RESULTS The course trained 121 participants with 63 faculty-42 from Tanzania and 21 international faculty. Training methods included lectures, hands-on surgical teaching, webinars, case discussions, surgical simulation, virtual reality, and bedside teaching. Although there were challenges with equipment and Internet connectivity, participant feedback was positive, with overall improvement in knowledge reported in all topics taught during the course. CONCLUSIONS International collaboration can be successful in delivering topic-specific training that aims to address the everyday needs of surgeons in their local setting. Suggestions for future courses include increasing training on allied topics to neurosurgery and neurosurgical subspecialty topics, reflecting the growth in neurosurgical capacity and services offered in Tanzania.
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Affiliation(s)
- Consolata S Shayo
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Julie Woodfield
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Zarina A Shabhay
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Chibuikem Anthony Ikwuegbuenyi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - John Mtei
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Boaz Yonah
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Maxigama Y Ndossi
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Sylvia L Massawe
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Dorcas G Magawa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Hadija Mndeme
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Costansia A Bureta
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Japhet Ngeregeza
- Department of Neurosurgery, Muhimbili National Hospital - Mloganzila, Dar es Salaam, Tanzania
| | - Caitlin Hoffman
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA
| | - Halinder S Mangat
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Neurocritical Care Department, University of Kansas Medical Centre, Wichita, Kansas, USA
| | - Laurent Lemeri Mchome
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York, New York, USA; New York-Presbyterian - Och Spine, New York, New York, USA
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
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Moreno-Oliveras L, Rodriguez-Mena R, Nahoda H, Chisbert-Genoves P, Ali Haji M, Llacer-Ortega JL, Piquer-Belloch J. Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania). World Neurosurg X 2023; 20:100222. [PMID: 37502101 PMCID: PMC10368924 DOI: 10.1016/j.wnsx.2023.100222] [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: 09/06/2022] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
Objective Our main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures. Methods This is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted. Results The mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted. Conclusions Proper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.
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Affiliation(s)
- Luis Moreno-Oliveras
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Ruben Rodriguez-Mena
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Hadia Nahoda
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Pilar Chisbert-Genoves
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Mohamed Ali Haji
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Jose L. Llacer-Ortega
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
| | - Jose Piquer-Belloch
- Cátedra Neurociencia Global y Cambio Social NED VIU. Calle Pintor Sorolla 21, 46002, Valencia, Spain
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Zanzibar, Tanzania
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. BRAIN & SPINE 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Ukachukwu AEK, Still MEH, Seas A, von Isenburg M, Fieggen G, Malomo AO, Shokunbi MT, Egger JR, Haglund MM, Fuller AT. Fulfilling the specialist neurosurgical workforce needs in Africa: a systematic review and projection toward 2030. J Neurosurg 2023; 138:1102-1113. [PMID: 35962968 DOI: 10.3171/2022.2.jns211984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Africa contributes significantly to the global neurosurgical disease burden but has only 1% of the neurosurgery workforce. This study appraises the neurosurgical workforce and training capacity in Africa and projects the workforce capacity by 2030. METHODS The authors conducted a systematic review of the online literature on neurosurgical workforce and training in Africa obtained from three journal databases (PubMed, Embase, and African Index Medicus), as well as from a gray literature search, between September and December 2020. Included literature passed a two-level screening conducted using a systematic review software by a team of two independent reviewers. Data were extracted from selected articles and documented and analyzed on spreadsheets. RESULTS One hundred and fifty-nine eligible articles were analyzed: 1974 neurosurgeons serve 1.3 billion people in Africa (density 0.15 per 100,000 persons, ratio 1:678,740), with uneven distribution between the regions. North Africa has 64.39% of the neurosurgical workforce (n = 1271), followed by Southern Africa (12.66%, n = 250), West Africa (11.60%, n = 229), East Africa (8.26%, n = 163), and Central Africa (3.09%, n = 61). At an exponential growth rate of 7.03% (95% CI 5.83%-8.23%) per annum, Africa will have 3418 (95% CI 1811-6080) neurosurgeons by 2030, with a deficit of 5191 neurosurgeons, based on population workforce targets. In terms of training, there are 106 neurosurgery training institutions in 26 African countries. North Africa has 52 training centers (49.05%), West Africa 23 (21.70%), East Africa 15 (14.15%), Southern Africa 14 (13.21%), and Central Africa 2 (1.89%). The major regional training programs are those of the West African College of Surgeons (24 sites in 7 countries) and the College of Surgeons of East, Central, and Southern Africa (17 sites in 8 countries). CONCLUSIONS The study is limited as it is based on the online literature, some of which includes modeled estimates with questionable reliability. However, the results indicate that while countries in North Africa are expected to surpass their population workforce requirements, sub-Saharan African countries are likely to have significant workforce deficits accentuated by the paucity of neurosurgery training programs. To meet the 2030 population workforce requirements, the continent's exponential growth rate should be scaled up to 15.87% per annum. Scaling up neurosurgical training would help to meet this target and requires collaborative efforts from continental, regional, and national agencies and international organizations.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham
- 2Department of Neurosurgery, Duke University Health System, Durham, North Carolina
- 3Neurosurgery Unit, Asokoro District Hospital, Abuja FCT, Nigeria
| | - Megan E H Still
- 4Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Andreas Seas
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham
| | - Megan von Isenburg
- 5Duke University Medical Center Library and Archives, Durham, North Carolina
| | - Graham Fieggen
- 6Division of Neurosurgery and Neuroscience Institute, University of Cape Town, South Africa
| | - Adefolarin O Malomo
- 7Department of Neurological Surgery, College of Medicine, University of Ibadan, Nigeria; and
| | - Matthew T Shokunbi
- 7Department of Neurological Surgery, College of Medicine, University of Ibadan, Nigeria; and
| | - Joseph R Egger
- 8Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Michael M Haglund
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham
- 2Department of Neurosurgery, Duke University Health System, Durham, North Carolina
- 8Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Anthony T Fuller
- 1Duke Global Neurosurgery and Neurology, Duke University, Durham
- 2Department of Neurosurgery, Duke University Health System, Durham, North Carolina
- 8Duke Global Health Institute, Duke University, Durham, North Carolina
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Waterkeyn F, Woodfield J, Massawe SL, Mzimbiri JM, Shabhay ZA, Bureta CA, Sommer F, Mndeme H, Magawa DG, Kwelukilwa D, Ndossi MY, Kinghomella AA, Kaale AJ, Ahmed S, Mtei J, Minja F, Moses M, Medary B, Hussain I, Ikwuegbuenyi CA, Petr O, Kiloloma WO, Rutabasibwa NB, Mangat HS, Mchome LL, Härtl R, Shabani HK. The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence. BRAIN & SPINE 2023; 3:101727. [PMID: 37383451 PMCID: PMC10293233 DOI: 10.1016/j.bas.2023.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.
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Affiliation(s)
- François Waterkeyn
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Julie Woodfield
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Sylvia Leon Massawe
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Juma Magogo Mzimbiri
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Department of Neurosurgery, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Zarina Ali Shabhay
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Fabian Sommer
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Hadija Mndeme
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Dorcas Gidion Magawa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | | | - Aingaya Jackson Kaale
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Shakeel Ahmed
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - John Mtei
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Fidelis Minja
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Moses Moses
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Branden Medary
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Chibuikem Anthony Ikwuegbuenyi
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Ondra Petr
- Charles University in Prague, Prague, Czech Republic
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wanin Othman Kiloloma
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Halinder Singh Mangat
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Laurent Lemeri Mchome
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Roger Härtl
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Hamisi Kimaro Shabani
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
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Wireko AA, Patel H, Mehta A, Jiffry R, Adebusoye FT, Miteu GD. Pediatric brain tumors in low- and middle-income countries: available evidence on recent advancements in management, challenges, and recommendations – editorial. Int J Surg 2023; 109:235-238. [PMID: 37093068 PMCID: PMC10389311 DOI: 10.1097/js9.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 04/08/2023]
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11
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Waterkeyn F, Lohkamp LN, Ikwuegbuenyi CA, Mchome LL, Rutabasibwa NB, Shabani HK, Härtl R, Petr O. Current Treatment Management of Aneurysmal Subarachnoid Hemorrhage with Prevailing Trends and Results in Tanzania: A Single-Center Experience at Muhimbili Orthopedic and Neurosurgery Institute. World Neurosurg 2023; 170:e256-e263. [PMID: 36336272 DOI: 10.1016/j.wneu.2022.11.003] [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: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In Africa, no cerebral aneurysm treatment guidelines exist. Epidemiology, management, and outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain poorly understood, with many underdiagnosed cases. Muhimbili Orthopaedic and Neurosurgery Institute (MOI) is the only neurosurgical referral center in Tanzania. The aim of this study is to describe the current aSAH management with regional outcomes and limitations. METHODS Patients with aSAH confirmed by computed tomography/magnetic resonance angiography between February 2019 and June 2021 were retrospectively studied. The analyzed parameters included demographics, clinical/radiologic characteristics, injury characteristics, and the modified Rankin Scale (mRS) score. RESULTS In total, 22 patients, with a female/male ratio of 1.4 and a median age of 54 years (interquartile range [IQR], 47.2-63 years) harboring 24 aneurysms were analyzed. Thirteen patients (59.1%) paid out of pocket. The median distance traveled by patients was 537 km (IQR, 34.7-635 km). The median time between admission and treatment was 12 days (IQR, 3.2-39 days). The most common symptoms were headache (n = 20; 90.9%) and high blood pressure (n = 10; 45.4%). Nine patients (40.9%) had Fisher grade 1 and 12 (54.5%) World Federation of Neurosurgical Societies grade I. The most common aneurysms were of the middle cerebral artery (7/29.2%). Fourteen patients (63.6%) underwent clipping; of those, only 4 (28.6%) were operated on within 72 hours. Mortality was 62.5% in the nonsurgical group. Among clipped patients, 78.6% showed favorable outcomes, with no mortality. Endovascular treatment is not available in Tanzania. CONCLUSIONS To our best knowledge, this is the first study highlighting aSAH management in Tanzania, with its assets and shortcomings. Our data show pertinent differences among international treatment guidelines, with the resultant outcomes, such as high preoperative mortality resulting from delayed/postponed treatment. Regional difficult circumstances notwithstanding, our long-term goal is to significantly improve the overall management of aSAH in Tanzania.
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Affiliation(s)
- François Waterkeyn
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA; Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Laura-Nanna Lohkamp
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Chibuikem A Ikwuegbuenyi
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Lemeri L Mchome
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Nicephorus B Rutabasibwa
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Hamisi K Shabani
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa
| | - Roger Härtl
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, New York, USA
| | - Ondra Petr
- Division of Neurosurgery, Muhimbili Orthopaedic and Neurosurgery Institute, Dar es Salam, Tanzania, Africa; First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
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12
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Leidinger A, Zuckerman SL, Feng Y, He Y, Chen X, Cheserem B, Gerber LM, Lessing NL, Shabani HK, Härtl R, Mangat HS. Predictors of spinal trauma care and outcomes in a resource-constrained environment: a decision tree analysis of spinal trauma surgery and outcomes in Tanzania. J Neurosurg Spine 2023; 38:503-511. [PMID: 36640104 DOI: 10.3171/2022.11.spine22763] [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: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings. METHODS This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated. RESULTS Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26-43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1-6) days; surgery was performed after a further median delay of 22 (IQR 13-39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively. CONCLUSIONS Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors' results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
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Affiliation(s)
- Andreas Leidinger
- 1Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott L Zuckerman
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yueqi Feng
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Yitian He
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Xinrui Chen
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | | | | | - Noah L Lessing
- 6School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hamisi K Shabani
- 7Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and
| | - Roger Härtl
- 8Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Halinder S Mangat
- 9Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, Kansas
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Abu-Bonsrah N, Totimeh T, Kanmounye US, Banson M, Bandoh D, Sarpong K, Dadey D, Adam A, Nketiah-Boakye F, Dakurah T, Boakye M, Haizel-Cobbina J, Ametefe M, Bankah P, Groves ML. Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities. World Neurosurg 2022; 167:e953-e961. [PMID: 36064120 DOI: 10.1016/j.wneu.2022.08.120] [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: 07/13/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low- and middle-income countries experience numerous challenges in the provision of neurosurgical care. However, limited information exists on the neurosurgical workforce and the constraints under which care is delivered in Ghana, West Africa. METHODS A 19-item survey assessing neurosurgical workforce, infrastructure, and education was administered to Ghanaian consultant neurosurgeons and neurosurgeon trainees between November 8, 2021, and January 20, 2022. The data were analyzed using summary descriptions, and qualitative data were categorized into themes. RESULTS There were 25 consultant neurosurgeons and 8 neurosurgical trainees (from 2 training centers) identified at 11 hospitals in Ghana totaling a workforce density of 1 neurosurgeon per 1,240,000. Most neurosurgical centers were located in Accra, the capital city. Almost half of the population did not have access to a hospital with a neurosurgeon in their region. Of hospitals, 82% had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively). There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures. CONCLUSIONS The provision of neurosurgical care in Ghana has come a long way since the 1960s. However, the neurosurgical community continues to face significant challenges. Alleviating these barriers to care will call for systems-level changes that allow for the prioritization of neurosurgical care within the Ghanaian health care system.
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Affiliation(s)
- Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.
| | - Teddy Totimeh
- Department of Neurosurgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Mabel Banson
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Dickson Bandoh
- Department of Neurosurgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, DC, USA
| | - David Dadey
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Abass Adam
- Department of Neurosurgery, Tamale Teaching Hospital, Tamale, Ghana
| | | | - Thomas Dakurah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Joseline Haizel-Cobbina
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mawuli Ametefe
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Patrick Bankah
- Department of Neurosurgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mari L Groves
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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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Geospatial Mapping of International Neurosurgical Partnerships and Evaluation of Extent of Training and Engagement. World Neurosurg 2020; 144:e898-e907. [PMID: 32992055 DOI: 10.1016/j.wneu.2020.09.107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the presence, extent, and temporality of transnational neurosurgical partnerships, to understand and inform measures to address neurosurgical deficiencies in low- and middle-income countries (LMICs). METHODS A Web search was conducted to identify actors from high-income countries (HICs) participating in neurosurgical delivery and/or capacity-building with LMICs from 2010 to 2018. Descriptive data on current neurosurgical partnerships were collected from published case reports, literature reviews, reports from academic institutions, and information on stakeholder Web pages. The level of training and engagement of each partnership was separately graded based on prespecified criteria, in which grade 3 represented partnerships that have most extensive training and engagement, and grade 1, the least extent. Data were analyzed using descriptive statistics and geospatially depicted on ArcMap GIS software. RESULTS A total of 123 unique HIC-LMIC partnerships were described. Of these partnerships, 85 (69%) are derived from HICs in North America, followed by Europe, with 23 (19%). The most common LMIC partners were from Africa (n = 56, 45%) and Latin America (n = 32, 26%). In addition, most partnerships provided services in pediatric neurosurgery (88%). The most frequent engagement classifications were grade 2 (35%) or 1 (36%). Similarly, for training, the most common classifications were grade 1 (40%) or 2 (30%). CONCLUSIONS A robust network of HIC-LMIC partnerships exists with varying degrees of engagement and training activities. Several regions are particularly suitable for growth and development. Systematic consolidation and indexing of transnational neurosurgical partnerships aim to enhance resource allocation and present opportunities for future partnership.
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Ham EI, Kim J, Kanmounye US, Lartigue JW, Gupta S, Esene IN, Park KB. Cohesion Between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: A Scoping Review. World Neurosurg 2020; 143:e88-e105. [PMID: 32673809 DOI: 10.1016/j.wneu.2020.06.237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. METHODS PubMed, CINAHL, and Embase were searched for GNS literature published from 1999 to 2019. Then, health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change. This items chart was subsequently used to categorize the GNS literature into health system domains. RESULTS A total 63 articles were determined to focus on a health system domain. Of these articles, 6 focused on multiple domains, yielding an adjusted total of 70 articles. Overall, the most represented health system domain was service delivery (21 articles), followed by workforce (19), infrastructure (15), financing (12) and information management (3). A total of 30 low- and middle-income countries (LMICs) were represented across all articles. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the articles. CONCLUSIONS This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system-focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.
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Affiliation(s)
- Edward I Ham
- Stony Brook School of Medicine, Stony Brook, New York, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Ulrick Sidney Kanmounye
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jean Wilguens Lartigue
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Du RY, Thiong'o GM, LoPresti MA, Mohan NK, Dewan MC, Lepard J, Lam S. Pediatric Neurosurgery in East Africa: An Education and Needs-Based Survey. World Neurosurg 2020; 141:e374-e382. [PMID: 32454199 DOI: 10.1016/j.wneu.2020.05.155] [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: 03/12/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION A pediatric neurosurgery training workshop was organized for residents and consultants in East Africa. We aimed to compile feedback from the course participants to 1) characterize the state of neurosurgical education; and 2) identify the perceived practical education needs. METHODS The survey of demographic, clinical background and practice, and feedback questions was distributed to all attendees. Responses were elicited via yes/no questions and Likert scales, with the score ranging from 1 (not important, not useful, never) to 5 (very important, very useful, often). The data were de-identified and analyzed in aggregate. RESULTS A total of 11 neurosurgeons and trainees completed the survey, including 6 residents (55%) and 5 consultants (45%). Although 5 countries of origin were represented, all attendees (100%) have completed their neurosurgery training in Kenya. The respondents had most frequently treated trauma (least common to most common, 1-5; mean, 4.55 ± 0.93), hemorrhagic stroke (mean, 4.27 ± 0.79), and pediatric tumors (mean, 4.27 ± 1.01). In training, the most commonly used study resources were online resources (9; 82%), textbooks (7; 64%), and online lectures (7; 64%). The areas of greatest perceived need in education and training included general neurosurgery (least to most need, 1-10: 9; 82%), pediatric (9; 82%), trauma and neurocritical care (7; 64%), and neuro-oncology (7; 64%). All 11 respondents (100%) reported that more direct operative teaching was important for educational improvement. Hydrocephalus (least to most useful, 1-5: 5.00 ± 0.00), neuro-endoscopy (4.91 ± 0.30), and tumor (4.91 ± 0.30) were considered the most useful content covered in the pediatric neurosurgery-focused training program to improve skills and knowledge base. CONCLUSIONS The results from the present survey identified areas of education and training needs to guide further neurosurgical education efforts in East Africa.
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Affiliation(s)
- Rebecca Y Du
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| | - Grace M Thiong'o
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Mohan
- Department of Neurosurgery, Moi Teaching and Referral Hospital, Eldoret, Kenya; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael C Dewan
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Lepard
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Sandi Lam
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine and Lurie Children's Hospital, Chicago, Illinois, USA
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18
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Schmidt FA, Kirnaz S, Wipplinger C, Kuzan-Fischer CM, Härtl R, Hoffman C. Review of the Highlights from the First Annual Global Neurosurgery 2019: A Practical Symposium. World Neurosurg 2020; 137:46-54. [PMID: 31996336 DOI: 10.1016/j.wneu.2020.01.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
This paper provides a detailed report of Global Neurosurgery 2019: A Practical Symposium held January 18-19, 2019, at Weill Cornell Medical College, New York, New York, USA. The meeting convened an international faculty and audience, leaders in the world of global neurosurgery (GNS), and junior faculty and residents beginning their contribution to the field. Remote access for the symposium was provided to include faculty practicing in developing countries. The goal of the symposium was to present the state of the union of GNS initiatives worldwide, to use this forum as a means to centralize resources and converge parallel efforts, and to identify the largest areas of need and successful means of advancing training and care in these areas. The meeting also served as a conduit for the presentation of funding and training opportunities for junior faculty and trainees looking for avenues to gain support and mentorship in pursuing academic and clinical endeavors globally.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Claudia M Kuzan-Fischer
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Caitlin Hoffman
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA.
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19
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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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Santos MM, Qureshi MM, Budohoski KP, Mangat HS, Ngerageza JG, Schöller K, Shabani HK, Zubkov MR, Härtl R. The Growth of Neurosurgery in East Africa: Challenges. World Neurosurg 2018; 113:425-435. [PMID: 29702966 DOI: 10.1016/j.wneu.2018.01.084] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/27/2022]
Abstract
As the second of 3 articles in this series, the aim of this article is to provide readers with an understanding of the development of neurosurgery in East Africa (foundations), the challenges that arise in providing neurosurgical care in developing countries (challenges), and an overview of traditional and novel approaches to overcoming these challenges and improving health care in the region (innovations). Recognizing the challenges that need to be addressed is the first step to implementing efficient and qualified surgery delivery systems in low- and middle-income countries. We reviewed the major challenges facing health care in East Africa and grouped them into 5 categories: 1) burden of surgical disease and workforce crisis; 2) global health view of surgery as "the neglected stepchild"; 3) need for recognizing the surgical system as an interdependent network and importance of organizational and equipment deficits; 4) lack of education in the community, failure of primary care systems, and net result of overwhelming tertiary care systems; 5) personal and professional burnout as well as brain drain of promising human resources from low- and middle-income countries in East Africa and similar regions across the world. Each major challenge was detailed and analyzed by authors who have worked or are currently working in the region, providing a personal perspective.
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Affiliation(s)
- Maria M Santos
- Center for Global Health, Weill Cornell Medicine, New York, New York, USA; Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Mubashir M Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Karol P Budohoski
- Department of Neurosurgery, Addenbrookes Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Halinder S Mangat
- Division of Stroke and Critical Care, Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Japhet G Ngerageza
- Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Karsten Schöller
- Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany
| | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Micaella R Zubkov
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
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