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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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Aetiology and diagnostics of paediatric hydrocephalus across Africa: a systematic review and meta-analysis. Lancet Glob Health 2022; 10:e1793-e1806. [PMID: 36400085 DOI: 10.1016/s2214-109x(22)00430-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/01/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to identify the aetiological distribution and the diagnostic methods for paediatric hydrocephalus across Africa, for which there is currently scarce evidence. METHODS In this systematic review and meta-analysis, we searched MEDLINE (Ovid), the Cochrane Database of Systematic Reviews (Wiley), Embase (Ovid), Global Health (Ovid), Maternity & Infant Care (Ovid), Scopus, African Index Medicus (Global Index Medicus, WHO) and Africa-Wide Information (EBSCO) from inception to Nov 29, 2021. We included studies from any African country reporting on the distribution of hydrocephalus aetiology in children aged 18 years and younger, with no language restrictions. Hydrocephalus was defined as radiological evidence of ventriculomegaly or associated clinical symptoms and signs of the disorder, or surgical treatment for hydrocephalus. Exclusion criteria were studies only reporting on one specific subgroup or one specific cause of hydrocephalus. We also excluded conference and meetings abstracts, grey literature, editorials, commentaries, historical reviews, systematic reviews, case reports and clinical guidelines, as well as studies on non-humans, fetuses, or post-mortem reports. The proportions of postinfectious hydrocephalus, non-postinfectious hydrocephalus, and hydrocephalus related to spinal dysraphism were calculated using a random-effects model. Additionally, we included a category for unclear cases. Diagnostic methods were described qualitatively. To assess methodological study quality, we applied critical appraisal checklists provided by the Joanna Briggs Institute. The study was registered in Prospero (CRD42020219038). FINDINGS Our search yielded 3783 results, of which 1880 (49·7%) were duplicates and were removed. The remaining 1903 abstracts were screened and 122 (6·4%) full articles were sought for retrieval; of these, we included 38 studies from 18 African countries that studied a total of 6565 children. The pooled proportion of postinfectious hydrocephalus was 28% (95% CI 22-36), non-postinfectious hydrocephalus was 21% (95% CI 13-30), and of spinal dysraphism was 16% (95% CI 12-20), with substantial heterogeneity. The pooled proportion of hydrocephalus of unclear aetiology was 20% (95% CI 13-28). INTERPRETATION Our findings suggest that postinfectious hydrocephalus is the single most common cause of paediatric hydrocephalus in Africa. For targeted investments to be optimal, there is a need for consensus regarding the aetiological classification of hydrocephalus and improved access to diagnostic services. FUNDING Rikshospitalet, Oslo University Hospital, Oslo, Norway.
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Hoffman C, Härtl R, Shlobin NA, Tshimbombu TN, Elbabaa SK, Haglund MM, Rubiano AM, Dewan MC, Stippler M, Mahmud MR, Barthélemy EJ, Griswold DP, Wohns R, Shabani HK, Rocque B, Sandberg DI, Lafuente J, Dempsey R, Rosseau G. Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities. World Neurosurg 2022; 166:e404-e418. [PMID: 35868506 DOI: 10.1016/j.wneu.2022.07.030] [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: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships. METHODS The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees. RESULTS Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience. CONCLUSIONS The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.
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Affiliation(s)
- Caitlin Hoffman
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tshibambe N Tshimbombu
- Department of Neurosurgery, Geisel School of Medicine, Dartmouth University, Hannover, New Hampshire, USA
| | - Samer K Elbabaa
- Section of Pediatric and Fetal Neurosurgery, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology and Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrés M Rubiano
- Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Martina Stippler
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria Kaduna, Nigeria; Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Ernest J Barthélemy
- Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Dylan P Griswold
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA
| | | | - Hamisi K Shabani
- Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Brandon Rocque
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David I Sandberg
- Division of Pediatric Neurosurgery, University of Texas Health Sciences Center, McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Jesús Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Robert Dempsey
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Aukrust, Mphil CG, Parikh K, Smart LR, Mdala I, Fjeld HE, Lubuulwa J, Makene AM, Härtl R, Winkler AS. Pediatric Hydrocephalus in Northwest Tanzania: a descriptive cross-sectional study of clinical characteristics and early surgical outcomes from the Bugando Medical Centre. World Neurosurg 2022; 161:e339-e346. [PMID: 35134579 DOI: 10.1016/j.wneu.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In this study, we present data from a neurosurgical training program in Tanzania for the treatment of pediatric hydrocephalus. The objectives of the study were to identify the demographics and clinical characteristics of pediatric patients with hydrocephalus who were admitted to Bugando Medical Centre in Mwanza, Tanzania, as well as to describe their surgical treatment and early clinical outcomes. METHODS This cross-sectional study included 38 pediatric patients. Physical examinations were conducted pre- and postoperatively, and their mothers completed a questionnaire providing demographic and clinical characteristics. RESULTS There was a slight preponderance of male sex (21/38; 55.3%) with median age at the time of admission of 98.5 days. The majority of patients were surgically treated (33/38; 86.8%). Among those surgically treated, most received a ventriculoperitoneal shunt (23/33; 69.7%), whereas 7 were treated with an endoscopic third ventriculostomy (7/33; 21.2%). At the time of admission, the majority of patients (86%) had head circumferences that met criteria for macrocephaly. The median time between admission and surgery was 23 days (2-49 days). Overall, 5 patients (13.2%) died, including 2 who did not receive surgical intervention. CONCLUSIONS We found that in our population, pediatric patients with hydrocephalus often present late for treatment with additional significant delays prior to receiving any surgical intervention. Five patients died, of whom 2 had not undergone surgery. Our study reinforces that targeted investments in clinical services are needed to enable access to care, improve surgical capacity, and alleviate the burden of neurosurgical disease from pediatric hydrocephalus in sub-Saharan Africa.
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Henderson D, Ndossi M, Majige R, Sued M, Shabani H. Understanding the Mothers of Children with Spina Bifida and Hydrocephalus in Tanzania. World Neurosurg 2020; 142:e331-e336. [PMID: 32652272 DOI: 10.1016/j.wneu.2020.06.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify if there are cultural, medical, educational, economic, nutritional and geographic barriers to the prevention and treatment of spina bifida and hydrocephalus. METHODS The mothers of infants with spina bifida and hydrocephalus admitted to Muhimbilli Orthopaedic Institute, Dar Es Salaam, Tanzania, between 2013 and 2014 were asked to complete a questionnaire. A total of 299 infants were identified: 65 with myelomeningoceles, 19 with encephaloceles, and 215 with isolated hydrocephalus. The questionnaire was completed by 294 of the mothers. RESULTS There was a high variation in the geographic origin of the mothers. Approximately 85% traveled from outside of Dar Es Salaam. The mean age was 29 (15-45) years old with a parity of 3 (1-10). The rates of consanguinity, obesity, antiepileptic medication, HIV seropositivity, and family history were 2%, 13%, 0%, 2%, and 2%, respectively. A maize-based diet was found in 84%, and only 3% of woman took folic acid supplementation, despite 61% of mothers stating that they wished to conceive another baby. Unemployment was high (77%), a low level of education was common (76% not attended any school or obtaining a primary level only), and 20% were single mothers. Hospital only was the preferred method of treatment for 94% of the mothers, and 85% of the babies were born in a hospital. CONCLUSIONS Our study highlights some of the cultural, educational, geographic, nutritional, and economic difficulties in the prevention and management of spina bifida and hydrocephalus in Tanzania.
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Affiliation(s)
| | | | - Rebeca Majige
- Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania
| | - Mwanaabas Sued
- Muhimbili Orthopaedic Institute, Dar Es Salaam, Tanzania
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Moreno Oliveras L, Llácer Ortega JL, Leidinger A, Ali Haji M, Chisbert Genovés MP, Piquer Belloch J. Infant hydrocephalus in sub-Saharan Africa: Impact of perioperative care in the Zanzibar archipelago. Neurocirugia (Astur) 2020; 31:223-230. [PMID: 32156453 DOI: 10.1016/j.neucir.2020.01.002] [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: 11/04/2019] [Revised: 12/20/2019] [Accepted: 01/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Child hydrocephalus in low- and middle-income countries represents one of the most sensitive ethical and health problems facing international health development. The most optimistic estimates indicate that 200,000 newborns annually will develop hydrocephalus or be born with a neural tube defect in East, Central and South Africa (ECSA). It is estimated that less than 10% of these children will be operated by ventriculoperitoneal shunts, and in general in poor quality conditions or with a very high complication rate. OBJECTIVE To describe the general characteristics, epidemiology and demographic data of childhood hydrocephalus of patients treated at the NED Institute in the Zanzibar archipelago, and assess the clinical details and medium-term results of the impact of the set-up nursing care. MATERIAL AND METHODS This is a descriptive and analytical observational study of a retrospective nature, in patients diagnosed and treated with childhood hydrocephalus, in the period from September 2016 to September 2018. With the implementation of a series of perioperative nursing protocols in these patients, the results obtained were described and analyzed. RESULTS A total of 96 patients were treated for childhood hydrocephalus. 51% (n=49) of these patients were male, with a mean age of 9.25 months. All the mothers of the patients were monitored during pregnancy, but only 8% were treated with folic acid during pregnancy. 81% of children were born through vaginal delivery or uncomplicated spontaneous delivery. Regarding the etiology, 27.1% of treated hydrocephalus was associated with an infectious cause and 35.4% with an unknown cause. 67 ventriculoperitoneal shunt surgery and 15 endoscopic ventriculostomies were performed. The complication rate was 23.17%. CONCLUSIONS The results of this research indicate that childhood hydrocephalus in Zanzibar has etiology, evolution and complications that are similar to or less than those described to date in East Africa. Implementing a series of perioperative protocols and standardized nursing care positively influences the results obtained. Currently, the Mnazi Mmoja Surgical NED Institute is one of the few centers in East Africa with an exhaustive record of healthcare activity and is the first health center that offers further training to nurses.
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Affiliation(s)
- Luis Moreno Oliveras
- Cátedra de Neurociencias, Universidad Cardenal Herrera CEU-Fundación Vithas Nisa, Moncada, Valencia, España.
| | | | - Andreas Leidinger
- Fundación NED (Neurocirugía, Educación y Desarrollo), Valencia, España
| | - Mohamed Ali Haji
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Stonetown, Tanzania
| | | | - José Piquer Belloch
- Cátedra de Neurociencias, Universidad Cardenal Herrera CEU-Fundación Vithas Nisa, Moncada, Valencia, España; Servicio de Neurocirugía, Hospital Universitario de La Ribera, Alzira, Valencia, España
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8
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Weiss HK, Garcia RM, Omiye JA, Vervoort D, Riestenberg R, Yerneni K, Murthy N, Wescott AB, Hutchinson P, Rosseau G. A Systematic Review of Neurosurgical Care in Low-Income Countries. World Neurosurg X 2020; 5:100068. [PMID: 31956859 PMCID: PMC6957821 DOI: 10.1016/j.wnsx.2019.100068] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/29/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE More than 5 billion individuals lack access to essential surgical care. Neurosurgical care is especially limited in low-income countries (LICs). Studies describing neurosurgical care in LICs are critical for understanding global disparities in access to neurosurgical procedures. To better understand these disparities, we conducted a systematic review of the literature identifying neurosurgical patients in LICs. METHODS MEDLINE (PubMed), Embase (embase.com), and Cochrane Library (Wiley) databases were systematically searched to retrieve studies describing neurosurgical care in LICs as defined by the World Bank Country and Lending Groups income classification. All databases were searched from their inception; no date or language limits were applied. All the articles were blindly reviewed by 2 individuals. Data from eligible studies were extracted and summarized. RESULTS Of the 4377 citations screened, 154 studies met inclusion criteria. The number of publications substantially increased over the study period, with 49% (n = 76) of studies published in the last 5 years. Twenty-six percent (n = 40) of studies had a first author, and 30% (n = 46) had a senior author, affiliated with a country different from the LIC of study. The most common neurosurgical diagnosis was traumatic brain injury (24%, n = 37), followed by hydrocephalus (26%, n = 40), and neoplastic intracranial mass (10%, n = 16). Of LICs, 43% (n = 15/35) had no published neurosurgical literature. CONCLUSIONS There is a significant deficit in the literature on neurosurgical care in LICs. Efforts must focus on supporting research initiatives in LICs to improve publication bias and understand disparities in access to neurosurgical care in the lowest-resource countries.
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Affiliation(s)
- Hannah K. Weiss
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Roxanna M. Garcia
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
- Institute for Public Health and Medicine (IPHAM), Center for Healthcare Studies, Northwestern University, Chicago, Illinois, USA
| | | | - Dominique Vervoort
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Riestenberg
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Ketan Yerneni
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Nikhil Murthy
- Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Annie B. Wescott
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, Illinois, USA
| | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
| | - Gail Rosseau
- Midwest Neurosurgical Associates, Oak Brook, Illinois, USA
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Leidinger A, Piquer J, Kim EE, Nahonda H, Qureshi MM, Young PH. Experience in the Early Surgical Management of Myelomeningocele in Zanzibar. World Neurosurg 2018; 121:e493-e499. [PMID: 30268549 DOI: 10.1016/j.wneu.2018.09.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago. METHODS From December 2016 to December 2017, we prospectively collected data on all patients admitted with the diagnosis of myelomeningocele. We collected variables regarding demographics, maternal health, preoperative imaging, surgical procedures, and complications at follow-up. RESULTS We collected data on 19 patients. Mean age was 9.8 ± 18.7 days. Of these patients, 52.6% were male and 47.3% were female; 47.3% patients were from Unguja, 42.0% from Pemba, and 5.2% from mainland Tanzania; 68.4% of all mothers were found to have undergone prenatal ultrasonography and 89.5% of all patients received surgery. Surgical wound infection was present in 29.4% of all surgical patients and 52.9% developed secondary hydrocephalus. CONCLUSIONS Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.
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Affiliation(s)
- Andreas Leidinger
- Neurosurgery Education and Development (NED) Foundation, Valencia, Spain; Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Stonetown, Tanzania.
| | - Jose Piquer
- Neurosurgery Education and Development (NED) Foundation, Valencia, Spain; Chair of Neuroscience Vithas CEU University, Valencia, Spain
| | - Eliana E Kim
- Neurosurgery Education and Development (NED) Foundation, Valencia, Spain
| | - Hadia Nahonda
- Neurosurgery Education and Development (NED) Institute, Mnazi Mmoja Hospital, Stonetown, Tanzania
| | | | - Paul H Young
- Section of Neurosurgery, Department of Surgery, St Louis University, St. Louis, Missouri, USA
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