Barriers to Management of Nontraumatic Neurosurgical Diseases at 2 Cameroonian Neurosurgical Centers: Cross-Sectional Study

Management and outcome of intracranial fungal infections in children and adults in Africa: a scoping review

INTRODUCTION

Intracranial fungal infections' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa.

METHODS

This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review.

RESULTS

Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%).

CONCLUSION

Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients.

Oligodendroglioma: a neurological perspective in Sub-saharan Africa

Gliomas are a kind of brain cancer that develops from glial cells. Glial cells provide nourishment and energy to nerve cells, and they also preserve the blood-brain barrier. A primary cancer of the central nervous system (CNS) is oligodendroglioma. This suggests that it originates in the brain or spinal cord. While oligodendrogliomas can strike anyone at any age, the age range of 35 to 44 is when they most commonly occur. Oligodendrogliomas are rare in young people and more common in men than women. Based on anecdotal data, patients with oligodendroglioma may present management challenges in Africa. There are delays in diagnosis and referrals due to the scarcity of neuroimaging facilities. A wide range of strategies have been put forth to improve pathology services in low- and middle-income nations. Adequate mentorship, short-term visitor programs, overcoming supply chain constraints, establishing training standards, and establishing the role of pathologists in cancer screening and early diagnosis have all been proposed as solutions to this problem. To sum up, oligodendroglioma is one of the low-grade gliomas this study looked at. Brain cancer is a serious public health concern in Africa. Improved options for screening and therapy are required to better address this problem.

Barriers to Accessing Neurosurgical Services: A Cross-Sectional Study of Public and Patient Perspectives in Saudi Arabia

INTRODUCTION

Neurosurgical care is paramount for addressing various neurological conditions. However, several factors may hinder individuals from accessing these services. This study aimed to identify the factors that deter Saudi citizens from receiving neurosurgical care, emphasizing perceived barriers and sociodemographic influences.

METHODS

Utilizing a cross-sectional research design, this study surveyed 1,795 participants from five distinct regions in Saudi Arabia, capturing a wide demographic range including age, gender, education, occupation, and residence. Stratified random sampling was adopted to ensure representation across different socioeconomic backgrounds. Data was collected using structured online questionnaires in both Arabic and English, which assessed demographic characteristics, patient experiences, perceived barriers, and satisfaction related to neurosurgical services.

RESULTS

The majority of the participants (79.6%) reported never accessing neurosurgical services, and 28.8% indicated difficulties in accessing them. Most participants expressed neutral feelings (38.1%) or satisfaction (23.4%) with neurosurgical service accessibility, though a significant minority expressed dissatisfaction (9.0%) or strong dissatisfaction (4.3%). Concerning factors for selecting neurological services, the expertise and reputation of healthcare professionals were paramount, while cost and proximity were lesser concerns. Significant perceived barriers included financial constraints and prolonged appointment waiting times. Results also revealed a relationship between sociodemographic characteristics and perceived barriers: females, certain age groups (25 to 34 and above 65), those with higher education levels, retired individuals, and residents of the Northern Province and urban areas reported higher perceived barriers. Regression analysis identified gender, education level, employment status, and residency as significant predictors of perceived barriers.

CONCLUSION

This study underscores the prominent barriers faced by Saudi citizens in accessing neurosurgical care, with financial constraints and waiting times being paramount. Additionally, sociodemographic factors play a crucial role in the perception of these barriers. As healthcare disparities persist, targeted interventions, policy reforms, and educational campaigns are essential to bridge the gap and ensure equitable neurosurgical care access across all demographic segments in Saudi Arabia.

Historical determinants of neurosurgical inequities in Africa and the African diaspora: A review and analysis of coloniality

The movement to decolonize global health challenges clinicians and researchers of sub-disciplines, like global neurosurgery, to redefine their field. As an era of racial reckoning recentres the colonial roots of modern health disparities, reviewing the historical determinants of these disparities can constructively inform decolonization. This article presents a review and analysis of the historical determinants of neurosurgical inequities as understood by a group of scholars who share Sub-Saharan African descent. Vignettes profiling the colonial histories of Cape Verde, Rwanda, Cameroon, Ghana, Brazil, and Haiti illustrate the role of the colonial legacy in the currently unmet need for neurosurgical care in each of these nations. Following this review, a bibliographic lexical analysis of relevant terms then introduces a discussion of converging historical themes, and practical suggestions for transforming global neurosurgery through the decolonial humanism promulgated by anti-racist practices and the dialogic frameworks of conscientization.

Management and outcomes of intracranial fungal infections in children and adults in Africa: a scoping review protocol

INTRODUCTION

The protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.

METHODS AND ANALYSIS

The scoping review will be conducted in accordance with the Arksey and O'Malley's framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.

ETHICS AND DISSEMINATION

This study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.

Global Epidemiology of Craniosynostosis: A Systematic Review and Meta-Analysis

OBJECTIVE

Craniosynostosis leads to craniofacial deformity and may result in raised intracranial pressure, neurocognitive deficits, and psychosocial issues if left untreated. The global epidemiology of craniosynostosis is unknown. We conducted a meta-analysis to estimate global birth prevalence.

METHODS

PubMed, Embase, and Scopus were searched. Articles were screened by title and abstract and then full text. Meta-analysis of birth prevalence was conducted. Birth prevalence figures were combined with metrics detailing the number of births in 2019 to estimate the number of children worldwide born with craniosynostosis annually.

RESULTS

Of 1378 resultant articles, 24 studies were included, including 20 providing data for craniosynostosis overall and 9 for nonsyndromic craniosynostosis. World Health Organization regions of included studies were 9 (37.5%) European Region, 8 (33.3%) Region of the Americas, 4 (16.7%) Western Pacific region, 2 (8.3%) African Region, and 1 (4.2%) Eastern Mediterranean Region. Lower middle-income countries represented only 4% of study manuscripts. The overall birth prevalence of craniosynostosis was 5.9 per 10,000 live births (20 studies; 95% confidence interval [CI]: 3.9, 8.4; I² = 100%). The birth prevalence of nonsyndromic craniosynostosis was 5.2 per 10,000 live births (9 studies; 95% CI: 3.4, 7.3; I² = 98%). The number of children born globally with craniosynostosis in 2019 was estimated to be 84,665 (95% CI: 55,965, 120,540), including 72,857 (95% CI: 47,637, 120,280) with nonsyndromic craniosynostosis.

CONCLUSIONS

Craniosynostosis is a common condition that affects the neurocognitive and craniofacial skeletal development of children worldwide. Initiatives to scale up capacity for craniosynostosis epidemiologic research and clinical care are warranted, particularly in low- and middle-income countries.

Adult brain tumors in Sub-Saharan Africa: A scoping review

BACKGROUND

Sub-Saharan African (SSA) neuro-oncologists report high workloads and challenges in delivering evidence-based care; however, these reports contrast with modeled estimates of adult neuro-oncology disease burden in the region. This scoping review aimed to better understand the reasons for this discrepancy by mapping out the SSA adult brain tumor landscape based on published literature.

METHODS

Systematic searches were conducted in OVID Medline, Global Index Medicus, African Journals Online, Google Scholar, and faculty of medicine libraries from database inception to May 31 st, 2021. The results were summarized quantitatively and narratively. English and French peer-reviewed articles were included (title, abstract, and full text).

RESULTS

Of the 819 records identified, 119 articles by 24 SSA countries (42.9%) were included in the final review. Odeku published the first article in 1967, and nine of the ten most prolific years were in the 21 st century. The greatest contributing region was Western Africa (n=58, 48.7%) led by Nigeria (n=37, 31.1%). Central Africa had fewer articles published later than the other SSA regions (p=0.61). Most studies were non-randomized (n=75, 63.0%) and meningiomas (n=50, 42.0%) were the most common brain tumors reported. Less than 30 studies reported on adjuvant treatment or patient outcomes.

CONCLUSIONS

Most publications were hospital-based, and there was significant heterogeneity in the quality of evidence and reporting. This study highlights the need for rapid and sustainable investments and brain tumor research capacity in SSA.

Management and outcomes of low-grade gliomas in Africa: A scoping review

Introduction

Methods

Results

Conclusion

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Highlights for ‘Management and Outcomes of Low Grade Gliomas in Africa’.

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The burden of low-grade gliomas in Africa is underreported.

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There was no reported use of molecular pathology testing or intraoperative adjuncts.

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There were low rates of awake surgery for patients with supratentorial tumours.

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There was a lag in the uptake of techniques and technologies used in the management of low-grade gliomas.

The Burden of Pediatric Subarachnoid Hemorrhage Healthcare Disparities in Senegal: A Retrospective Cohort Study

INTRODUCTION

Pediatric aneurysms are uncommon but potentially deadly clinical conditions with varied etiology and outcomes. In low-resource countries, numerous barriers prevent the timely diagnosis and management of pediatric aneurysmal subarachnoid hemorrhage (aSAH). Thus, this study aimed to assess the mortality of pediatric aSAH stemming from limited access to pediatric neurological surgery care in Senegal.

METHODS

Pediatric aSAH patients admitted at the authors' institution from 2012 to 2020 were recruited. Spearman Rho's correlation, McNemar's test, and Wilcoxon signed-rank test were used. Odds ratios and their 95% confidence intervals were calculated, and the population attributable fraction (PAF) was used to quantify aSAH mortality attributable to lack of surgical care.

RESULTS

Twenty-four pediatric patients (12 females and 12 males) aged 12.2 (95% CI = 10.0-14.3) years presented with aSAH. Most patients had a single aneurysm measuring 12.6 (6.1-19.0) mm with 1 patient having 2. The median WFNS grade was 3 (range [1-4]), and the mean Fisher grade was 4 (range [1-4]). Fifteen patients (62.5%) had surgical treatment on day 15.0 (IQR = 23.0) of hospitalization. The overall mortality rate was 20.8%, and the PAF of mortality for lack of surgical treatment during hospitalization was 0.08.

CONCLUSION

Eight percent of deaths among pediatric aSAH patients who do not receive surgical treatment are attributable to lack of access to surgical treatment. Health system strengthening policies should be implemented to address this health inequity.

Management and Outcomes of Paediatric Intracranial Suppurations in Low- and Middle-Income Countries: A Scoping Review

Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included. Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4-29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7-95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%. Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Prevalence of spine surgery navigation techniques and availability in Africa: A cross-sectional study

Background

Africa has a large burden of spine pathology but has limited and insufficient infrastructure to manage these spine disorders. Therefore, we conducted this e-survey to assess the prevalence and identify the determinants of the availability of spine surgery navigation techniques in Africa.

Materials and methods

A two-part questionnaire was disseminated amongst African neurological and orthopedic surgery consultants and trainees from January 24 to February 23, 2021. The Chi-Square, Fisher Exact, and Kruskal-Wallis tests were used to evaluate bivariable relationships, and a p-value <0.05 was considered statistically significant.

Results

We had 113 respondents from all regions of Africa. Most (86.7 %) participants who practiced or trained in public centers and centers had an annual median spine case surgery volume of 200 (IQR = 190) interventions. Fluoroscopy was the most prevalent spine surgery navigation technique (96.5 %), followed by freehand (55.8 %), stereotactic without intraoperative CT scan (31.9 %), robotic with intraoperative CT scan (29.2 %), stereotactic with intraoperative CT scan (8.8 %), and robotic without intraoperative CT scan (6.2 %). Cost of equipment (94.7 %), lack of trained staff to service (63.7 %), or run the equipment (60.2 %) were the most common barriers to the availability of spine instrumentation navigation. In addition, there were significant regional differences in access to trained staff to run and service the equipment (P = 0.001).

Conclusion

There is a need to increase access to more advanced navigation techniques, and we identified the determinants of availability.

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African spine surgery has regional disparities in navigation techniques.

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Fluoroscopy is the most prevalent navigation technique.

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Cost and lack of trained personnel are the most significant barriers.

Training the Next Generation of Academic Global Neurosurgeons: Experience of the Association of Future African Neurosurgeons

Introduction: Although the past decade has seen a substantial increase in African neurosurgeons' academic productivity, productivity remains low compared to their colleagues from other regions. Aspiring neurosurgeons can contribute to the academic neurosurgery workforce by taking care of less technical and time-consuming research tasks. Fortunately, global neurosurgery institutions have also made efforts to increase research exposure and scholarly output in academic global neurosurgery. The Association of Future African Neurosurgeons (AFAN) created a research incubator for aspiring academic global neurosurgeons in Africa to provide enrollees with mentorship, skills, and experience. This study assesses and reports the activities and results of the research incubator.

Methods: Aspiring academic global neurosurgeons were enrolled in the AFAN Research Incubator Program (ARIP), whose primary objective was to provide enrollees with foundational skills in all aspects of the research cycle. ARIP enrollees participated in didactic and practical activities with the aim of publishing ≥1 article and presenting ≥1 abstracts at international conferences in one year.

Results: Fifteen AFAN members aged 25.0 ± 3.0 years enrolled in ARIP: 7 (46.7%) medical students, 4 (26.7%) general practitioners, and 4 (26.7%) residents. Eleven (73.3%) were male, 6 (40.0%) were from Cameroon and 6 (40.0%) had no previous research experience. Two (13.3%) enrollees dropped out. ARIP enrollees published a total of 28 articles, and enrollees published a median of 1.0 (IQR = 2) first-author articles on neurosurgical system strengthening. Additionally, ARIP enrollees presented 20 abstracts with a median of one abstract (IQR = 3.0).

Conclusion: South-South research collaborations like ARIP can contribute to improving global neurosurgery research capacity and output. These collaborations can set up the foundations for robust research in low- and middle-income countries.