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Anand A, Ajayi AO, Ansari A, Mustapha MJ, Verma A, Adinoyi SA, Uthman U, Usman A, Mofatteh M, Khatib MN, Zahiruddin QS, Gaidhane S, Sharma RK, Rustagi S, Satapathy P, Ajibade AA, Oluwamayowa O, Obanife HO, Ahmad KI, Ogunleye OO. Academic Neurosurgery in Nigeria- Past, Present, and Future: A Review. World Neurosurg 2024; 189:108-117. [PMID: 38851629 DOI: 10.1016/j.wneu.2024.05.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Nigeria's neurosurgical field faces profound challenges, including a critically low neurosurgeon-to-patient ratio and significant migration of medical professionals to developed countries. High costs, low socioeconomic status, and the urban-centric location of neurosurgical centers impede access to care. Key barriers to service delivery include lack of manpower, insufficient emergency care, limited imaging modalities, inadequate operative equipment, and ineffective political and administrative policies. Neurotrauma is the primary reason for neurosurgical intervention but is poorly managed due to delayed access and insufficient guidelines. The neurosurgical education system is strained by limited training capacity and the absence of subspecializations, restricting specialized care. Research output is low, hindered by limited infrastructure, lack of databases, insufficient funding, and minimal international collaboration. To address these issues, it is critical to enhance the imaging capabilities, ensure the availability of operative equipment, and establish effective policies for task sharing and communication at different levels of care. Other approaches include expanding training capacity, particularly in rural areas, implementing a uniform match system for residency, addressing gender disparities, and utilizing dual practice to ensure adequate compensation for neurosurgeons. Furthermore, stakeholders should develop subspecialization programs in areas such as neurovascular, neuro-oncology, pediatric neurosurgery, and minimally invasive neurosurgery to expand service scope. To transform the neurosurgical research landscape, efforts should be made to establish electronic medical databases, foster international collaborations to ensure funding, and make research mandatory for accreditation renewal to ensure continuous academic contribution.
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Affiliation(s)
- Ayush Anand
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal; MediSurg Research, Darbhanga, India; Global Consortium of Medical Education and Research, Pune, India
| | | | - Ayesha Ansari
- Global Consortium of Medical Education and Research, Pune, India; Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), India
| | | | - Amogh Verma
- Rama Medical College Hospital and Research Centre, Hapur, India
| | | | | | - Abubakar Usman
- Ahmadu Bello University Teaching Hospital Zaria, Nigeria
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Quazi Syed Zahiruddin
- Division of Evidence Synthesis, South Asia Infant Feeding Research Network (SAIFRN), Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
| | - Shilpa Gaidhane
- One Health Centre (COHERD), Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India
| | - Rakesh Kumar Sharma
- Graphic Era (Deemed to be University), Dehradun, India; Graphic Era Hill University, Dehradun, India
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Iraq
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Ukachukwu AEK, Njeru PN, Ayodele OA, Ahmad MH, Onyia CU, Morgan E, Ekweogwu OC, Usman B, Badejo OA, Dawang Y, Orhorhoro OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Petitt Z, Oboh EC, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Fuller AT, Haglund MM, Chikani MC, Adeolu AA, Adeleye AO. A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050. World Neurosurg 2024; 185:e16-e29. [PMID: 38741324 DOI: 10.1016/j.wneu.2023.10.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 05/16/2024]
Abstract
OBJECTIVE There has been a modest but progressive increase in the neurosurgical workforce, training, and service delivery in Nigeria in the last 2 decades. However, these resources are unevenly distributed. This study aimed to quantitatively assess the availability and distribution of neurosurgical resources in Nigeria while projecting the needed workforce capacity up to 2050. METHODS An online survey of Nigerian neurosurgeons and residents assessed the country's neurosurgical infrastructure, workforce, and resources. The results were analyzed descriptively, and geospatial analysis was used to map their distribution. A projection model was fitted to predict workforce targets for 2022-2050. RESULTS Out of 86 neurosurgery-capable health facilities, 65.1% were public hospitals, with only 17.4% accredited for residency training. Dedicated hospital beds and operating rooms for neurosurgery make up only 4.0% and 15.4% of the total, respectively. The population disease burden is estimated at 50.2 per 100,000, while the operative coverage was 153.2 cases per neurosurgeon. There are currently 132 neurosurgeons and 114 neurosurgery residents for a population of 218 million (ratio 1:1.65 million). There is an annual growth rate of 8.3%, resulting in a projected deficit of 1113 neurosurgeons by 2030 and 1104 by 2050. Timely access to neurosurgical care ranges from 21.6% to 86.7% of the population within different timeframes. CONCLUSIONS Collaborative interventions are needed to address gaps in Nigeria's neurosurgical capacity. Investments in training, infrastructure, and funding are necessary for sustainable development and optimized outcomes.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | | | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA; School of Medicine, Duke University, Durham, NC, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Ayodamola Otun
- School of Medicine, Washington University, St. Louis, MO, USA
| | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, NC, USA; Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA; Global Health Institute, Duke University, Durham, NC, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Ukachukwu AEK, Ogundeji OD, Abu-Bonsrah N, Still MEH, Trillo-Ordonez Y, Oboh EN, Nischal SA, Deng DD, Ugorji C, Seas A, Badejo OA, Malomo TA, Nwaribe EE, Oyemolade TA, Okere OE, Oboh E, Waguia-Kouam R, Rahman R, Asemota I, Reddy R, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO. The Scope, Trends, and Challenges of Neurosurgical Research in Nigeria: A Bibliometric Review. World Neurosurg 2024; 185:e86-e98. [PMID: 37931875 DOI: 10.1016/j.wneu.2023.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study investigates the scope, trends, and challenges of neurosurgical research in Nigeria since inception of the specialty in 1962. METHODS A bibliometric review of the neurosurgical literature from Nigeria was performed. Variables extracted included year and journal of publication, article topic, article type, research type, study design, article focus area, and limitations. Descriptive and quantitative analyses were performed for all variables. Trends of research publications were described in three periods: pioneering (1962-1981), recession (1982-2001), and resurgent (2002-2021). RESULTS Of the 1023 included articles, 10.0% were published in the pioneering period, 9.2% in the recession period, and 80.8% in the resurgent period. Papers were predominantly published in World Neurosurgery (4.5%) and Nigerian Journal of Clinical Practice (4.0%). A total of 79.9% of the 4618 authors were from Nigerian institutions; 86.3% of the articles covered clinical research and were mainly focused on service delivery and epidemiology (89.9%). The most prominent topics were traumatic brain injury (25.8%) and central nervous system malignancy (21.4%). Only 4.4% of the publications received funding, mostly from agencies in the United States (31.7%). Barriers to neurosurgical research included lack of clinical databases (18.0%), increasing burden of disease (12.5%), and diagnostic challenges (12.4%). CONCLUSIONS Neurosurgical research in Nigeria continues to grow due to increased training, workforce, and infrastructural improvements. Addressing the major challenges through establishment of research databases, development of evidence-based management guidelines, and increasing research training, funding and opportunities can increase research capacity in Nigeria.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Ena Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Ukachukwu AEK, Petitt Z, Usman B, Ekweogwu OC, Dawang Y, Ahmad MH, Ayodele OA, Badejo OA, Morgan E, Onyia CU, Orhorhoro OI, Oyemolade TA, Okere OE, Abu-Bonsrah N, Njeru PN, Oboh EC, Otun A, Nischal SA, Deng DD, Mahmud MR, Mezue WC, Malomo AO, Shehu BB, Shokunbi MT, Ohaegbulam SC, Chikani MC, Adeleye AO, Fuller AT, Haglund MM, Adeolu AA. The Status of Specialist Neurosurgical Training in Nigeria: A Survey of Practitioners, Trainers, and Trainees. World Neurosurg 2024; 185:e44-e56. [PMID: 37979680 DOI: 10.1016/j.wneu.2023.11.040] [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: 06/13/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to reassess the current status of specialist neurosurgical training in the country. METHODS An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. RESULTS Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons, and 6 by the National Postgraduate Medical College of Nigeria. The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. CONCLUSIONS Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Zoey Petitt
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, FCT, Nigeria
| | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Olabamidele A Ayodele
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | | | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paula N Njeru
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Ena C Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Wilfred C Mezue
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Bello B Shehu
- Regional Center for Neurosurgery, Usman DanFodio University Teaching Hospital, Sokoto, Nigeria
| | - Matthew T Shokunbi
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | | | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Ukachukwu AEK, Adeolu AA, Adeleye AO, Chikani MC, Haglund MM, Fuller AT. Neurosurgical Practice, Training, and Research Capacity Assessment in Nigeria: A Methodological Approach. World Neurosurg 2024; 185:e4-e15. [PMID: 38741329 DOI: 10.1016/j.wneu.2024.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE There has been a progressive growth of neurosurgery in Nigeria over the past 6 nulldecades. This study aims to comprehensively evaluate the state of neurosurgical practice, training, and research in the country. METHODS We used a mixed-methods approach that combined a survey of neurosurgery providers and a systematic review of the neurosurgical literature in Nigeria. The 83-question online survey had 3 core sections for assessing capacity, training, and gender issues. The systematic review involved a search of 4 global databases and gray literature over a 60-year period. RESULTS One hundred and forty-nine respondents (95% male) completed the survey (65.4%). Their age ranged from 20 to 68 years, with a mean of 41.8 (±6.9) years. Majority were from institutions in the nation's South-West region; 82 (55.0%) had completed neurosurgery residency training, with 76 (51%) employed as consultants; 64 (43%) identified as residents in training, 56 (37.6%) being senior residents, and 15 (10.1%) each held academic appointments as lecturers or senior lecturers. The literature review involved 1,023 peer-reviewed journal publications: 254 articles yielding data on 45,763 neurotrauma patients, 196 on 12,295 pediatric neurosurgery patients, and 127 on 8,425 spinal neurosurgery patients. Additionally, 147 papers provided data on 5,760 neuro-oncology patients, and 56 on 3,203 patients with neuro-vascular lesions. CONCLUSIONS Our mixed-methods approach provided significant insights into the historical, contemporary, and future trends of neurosurgery in Nigeria. The results could form the foundation for policy improvement; health-system strengthening; better resource-planning, prioritization, and allocation; and more purposive collaborative engagement in Nigeria and other low- and middle-income countries.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Augustine A Adeolu
- Department of Surgery, College of Medicine, University of Ibadan; and Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Amos O Adeleye
- Department of Surgery, College of Medicine, University of Ibadan; and Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
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Onyia CU, Morgan E, Oyemolade TA, Ekweogwu OC, Orhorhoro OI, Ahmad MH, Ayodele OA, Usman B, Badejo OA, Dawang Y, Malomo TA, Nwaribe EE, Okere OE, Abu-Bonsrah N, Petitt Z, Njeru PN, Oboh EC, Otun A, Deng DD, Ogundeji OD, Still MEH, Nischal SA, Seas A, Asemota I, Oboh EN, Ugorji C, Reddy R, Rahman R, Trillo-Ordonez Y, Waguia-Kouam R, von Isenburg M, Chikani MC, Adeleye AO, Adeolu AA, Haglund MM, Ukachukwu AEK, Fuller AT. The Role of International Collaborations in Sustainable Neurosurgical Development in Nigeria. World Neurosurg 2024; 185:e264-e273. [PMID: 37979681 DOI: 10.1016/j.wneu.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE Despite 6 decades of existence, neurosurgery is still in the developing stages in Nigeria. In this era of collaborative health system capacity-building in low- and middle-income countries, this article reviews past efforts and future prospects for collaborative neurosurgical development in Nigeria. METHODS A bibliometric review of the Nigerian neurosurgical literature and data from a structured survey of Nigerian neurosurgeons and residents provided details of current local and international collaborations for neurosurgical research, service delivery, training, and capacity building. These were analyzed to provide an overview of the role of collaborations in sustainable neurosurgical development in Nigeria and to recommend approaches to enhance neurosurgical capacity. RESULTS In 1023 peer-reviewed neurosurgery publications from Nigeria, there were 4618 authors with 3688 from 98 Nigerian institutions and 930 from 296 foreign institutions in 70 countries. While there were significant research collaborations amongst Nigerian institutions, the most common were with institutions in the US, United Kingdom, and Cameroon. From the survey, 62 of 149 respondents (41.6%) from 32 health facilities noted their institution's involvement in capacity-building neurosurgical collaborations. These collaborations involved 22 Nigerian institutions and 13 foreign institutions in 9 countries and were mostly for training and workforce development (78.1%), and research and data management (59.4%). The majority of foreign institutions were from the US and United Kingdom. CONCLUSIONS Current and previous neurosurgical collaborations have led to sustainable progress in Nigeria. Further local, regional, and international collaborations would enhance the capacity to address the needs and challenges affecting neurosurgery in Nigeria.
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Affiliation(s)
| | - Eghosa Morgan
- Department of Surgery, Babcock University Teaching Hospital, Ilishan Remo, Nigeria
| | | | - Ofodile C Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Omuvie I Orhorhoro
- Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Misbahu H Ahmad
- Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zoey Petitt
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Paula N Njeru
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Ena C Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Augustine A Adeolu
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Ukachukwu AEK, Fuller AT, Hurlbert RJ. Sustainable Neurosurgical Development in Nigeria Despite Resource Limitations: A Lesson for the Future of Global Neurosurgery. World Neurosurg 2024; 185:491-492. [PMID: 38741322 DOI: 10.1016/j.wneu.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA; Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA.
| | - Anthony T Fuller
- Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke Global Health Institute, Durham, North Carolina, USA; Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - R John Hurlbert
- Department of Neurosurgery, University of Arizona, Tucson, Arizona, USA
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Corell A, Jabang JN, Manneh J, Manneh EK, Tisell M, Brandt C, Majing T, Smedberg C, Förars C, Rebucas S, Goswell P, Ronold T, Landén C, Engström A, Sorto P, Uche E, Wague D, Sakho Y, Sundblom J. Successful adaptation of twinning concept for global neurosurgery collaborations-a validation study. Acta Neurochir (Wien) 2024; 166:174. [PMID: 38600222 PMCID: PMC11006720 DOI: 10.1007/s00701-024-06060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/06/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Globally, many regions have an urgent, unmet need of neurosurgical care. A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), was proved to be successful during a previous mission to Neurosurgical Unit, Enugu, Nigeria. The Swedish African Neurosurgical Collaboration (SANC) performed a developmental mission together with the local neurosurgical unit in The Gambia, adopting the INTIMA model. METHODS A multidisciplinary team visited for a 2-week collaborative mission at the Neurosurgical Department of the Edward Francis Small Teaching Hospital in Banjul, The Gambia. The mission followed the data of neurosurgical operations during and after the mission as well as about the operations 3 months prior to and after the mission was collected. RESULTS During the mission, a total of 22 operations was carried out, the most common being degenerative spinal conditions (n = 9). In the 3 months following the mission, 43 operations were performed compared to 24 during the 3 months leading up to the mission. The complexity of the performed procedures increased after the mission. An operating microscope (Möller-Wedel) was donated and installed and the neurosurgeons on site underwent training in microneurosurgery. The surgical nurses, nurses at the postoperative ward, and the physiotherapists underwent training. A biomedical engineer serviced multiple appliances and devices improving the patient care on site while training local technicians. CONCLUSION This study validated the use of the INTIMA model previously described in a mission by Swedish African Neurosurgical Collaboration (SANC). The model is sustainable and produces notable results. The core strength of the model is in the multidisciplinary team securing all the aspects and steps of the neurosurgical care. Installation of an operating microscope opened for further microsurgical possibilities, improving the neurosurgical care in The Gambia.
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Affiliation(s)
- Alba Corell
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden.
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - John N Jabang
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Job Manneh
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Ebrima K Manneh
- Neurosurgical Unit, Department of Surgery, EFSTH Teaching Hospital, Banjul, The Gambia
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Christian Brandt
- Neurosurgical Department, Lund University Hospital, Lund, Sweden
| | - Tomas Majing
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Camilla Smedberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Förars
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Sarinah Rebucas
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Pascal Goswell
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Ronold
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Caroline Landén
- Department of Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Engström
- Department of Strategic Planning, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Sorto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Enoch Uche
- Department of Neurosurgery, The University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Daouda Wague
- Department of Neurosurgery, Fann University Teaching Hospital, Dakar, Senegal
| | - Youssoupha Sakho
- Department of Neurosurgery, Grand Yoff General Hospital, Dakar, Senegal
| | - Jimmy Sundblom
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
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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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Cheyuo C, Hodaie M. Editorial. Neurosurgical capacity-building in Africa: how do we build an equitable future? J Neurosurg 2023; 138:1098-1099. [PMID: 35962962 DOI: 10.3171/2022.5.jns22378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cletus Cheyuo
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario; and
| | - Mojgan Hodaie
- 1Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario; and
- 2Krembil Research Institute, Toronto, Ontario, Canada
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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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Uche E, Sundblom J, Uko UK, Kamalo P, Nah Doe A, Eriksson L, Sandvik U, Revesz DF, Ryttlefors M, Tisell M. Global neurosurgery over a 60-year period: Conceptual foundations, time reference, emerging Co-ordinates and prospects for collaborative interventions in low and middle income countries. BRAIN & SPINE 2022; 2:101187. [PMID: 36506294 PMCID: PMC9729807 DOI: 10.1016/j.bas.2022.101187] [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: 06/03/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/15/2022]
Abstract
Introduction We evaluated salient initiatives invested in global neurosurgery over a 60-year period. Research question What are the Phases, Achievements, Challenges, and Lessons of Global Neurosurgery. Methods A 60-year retrospective study from 1960 to 2020 analyzing the major phases, lessons, and progress notes. We reviewed the foundational need questions and innovated tools used to answer them. Results Three phases defining our study period were identified. In the early phase, birthing academic units and the onset of individual volunteerism were dominant concepts. The 2nd phase is summarized by the rise of volunteerism and surgical camps.The third phase is heralded by advocacy and strategies for achieving care equity. The defining moment is the Lancet commission for global surgery summit in 2015. Lessons include the need for evaluation of the resources of recipient and donor locations using novel global surgery tools. Conclusion Global neurosurgery over the 60-year study period is summarized by indelible touchstones of personal and group efforts as well as triumphs derived from innovations in the face of formidable challenges.
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Affiliation(s)
- E.O. Uche
- Neurosurgery Unit, Faculty of Medical Sciences, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria,Corresponding author. Neurosurgery Unit, Faculty of MedicalSciences, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu 40001, Nigeria.
| | - Jimmy Sundblom
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Uko Kalu Uko
- Neurosurgery Unit, Faculty of Medical Sciences, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria
| | - Patrick Kamalo
- Department of Neurosurgery, Blantyre Institute of Neurological Sciences, Malawi
| | - Alvin Nah Doe
- Neurosurgery Unit, Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia
| | - Linn Eriksson
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Sandvik
- Department of Neurosurgery/ Clinical Neuroscience, The Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden
| | - David F Revesz
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, 13 45, Gothenburg, Sweden
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Uche EO, Eke CB, Okafor OC, Uche NJ, Ajuzieogu OV, Amuta DS, Onyia EE, Guga DA, Okpara S, Mezue WC, Tisell M, Ryttlefors M. Pediatric brain tumor care in a Sub-Saharan setting: current poise of a precariously loaded dice. Br J Neurosurg 2020; 35:174-180. [PMID: 32657167 DOI: 10.1080/02688697.2020.1777259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the current status of pediatric brain tumor (PBT) care and identify determinants and profiles of survival and school attendance. METHODS An 8-year institution-based prospective longitudinal study. All cases investigated with neuroimaging and treated were enrolled. Data was analyzed with SPSS (Inc) Chicago IL, USA version 23. Chi Square test, One-way ANOVA and confidence limits were used to evaluate associations at the 95% level of significance. Ethical approval for our study was obtained Health Research Ethics Committee of our hospital. RESULTS Among 103 patients enrolled, 92 satisfied our study criteria. There were 45 males and 39 females, M: F = 0.8. The mean age was 9.5 ± 2.1 years 95%CI with a range of 7 months to 16 years. The most common symptom was headache for supratentorial lesions (73%) and gait disturbance (80.2%) for infratentorial lesions. More tumors were supratentorial in location 51 (55.4%), 35 (38.1%) were infratentorial and 6 (6.5%) were transtentorial. Craniopharyngiomas (n = 23), medulloblastomas (n = 22) and astrocytomas (n = 15) were the most common tumors. Hemoglobin genotype (AA and AS) had some influence on tumor phenotype FT, P = 0.033. 76 cases were microsurgically resected while 16 patients were treated with radiotherapy alone. The 30-day mortality for operated cases is 7.2 ± 0.7%. Overall 1-year and 5-year survival was 66.7 and 52.3%, respectively. School attendance, performance and outcome varied among treatment subgroups. CONCLUSION Survival profile in this series suggests some improvement in comparison to previous studies from our region, Hemoglobin genotype profiles may signature paediatric brain tumor phenotypes in our setting.
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Affiliation(s)
- Enoch Ogbonnaya Uche
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Christopher B Eke
- Department of Pediatrics, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid and Anatomic Pathology, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | | | - Obinna V Ajuzieogu
- Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dubem S Amuta
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ephraim E Onyia
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Dung A Guga
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Samuel Okpara
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Wilfred C Mezue
- Division of Neurosurgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria
| | - Magnus Tisell
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
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