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Tirsit A, Yigaramu M, Zewdneh D, Kucha W, Hagos S, Shikur B, Laeke T, Moen BE, Lie RT, Lund-Johansen M, Mahesparan R. Risk Factors for Neural-Tube Defects Detected in Utero: A Prospective Community-Based Study from Addis Ababa. World Neurosurg 2024; 185:e683-e690. [PMID: 38417626 DOI: 10.1016/j.wneu.2024.02.108] [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: 12/12/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND A recent community-based study from Addis Ababa identifying Neural Tube Defect (NTD) cases by ultrasound examination of pregnant women showed a higher prevalence of 17 per 1000 fetuses. The risk factors behind the high prevalence remain unclear. METHODS Altogether 891 of the 958 women participated in the ultrasound examination. Thirteen with unaffected twin pregnancies were excluded. Among 878 singleton pregnancies, 15 NTD cases were identified. Serum Folate, vitamin B12, and homocysteine levels were measured in case-mothers and a sub-set of 28 noncase mothers. Because of the modest sample size, exact logistic regression analysis was used to estimate associations between risk factors and NTDs. RESULTS Serum vitamin status was generally poor for participants in the study. Still, relatively higher values of folate or vitamin B12 in serum, appeared to be protective for NTD (odds ratio [OR] = 0.61 per ng/ml, 95% Confidence interval [CI]: 0.42-0.85 and OR = 0.67 per 100 pg/ml, 95% CI: 0.41-1.02, respectively). High serum homocysteine was associated with higher risk of NTD (OR = 1.3 per μmol/l, 95% CI: 1.02-1.8). Women aged 30 years or more had an OR of 3.5 (95% CI: 1.1-12) for having a NTD child, and families with NTD children had lower household income. Women in the NTD group also had more spontaneous abortions or stillbirths in previous pregnancies. Self-reported intake of folate did not appear to protect against NTDs. CONCLUSIONS Within this high-prevalence community, poor vitamin status was identified as a risk factor for NTDs detected at ultrasound examination. Improving food security and fortification of foods or food ingredients could be alternative measures.
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Affiliation(s)
- Abenezer Tirsit
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Mahlet Yigaramu
- Department of Gynecology and Obstetrics, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Zewdneh
- Department of Radiology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Winner Kucha
- Department of Biochemistry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seifu Hagos
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bilal Shikur
- School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsegazeab Laeke
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bente E Moen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rolv T Lie
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway; Centre for Fertility and Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Rupavathana Mahesparan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway.
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Tesfay N, Hailu G, Habtetsion M, Woldeyohannes F. Birth prevalence and risk factors of neural tube defects in Ethiopia: a systematic review and meta-analysis. BMJ Open 2023; 13:e077685. [PMID: 37940152 PMCID: PMC10632862 DOI: 10.1136/bmjopen-2023-077685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context. STUDY DESIGN Systematic review and meta-analysis. STUDY PARTICIPANTS A total of 611 064 participants were included in the review obtained from 42 studies. METHODS PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I2 test statistics. Small study effects were checked using Egger's statistical test at a 5% significance level. RESULT The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I2= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases. CONCLUSION The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures. PROSPERO REGISTRATION NUMBER CRD42023413490.
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Affiliation(s)
- Neamin Tesfay
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Girmay Hailu
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Medhanye Habtetsion
- Centre of Public Health Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fistum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Mengiste FG, Shibeshi MS, Gechera DY. Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome. Pediatric Health Med Ther 2023; 14:289-299. [PMID: 37746523 PMCID: PMC10517686 DOI: 10.2147/phmt.s421868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Background There is a huge burden of neural tube defect (NTD) in Ethiopia, and surgical management is not readily available. We aimed to assess the clinical profile and hospital outcome of children with NTD that were operated in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. Methods A retrospective cross-sectional study on 250 children with NTD that were treated in a tertiary hospital from March 2016 to May 2020 was conducted to describe the clinical profile and treatment outcome at discharge. Logistic regression analysis was carried out to evaluate factors that determine mortality. Results Out of the 250 children, 50.4% were male. Myelomeningocele was the most common type of NTD (77.2%) followed by meningocele (10.4%). Only 3 mothers (1.2%) received periconceptional folic acid. Prenatal diagnosis of NTD was made in only 22 (8.8%) cases. 52.8% of the NTDs were ruptured at presentation and 50.8% had associated sepsis. At presentation, 42.4% were ≤72 hours of age and only 18 neonates (7.2%) were operated within 72 hours of admission. 54% had associated hydrocephalus, 31.6% had Chiari II malformation and 19.6% had club foot. Surgical site infection, post MMC repair hydrocephalus, and meningitis were seen in 8%, 14% and 16.8% of the participants, respectively. The mean duration of hospitalization was 24 ± 14.4 days. Twenty patients (8%) died before discharge from hospital. Prematurity [AOR: 26 (95% CI: 8.01, 86.04), P < 0.001] and the presence of meningitis [AOR: 3.8 (95% CI: 1.12,12.9), P = 0.03]were determinants of mortality. Conclusion NTDs are substantial health problem in this part of the country. Periconceptional folic acid supplementation is almost non-existent. Prenatal detection of NTDs is very low and management is delayed in the majority of cases. Myelomeningocele is the most common type of NTD. There is high in-hospital mortality, and prematurity and the presence of meningitis are its determinants.
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Tirsit A, Zewdneh D, Yigeremu M, Legese A, Moen BE, Lie RT, Lund-Johansen M, Mahesparan R. Prevalence of neural tube defects among pregnant women in Addis Ababa: a community-based study using prenatal ultrasound examination. Childs Nerv Syst 2023; 39:2423-2431. [PMID: 36864350 PMCID: PMC10432327 DOI: 10.1007/s00381-023-05901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE The primary aim of this study was to estimate the prevalence of NTDs at ultrasound examination in communities of Addis Ababa and secondarily to provide a description of the dysmorphology of the NTD cases. METHODS We enrolled 958 pregnant women from 20 randomly selected health centers in Addis Ababa during the period from October 1, 2018, to April 30, 2019. Of these 958 women, 891 had an ultrasound examination after enrollment, with a special focus on NTDs. We estimated the prevalence of NTDs and compared it with previously reported hospital-based birth prevalence estimates from Addis Ababa. RESULTS Among 891 women, 13 had twin pregnancies. We identified 15 NTD cases among 904 fetuses, corresponding to an ultrasound-based prevalence of 166 per 10,000 (95% CI: 100-274). There were no NTD cases among the 26 twins. Eleven had spina bifida (122 per 10,000, 95% CI: 67-219). Among the 11 fetuses with spina bifida, three had a cervical and one had a thoracolumbar defect while the anatomical site for 7 was not registered. Seven of the 11 spina bifida defects had skin covering, while two of the cervical lesions were uncovered. CONCLUSION We report a high prevalence of NTDs among pregnancies in communities of Addis Ababa based on screening by ultrasound. The prevalence was higher than in previous hospital-based studies in Addis, and the prevalence of spina bifida was particularly high.
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Affiliation(s)
- Abenezer Tirsit
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Daniel Zewdneh
- Department of Radiology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mahlet Yigeremu
- Department of Gynecology and Obstetrics, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aga Legese
- Department of Radiology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bente E Moen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolv T Lie
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Rupavathana Mahesparan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Bergen, Norway.
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Tirsit A, Bizuneh Y, Yesehak B, Yigaramu M, Demetse A, Mengesha F, Masresha S, Zenebe E, Getahun S, Laeke T, Moen BE, Lund-Johansen M, Mahesparan R. Surgical treatment outcome of children with neural-tube defect: A prospective cohort study in a high volume center in Addis Ababa, Ethiopia. BRAIN & SPINE 2023; 3:101787. [PMID: 38020985 PMCID: PMC10668049 DOI: 10.1016/j.bas.2023.101787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 12/01/2023]
Abstract
Introduction Prevalence of neural tube defects (NTD) is high thus many children are born with a neural tube defect in Addis Ababa, and surgical closure is a commonly performed procedure at the pediatric neurosurgical specialty center. Research question The primary aim is to study the outcomes in children undergoing surgical closure of NTDs and to identify risk factors for readmission, complications and mortality. Material and methods Single-center prospective study of all surgically treated NTDs from April 2019 to May 2020. Results A total of 228 children, mean age 11 days (median 4) underwent surgery during the study period. There were no in-hospital deaths. Perioperatively 11 (4.8%) children developed wound complications, none of them needed surgery and there was no perioperative mortality. The one-year follow-up rate was 62.7% (143/228) and neurological status remained stable since discharge in all. The readmission and reoperation rates were 38 % and 8 % and risk factors for readmission were hydrocephalus (80%) and open defects (88%). Hydrocephalus (P = 0.05) and younger age (P = 0.02) were identified as risk factors for mortality. The wound-related complication rate was 55% at and was associated with large defects (P = 0.04) and delayed closure due to late hospital presentation (P = 0.01). Discussion and conclusion The study reveals good perioperative surgical outcome and further need for systematic improvement in treatment and follow-up of NTD patients especially with hydrocephalus. We identified risk factors for wound-related complications, readmission and mortality.
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Affiliation(s)
- Abenezer Tirsit
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
- Department of Clinical Medicine, University of Bergen, Norway
| | - Yemisirach Bizuneh
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
| | - Bethelehem Yesehak
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
| | - Mahlet Yigaramu
- Department of Gynecology and Obstetrics, College of Health Science, Addis Ababa University, Ethiopia
| | - Asrat Demetse
- Department of Pediatrics and Child Health, College of Health Science, Addis Ababa University, Ethiopia
| | - Filmon Mengesha
- Department of Psychiatry, College of Health Science, Addis Ababa University, Ethiopia
| | - Samuel Masresha
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
| | - Eyob Zenebe
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
| | - Samuel Getahun
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
| | - Tsegazeab Laeke
- Division of Neurosurgery, College of Health Science, Addis Ababa University, Ethiopia
- Department of Clinical Medicine, University of Bergen, Norway
| | - Bente E. Moen
- Departments of Global Public Health and Primary Care, University of Bergen, Norway
| | - Morten Lund-Johansen
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Norway
| | - Rupavathana Mahesparan
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, University of Bergen, Norway
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Koning M, Koning J, Kancherla V, O'Neill P, Dorsey A, Zewdie K, Yesehak B, Ashagre Y, Woldermarium M, Biluts H. A case study of ReachAnother Foundation as a change champion for developing spina bifida neurosurgical care and advocating for primary prevention in Ethiopia. Childs Nerv Syst 2023; 39:1783-1790. [PMID: 36964773 PMCID: PMC10039347 DOI: 10.1007/s00381-023-05932-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023]
Abstract
Spina bifida is a serious birth defect affecting the central nervous system, characterized by incomplete closure of the neural tube. Ethiopia has a very high prevalence of spina bifida, affecting about 40 cases per 10,000 births. Babies born with spina bifida require early closure surgery, done within the first 2-3 days after birth. Some babies need repeat surgeries to address complications, including hydrocephalus. Without medical care, babies have a high risk of death within the first 5 years of their life. Neurosurgical capacity for spina bifida closure surgery at birth is a relatively new development in Ethiopia. ReachAnother Foundation, a not-for-profit organization based in OR, USA, started work in Ethiopia in 2009 and has been instrumental in training neurosurgeons and improving treatment for spina bifida and hydrocephalus. Along with the development of neurosurgical care, the Foundation has invested in training multi-disciplinary teams to conduct patient aftercare and has launched a platform for improved patient outcomes research. As of year 2022, they support six spina bifida "Centers of Excellence" nationwide and are continuously advocating for primary prevention of spina bifida through mandatory fortification of staple foods in Ethiopia. This paper describes ReachAnother's efforts in Ethiopia in a short interval of time, benefiting numerous patients and families with spina bifida and anencephaly. We document this as a case study for other countries to model where resources are limited and the prevalence of spina bifida and hydrocephalus is high, especially in Asia and Africa.
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Affiliation(s)
- Marinus Koning
- ReachAnother Foundation, 1900 NE 3Rd St, Bend, OR, 97701, USA
| | - Jan Koning
- ReachAnother Foundation Nederland, Delft, the Netherlands
| | - Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Amanda Dorsey
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Kibruyisfaw Zewdie
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelehem Yesehak
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yordanos Ashagre
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Hagos Biluts
- Department of Neurosurgery, Addis Ababa University, Addis Ababa, Ethiopia
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Abdi H, Wang Z, Ham EI, Laeke T, Park KB, Negida A, Bizuneh Y, Tirsit A. Neurosurgery Research Output in Ethiopia: A Scoping Review. World Neurosurg 2022; 164:291-297. [PMID: 35609725 DOI: 10.1016/j.wneu.2022.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurosurgery-specific research plays a critical role in improving outcomes in patients with neurosurgical diseases. Despite the high burden of neurosurgical diseases in Ethiopia, little is known about types of neurosurgical research from Ethiopia. The goal of this scoping review is to assess the quantity and types of neurosurgical research published in peer-reviewed journals by authors from Ethiopia. METHODS PubMed, CINAHL, Embase, and Scopus were searched for Ethiopian neurosurgery literature published from 2001 to 2021. We selected articles based on the following criteria: articles must 1) discuss topics within neurosurgery and 2) focus on clinical practice and/or public health in Ethiopia. We collected data on research originality, study designs, and clinical versus public health research. The frequencies and percentages of categorical variables were reported. All analyses were conducted using Jamovi software. RESULTS Of the 362 results, 89 neurosurgical research articles were included in the final analysis. Of the 89 articles, case reports/series were most common (28.7%), followed by retrospective cohort (20.7%) and prospective cohort studies (18.4%). There were 8 literature reviews (9.2%) and 1 systematic review and meta-analysis (1.1%). No randomized controlled trial was found. Of all articles, 66 (75.9%) focused on clinical practice, and 21 (23.6%) were related to the public health aspect of neurosurgery. Forty-two articles (48.3%) included authors only from Ethiopia; 37 articles (42.5%) involved collaboration between Ethiopian and authors from another country, and 8 articles (9.2%) did not have Ethiopian authors. CONCLUSIONS Neurosurgery research from Ethiopia is lacking, despite its high disease burden. Case reports/series and cohort studies remain the mainstay, with few systematic reviews and no randomized controlled trial. International collaboration accounts for approximately half of Ethiopian neurosurgery research output. Further research support and infrastructure should be developed to encourage neurosurgery articles from Ethiopia.
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Affiliation(s)
- Hodan Abdi
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Zhe Wang
- Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Edward I Ham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Stony Brook University, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Tsegazeab Laeke
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed Negida
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Yemisirach Bizuneh
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abenezer Tirsit
- Neurosurgery Units, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Asfaw ZK, Tirsit A, Barthélemy EJ, Mesfin E, Wondafrash M, Yohannes D, Ashagre Y, Park K, Laeke T. Neurosurgery in Ethiopia: A New Chapter and Future Prospects. World Neurosurg 2021; 152:e175-e183. [PMID: 34052452 DOI: 10.1016/j.wneu.2021.05.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Inequitable access to surgical care is most conspicuous in low-income countries (LICs), such as Ethiopia, where infectious diseases, malnutrition, and other maladies consume the lion's share of the available health resources. The aim of this article was to provide an update on the current state of neurosurgery in Ethiopia and identify targets for future development of surgical capacity as a universal health coverage component in this East African nation. METHODS Publicly available data included in this report were gathered from resources published by international organizations. A PubMed search was used for a preliminary bibliometric analysis of scholarly output of neurosurgeons in Ethiopia and other low-income countries. Statistical analysis was used to determine the correlation between the number of neurosurgeons and academic productivity. RESULTS Neurosurgeon density has increased >20-fold from 0.0022 to 0.045 neurosurgeons per 100,000 population between 2006 and 2020. The increase in neurosurgeons was strongly correlated with an increase in total publications (P < 0.001) and the number of new publications per year (P = 0.003). Despite recent progress, the availability of neuroimaging equipment remains inadequate, with 38 computed tomography scanners and 11 magnetic resonance imaging machines for a population of 112.07 million. The geographic distribution of neurosurgical facilities is limited to 12 urban centers. CONCLUSIONS Ethiopian neurosurgery exemplifies the profound effect of international partnerships for training local surgeons on progress in low-income countries toward improved neurosurgical capacity. Collaborations that focus on increasing the neurosurgical workforce should synchronize with efforts to enhance the availability of diagnostic and surgical equipment necessary for basic neurosurgical care.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Abenezer Tirsit
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
| | - Ernest J Barthélemy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elam Mesfin
- Department of Neurosurgery, Mekelle University, Mekelle, Ethiopia
| | - Mulualem Wondafrash
- Department of Neurosurgery, St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Yordanos Ashagre
- Department of Neurosurgery, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kee Park
- Program in Global Surgery and Social Change, Department of Global Health & Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tsegazeab Laeke
- Neurosurgery Division, Department of Surgery, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
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