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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, Oyemolade TA, Nischal SA, Onyia CU, Morgan E, Ekweogwu OC, Orhorhoro OI, Ahmad MH, Ayodele OA, Usman B, Badejo OA, Dawang Y, Okere OE, Abu-Bonsrah N, Deng DD, Petitt Z, Njeru PN, Oboh EC, Otun A, Still MEH, Haglund MM, Fuller AT, Chikani MC, Adeleye AO, Adeolu AA. Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool. World Neurosurg 2024; 185:e30-e43. [PMID: 38741328 DOI: 10.1016/j.wneu.2023.12.104] [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: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria. METHODS An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index. RESULTS The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%). CONCLUSIONS The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.
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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.
| | | | - Shiva A Nischal
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - 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
| | - Olabamidele A Ayodele
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Babagana Usman
- Department of Surgery, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
| | - Oluwakemi A Badejo
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Yusuf Dawang
- Department of Surgery, University of Abuja Teaching Hospital, Abuja-FCT, Nigeria
| | - Oghenekevwe E Okere
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Paula N Njeru
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ena C Oboh
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Ayodamola Otun
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida at Gainesville, Gainesville, Florida, USA
| | - 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
| | - Mark C Chikani
- Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Amos O Adeleye
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Augustine A Adeolu
- Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
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