A Geospatial Analysis of the Availability, Distribution, and Accessibility of Neurosurgical Facilities, Workforce, and Infrastructure in Nigeria; and Projection Towards 2050

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.

The Status of Specialist Neurosurgical Training in Nigeria: A Survey of Practitioners, Trainers, and Trainees

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.

The Role of International Collaborations in Sustainable Neurosurgical Development in Nigeria

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.

Women in Nigerian Neurosurgery: A Cross-Sectional Survey

BACKGROUND

Although women have made remarkable strides in several medical specialties in Sub-Saharan Africa, their presence and contribution to the development of neurosurgery remain limited. We sought to study the gender differences within Nigerian neurosurgery, identify challenges resulting from these differences, and recommend how African female neurosurgeons can maximize their effects in neurosurgery.

METHODS

A structured online survey captured data on neurosurgical infrastructural capacity, workforce, and training from neurosurgical consultants and residents in neurosurgical centers in Nigeria. All the collected data were coded and analyzed.

RESULTS

Altogether, 82 neurosurgical consultants and 67 neurosurgical residents from 50 primary medical institutions in Nigeria completed the online survey. Only 8 of the respondents (5.4%) were women, comprising 3 consultants, 2 senior residents, and 3 junior residents. Although 40.2% of the respondents did not believe that being female affected the decision of whether to specialize in neurosurgery, 46.3% believed that being female was a disadvantage. Most did not believe that being female affected admission (57.8%), completion of a neurosurgery residency (58.5%), or life working as a neurosurgeon after graduation (63.4%). The most common challenges women face while navigating through neurosurgery training and practice are erosion of family and social life, lack of female mentors, and lack of a work-life balance.

CONCLUSIONS

There is a deficit of both female consultants and trainees among Nigerian neurosurgeons. Identifying female medical students with a strong interest in neurosurgery and providing early mentorship might increase the number of female neurosurgeons.

Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool

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.

Assessment of physicians' knowledge of Glasgow coma score

BACKGROUND

Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological services are not conversant with this life-saving tool.

OBJECTIVE

The objective of this study was to assess the level of knowledge of GCS among physicians practicing in a tertiary institution in South-East Nigeria, and to evaluate the call for a new and simpler scoring system.

MATERIALS AND METHODS

This study was carried out using the instrument of a structured-questionnaire in Nnamdi Azikiwe University Teaching Hospital Nnewi, a federal government tertiary health institution in South-East Zone of Nigeria, which is a 350-bed facility employing about 550 medical doctors of different cadres.

RESULTS

A total of 139 questionnaires were distributed to the doctors practicing in the institution who consented to participating in the study. The questionnaires were completed at the point of their administration and completed questionnaires were retrieved on the spot, and data were collated, and analyzed with the Statistical Package for Social Sciences, SPSS version 17.0. Statistical significance was calculated with the chi square, P ≤ 0.5. The modal age group was 20-30 years 66 (48%), and most were resident doctors 99 (66.2%). One week prior to the questionnaire distribution, 56 (42.1%) had been actively involved in emergency care of patients, and 41 (30%) could not recall what GCS stood for. Medical and house officers showed a better knowledge of GCS.

CONCLUSION

There was a poor knowledge of GCS among a good number of physicians practicing in our setting and hence, continuing medical education on GCS is strongly advocated.

Outcome of spinal cord injuries managed in a centre without modern imaging facilities

BACKGROUND

The paucity of published reports from West Africa on the outcome of spinal cord injuries (SCI) reflects the limitations of the developing health care delivery system in this part of the world.

OBJECTIVE

To review the outcome of the spinal cord injuries managed in our centre and relate same to those of published reports.

METHODS

We conducted a prospective study by utilizing a structured proforma on all SCI cases admitted to and managed in our service from April 21, 2006 to April 20, 2008. The collated data were then analyzed and compared to the literature.

RESULTS

Spinal injury (neural and non-neural) was diagnosed in 62 (7.5%) of 826 total consultations in the two-year period under study. Thirty five (56.5%) of them were less than 40 years with fewer cases at the extremes of age, and most 47 (76%) were males. Forty nine (79%) had neural injuries of which the majority (94%) involved the spinal cord. Treatment was nonoperative in all cases, and all those with complete cord injury remained without neurological recovery, whereas 91% of cases of incomplete injuries made varying degrees of recovery. Mortality from the cord injuries was 13 (28.3%), and all were in the cervical region. Twenty (32.3%) were followed up in the outpatient clinic for a mean period of 13.7 weeks (range 1.4 to 63.4 weeks) following discharge.

CONCLUSION

Our findings support the reports that cases of incomplete cord injury make neurological recovery, while those of complete injury do not. Our mortality rate of 28.3% compares closely with the mortality rates from other local series.