Neurosurgery in rural Nigeria: A prospective study

Abstract

Background:Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria.Objectives:This report details our initial experiences and the profile of neurosurgical admissions in our center.Methods:A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed.Results:A total of 249 males (75.2%) and 82 females (24.8%) were managed. The median age was 37 years (range: Day of birth – 94 years). Trauma was the leading cause of presentation with 225 (68.0%) and 35 (10.6%) having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%). Twenty-four (7.2%) patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4%) had satisfactory outcome while 30 (9.1%) died.Conclusion:Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities.

Starting a neurosurgical service in a Southern Nigeria rural community. Prospect, challenges, and future—the Irrua experience

“…These are also the absence of post-operative neuromonitoring and haemodynamic device, and thus has great impact on patients care. These issues were also noted some literature [8,11]. This sometimes endangers the patient, worsens neurological state of the patient, and overall outcome.…”

“…Irrua Specialist Teaching Hospital is geographically located in a rural community with a population of about 200,000. Starting a neurosurgical service in a rural setting portend a great challenge and it is tasking, our setup has also been likened to other similar settings as seen in the research by Rabiu et al [11] at Oshogbo, Nigeria, where the following were also encountered.…”

“…The challenges of starting a neurosurgical center in the rural area are quite enormous, though there are paucity of literature [2,8,11] on these challenges. These challenges include, ineffective coordination between all health care staffs with significant time wasted in attending to patients, manpower, critical care, materials for intervention, limited theater space, and post-operative care and which can result in significant mortality due to a variety of factors discussed below:…”

The Current State of Rural Neurosurgical Practice: An International Perspective

“…Trauma was the leading cause of presentation as 269 patients of the 331 underwent neurosurgical procedure due to a trauma-related event. [ 25 ]…”

“…The rural tertiary center studied by Rabiu and Komolafe was the first full-time rural neurosurgery center in the southwest of Nigeria,[ 25 ] serving an estimated 5 million people without access to CT, or magnetic resonance imaging (MRI). In 331 patients who presented for neurosurgical procedures (269 trauma-related, 62 nontrauma related), most frequently following motor vehicle accidents (80.3%) and assault (7.1%), with a breakdown of 66.2% mild TBI, 14.7% moderate TBI, and 19.1% severe TBI, only 54 (16.3%) received operative interventions.…”