Neurosurgical capacity building in the developing world through focused training

Abstract

Object In Tanzania, there are 4 neurosurgeons for a population of 46 million. To address this critical shortage of neurosurgical care, the authors worked with local Tanzanian health care workers, neurosurgeons, the Ministry of Health and Social Welfare, and the Office of the President of Tanzania to develop a train-forward method for sustainable, self-propagating basic and emergency neurosurgery in resource-poor settings. The goal of this study was to assess the safety and effectiveness of this method over a 6-year period. Methods The training method utilizes a hands-on bedside teaching technique and was introduced in 2006 at a remote rural hospital in northern Tanzania. Local health care workers were trained to perform basic and emergency neurosurgical procedures independently and then were taught to train others. Outcome information was retrospectively collected from hospital records for the period from 2005 (1 year before method implementation) through 2010. Analysis of de-identified data included descriptive statistics and multivariable assessment of independent predictors of complications following a patient's first neurosurgical procedure. Results By 2010, the initial Tanzanian trainee had trained a second Tanzanian health care worker, who in turn had trained a third. The number of neurosurgical procedures performed increased from 18 in 2005 to an average of 92 per year in the last 3 years of the study period. Additionally, the number of neurosurgical cases performed independently by Tanzanian health care providers increased significantly from 44% in 2005 to 86% in 2010 (p < 0.001), with the number of complex cases independently performed also increasing over the same time period from 34% to 83% (p < 0.001). Multivariable analysis of clinical patient outcome information to assess safety indicated that postoperative complications decreased significantly from 2005 through 2010, with patients who had been admitted as training progressed being 29% less likely to have postoperative complications (OR 0.71, 95% CI 0.52–0.96, p = 0.03). Conclusions The Madaktari Africa train-forward method is a reasonable and sustainable approach to improving specialized care in a resource-poor setting.

Enhancing Neurosurgical Education in Low- and Middle-income Countries: Current Methods and New Advances

“…5) Second, LMICs often see neurosurgical pathology presenting late in the course of the disease, making care far more complicated, and consequently increasing morbidity and mortality. 6) Other remaining factors affecting care include resource limitations and the limited ability of patients’ financial access, affecting the availability of some neurosurgical services such as MR imaging. 13) …”

“…6) However, neurological disorders affect people worldwide, regardless of age, sex, income, or level of education. Neurological illnesses, including traumatic brain injuries, degenerative diseases, and congenital disorders, affect up to one billion individuals.…”

“…4) In the developing world, approximately half the population are younger than 18 years of age. 6) These individuals, soon to become the most productive members of society, form a particularly vulnerable population with respect to the risk of traumatic injuries, the most common and prevalent cause for neurological injury in LMICs. 9) Clearly, an investment in affordable neurosurgical services for LMICs is not only an important life-saving action, it also fosters a much needed economic growth in the developing world.…”

“…9) Clearly, an investment in affordable neurosurgical services for LMICs is not only an important life-saving action, it also fosters a much needed economic growth in the developing world. 6) …”

Neurosurgical education in Egypt and Africa

“…Neurosurgery has been overlooked and falsely considered to be a luxury all over the world. 9 Neurosurgical care has not been considered a health priority, especially in the African continent. Without accessible neurosurgical care, easily treatable diseases will become high-risk diseases with high morbidity and mortality rates.…”