Neurosurgical Care: Availability and Access in Low-Income and Middle-Income Countries

Punchak, Maria; Mukhopadhyay, Swagoto; Sachdev, Sonal; Hung, Ya‐Ching; Peeters, Sophie; Rattani, Abbas; Dewan, Michael C.; Johnson, Walter D.; Park, Kee B.

doi:10.1016/j.wneu.2018.01.029

Cited by 157 publications

(82 citation statements)

References 15 publications

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“…6 Survey structure and question format were in accordance with the methodology previously outlined by Shrime et al 15 Surgeons had been identified via a global mapping project facilitated by the World Federation of Neurosurgical Societies (WFNS) and the Global Initiative Emergency and Essential Surgical Care (GIEESC) at the WHO. 13,14 Briefly, officers of the 130 societies registered with the WFNS or the members of the GIEESC were initially contacted via email to invite participation. For some countries without WFNS/WHO neurosurgery representation, an Internet search including "neurosurg* + country name" was conducted to identify the contact information for a single practicing neurosurgeon willing and able to complete the questionnaire.…”

Section: Survey Administrationmentioning

confidence: 99%

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective

Dewan

Rattani

Baticulon

et al. 2019

Journal of Neurosurgery

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OBJECTIVEThe global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload.METHODSAn electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics—including case volume and perceived workload—were also captured.RESULTSEighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon’s perceived workload (0—not busy, 100—overworked), respondents selected a mean workload of 75 (median 79).CONCLUSIONSWith a high level of confidence and strong concordance, neurosurgeons estimated that the vast majority of patients with central nervous system tumors, hydrocephalus, or neural tube defects mandate neurosurgical involvement. A significant proportion of other common neurological diseases, such as traumatic brain and spinal injury, vascular anomalies, and degenerative spine disease, demand the attention of a neurosurgeon—whether via operative intervention or expert counsel. These estimates facilitate measurement of the expected annual volume of neurosurgical disease globally.

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Section: Survey Administrationmentioning

confidence: 99%

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective

Dewan

Rattani

Baticulon

et al. 2019

Journal of Neurosurgery

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“…While searching for solutions to these issues, it must be kept in mind that the world faces a shortage of health resources and professionals to address the increasing burden of chronic and non-communicable diseases. These issues may be especially troublesome in underserved areas and low-and middle-income countries [1,[10][11][12][13][14]. In these regions, there is a risk of overuse or inappropriate use of urgent or specialty care to manage common spinal conditions such as non-specific back pain.…”

Section: Introductionmentioning

confidence: 99%

The Global Spine Care Initiative: model of care and implementation

et al. 2018

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“…An online model is a potential substitute to the surgical mission model in selected cases, which is also highly effective but significantly more expensive. While it is estimated that more than $250 million is spent each year for surgical trips alone, 25,31,32 eLearning projects would demand a fraction of this cost. Additionally, this model allows the students/trainees to have access to the learning material on demand, so review of different topics can be conducted at virtually any time and at any location.…”

Section: Online Surgical Curriculummentioning

confidence: 99%

Global neurosurgery: models for international surgical education and collaboration at one university

Almeida

Velásquez

Karekezi

et al. 2018

Neurosurgical Focus

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OBJECTIVEInternational collaborations between high-income (HICs) and low- and middle-income countries (LMICs) have been developed as an attempt to reduce the inequalities in surgical care around the world. In this paper the authors review different models for international surgical education and describe projects developed by the Division of Neurosurgery at the University of Toronto in this field.METHODSThe authors conducted a review of models of international surgical education reported in the literature in the last 15 years. Previous publications on global neurosurgery reported by the Division of Neurosurgery at the University of Toronto were reviewed to exemplify the applications and challenges of international surgical collaborations.RESULTSThe most common models for international surgical education and collaboration include international surgical missions, long-term international partnerships, fellowship training models, and online surgical education. Development of such collaborations involves different challenges, including limited time availability, scarce funding/resources, sociocultural barriers, ethical challenges, and lack of organizational support. Of note, evaluation of outcomes of international surgical projects remains limited, and the development and application of assessment tools, such as the recently proposed Framework for the Assessment of International Surgical Success (FAIRNeSS), is encouraged.CONCLUSIONSActions to reduce inequality in surgical care should be implemented around the world. Different models can be used for bilateral exchange of knowledge and improvement of surgical care delivery in regions where there is poor access to surgical care. Implementation of global neurosurgery initiatives faces multiple limitations that can be ameliorated if systematic changes occur, such as the development of academic positions in global surgery, careful selection of participant centers, governmental and nongovernmental financial support, and routine application of outcome evaluation for international surgical collaborations.

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Neurosurgical Care: Availability and Access in Low-Income and Middle-Income Countries

Cited by 157 publications

References 15 publications

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective

Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective

The Global Spine Care Initiative: model of care and implementation

Global neurosurgery: models for international surgical education and collaboration at one university

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