On progress in Africa, by African experts

Figaji, Anthony; Taylor, Allan; Mahmud, Muhammad Raji; Bello, S Sergio; Wegoye, Emmanuel; Ssenyonga, Peter; Mogere, Edwin; Mankahla, Ncedile; Fieggen, Graham; Qureshi, Mahmood

doi:10.1016/s1474-4422(17)30457-x

Cited by 10 publications

(6 citation statements)

References 1 publication

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“…2 But others have strongly cautioned against this "anything is better than nothing" approach, urging a more earnest recognition and support by the international community of ongoing efforts to train competent neurosurgeons. 11 Nonetheless, general pediatric surgeons reported that, on average, 14% of their practice involved the management of patients with neurosurgical conditions. Moreover, in most countries, general neurosurgeons (those not self-identifying as pediatric specialists) care for children in addition to their primary, adult practice.…”

Section: Discussionmentioning

confidence: 99%

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Dewan

Baticulon

Rattani

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe presence and capability of existing pediatric neurosurgical care worldwide is unknown. The objective of this study was to solicit the expertise of specialists to quantify the geographic representation of pediatric neurosurgeons, access to specialist care, and equipment and training needs globally.METHODSA mixed-question survey was sent to surgeon members of several international neurosurgical and general pediatric surgical societies via a web-based platform. Respondents answered questions on 5 categories: surgeon demographics and training, hospital and practice details, surgical workforce and access to neurosurgical care, training and equipment needs, and desire for international collaboration. Responses were anonymized and analyzed using Stata software.RESULTSA total of 459 surgeons from 76 countries responded. Pediatric neurosurgeons in high-income and upper-middle-income countries underwent formal pediatric training at a greater rate than surgeons in low- and lower-middle-income countries (89.5% vs 54.4%). There are an estimated 2297 pediatric neurosurgeons in practice globally, with 85.6% operating in high-income and upper-middle-income countries. In low- and lower-middle-income countries, roughly 330 pediatric neurosurgeons care for a total child population of 1.2 billion. In low-income countries in Africa, the density of pediatric neurosurgeons is roughly 1 per 30 million children. A higher proportion of patients in low- and lower-middle-income countries must travel > 2 hours to seek emergency neurosurgical care, relative to high-income countries (75.6% vs 33.6%, p < 0.001). Vast basic and essential training and equipment needs exist, particularly low- and lower-middle-income countries within Africa, South America, the Eastern Mediterranean, and South-East Asia. Eighty-nine percent of respondents demonstrated an interest in international collaboration for the purposes of pediatric neurosurgical capacity building.CONCLUSIONSWide disparity in the access to pediatric neurosurgical care exists globally. In low- and lower-middle-income countries, wherein there exists the greatest burden of pediatric neurosurgical disease, there is a grossly insufficient presence of capable providers and equipped facilities. Neurosurgeons across income groups and geographic regions share a desire for collaboration and partnership.

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Section: Discussionmentioning

confidence: 99%

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Dewan

Baticulon

Rattani

et al. 2018

Neurosurgical Focus

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“…While training general surgeons to do simpler neurosurgical procedures would expand the capacity for treating neurosurgical cases, opponents suggest that this may do more harm than good. 28,29 A coalition of African neurosurgeons responded to the trend of training general surgeons in LMICs to do neurosurgical procedures by arguing that sometimes the procedures themselves carry more risks than lack of treatment and that bad neurosurgical technique can have fatal complications. 29 There is also the argument that if other physicians are trained to perform neurosurgical procedures local governments and institutions will not invest in training programs for neurosurgeons.…”

Section: Pediatric Neurosurgical Trainingmentioning

confidence: 99%

“…28,29 A coalition of African neurosurgeons responded to the trend of training general surgeons in LMICs to do neurosurgical procedures by arguing that sometimes the procedures themselves carry more risks than lack of treatment and that bad neurosurgical technique can have fatal complications. 29 There is also the argument that if other physicians are trained to perform neurosurgical procedures local governments and institutions will not invest in training programs for neurosurgeons. The establishment of neurosurgery training programs in LMICs is already limited by a lack of funds and limited availability of mentors for trainees.…”

Section: Pediatric Neurosurgical Trainingmentioning

confidence: 99%

“…Furthermore, many global surgery efforts treat all LMICs as a monolith when in reality there is unlikely one solution to increase neurosurgical capacity that would apply to all countries in need. 29 For instance, in Haiti specific limitations like political instability and vulnerability to natural disasters act as barriers to global health efforts. 32 However, many limitations to global surgery programs are shared amongst LMICs.…”

Section: Pediatric Neurosurgical Trainingmentioning

confidence: 99%

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Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Hernandez

Wang

Ragheb

2022

JGNS

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The recent emphasis on surgery as an essential yet neglected component of global health care has drawn attention to the lack of pediatric neurosurgery in low- and middle-income countries (LMICs). Most LMICs have very few neurosurgeons able or willing to care for children, leaving few access to care for readily treatable conditions, like pediatric hydrocephalus and spina bifida. Herein, we review the role of pediatric neurosurgeons to improve hydrocephalus management and medical education in LMICs. A literature search on global pediatric neurosurgery was performed using the Pubmed database from the year 2000 to October 5th, 2021. The majority of current pediatric neurosurgical efforts focus on the management of hydrocephalus. Endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) has emerged as an effective alternative to ventriculoperitoneal (VP) shunting for CSF diversion in LMICs. Neurosurgical programs in LMICs are most successful when twinning is used to pair the program with an established center in a high-income country (HIC). Multiple international pediatric neurosurgical efforts aim to provide medical expertise, infrastructure, and surgical education to LMICs. The next step in developing sustainable surgery programs in LMICs includes establishing local training programs. Existing global pediatric neurosurgery programs are most successful when partnered to an experienced center in a HIC. A lack of funding, resources, and training programs all pose barriers to increasing the pediatric neurosurgical capacity in LMICs. Future global neurosurgery efforts may look to other neurosurgical conditions with high burdens of disease in LMICs, like epilepsy.

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“…7,14 Whereas experience with alternative endoscopic treatments for hydrocephalus is now a compulsory part of many modern training programs, trainees in resource-poor settings often are not exposed to the same level and breadth of training. 4 Equipping surgeons worldwide with endoscopic approaches to CSF diversion and reduction-which may ultimately reduce readmissions, reoperations, costs, and mortality-will build surgical capacity and more effectively address the deficit in neurosurgical care. 16 Such training is particularly important for surgeons in LMIC, where shunt complications are more likely to result in severe neurological injury or death because of barriers to obtaining emergency neurosurgical treatment.…”

Section: Rationale For Subspecialty Training In Hydrocephalus and Spimentioning

confidence: 99%

Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems

Dewan

Onen

et al. 2018

Neurosurgical Focus

Self Cite

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There is inadequate pediatric neurosurgical training to meet the growing burden of disease in low- and middle-income countries (LMIC). Subspecialty expertise in the management of hydrocephalus and spina bifida—two of the most common pediatric neurosurgical conditions—offers a high-yield opportunity to mitigate morbidity and avoid unnecessary death. The CURE Hydrocephalus and Spina Bifida (CHSB) fellowship offers an intensive subspecialty training program designed to equip surgeons from LMIC with the state-of-the-art surgical skills and equipment to most effectively manage common neurosurgical conditions of childhood. Prospective fellows and their home institution undergo a comprehensive evaluation before being accepted for the 8-week training period held at CURE Children’s Hospital of Uganda (CCHU) in Mbale, Uganda. The fellowship combines anatomy review, treatment paradigms, a flexible endoscopic simulation lab, daily ward and ICU rounds, radiology rounds, and clinic exposure. The cornerstone of the fellowship is the unique operative experience that includes a high volume of endoscopic third ventriculostomy with choroid plexus cauterization, myelomeningocele closure, and ventriculoperitoneal shunting, among many other procedures performed at CCHU. Upon completion, fellows return to their home institution to establish or rejuvenate a robust pediatric practice as part of a worldwide network of CHSB trainees committed to the care of underserved children. To date, the fellowship has graduated 33 surgeons from 20 different LMIC who are independently performing thousands of hydrocephalus and spina bifida operations each year.

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On progress in Africa, by African experts

Cited by 10 publications

References 1 publication

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide

Role of the Pediatric Neurosurgeon in the Management of Hydrocephalus Internationally

Subspecialty pediatric neurosurgery training: a skill-based training model for neurosurgeons in low-resourced health systems

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