Sources of delayed provision of neurosurgical care in a rural kenyan setting

Mansouri, Alireza; Chan, Vivien; Njaramba, Veronica; Cadotte, David W.; Albright, A. Leland; Bernstein, Mark

doi:10.4103/2152-7806.152141

Cited by 13 publications

(6 citation statements)

References 29 publications

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“…We identified rural residence and diagnosis of spina bifida as the main predictors for delays in care, similar to other studies in sub-Saharan Africa 6 8 13 34 35. Rural residence might be associated with financial constraints since travel distances and transportation are significant challenges in Somaliland 15 36. Other sources of delay reported in sub-Saharan Africa include misdiagnosis, incorrect management, and financing 36…”

Section: Discussionsupporting

confidence: 78%

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Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

Dahir

Cotache-Condor

Grimm

et al. 2023

World Jnl Ped Surgery

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BackgroundChildhood neurosurgical conditions such as hydrocephalus and spina bifida represent a significant burden of death and disability worldwide, particularly in low and middle-income countries. However, there are limited data on the disease prevalence and delays in care for pediatric neurosurgical conditions in very low-resource settings. This study aims to characterize the delays in access to care for pediatric neurosurgical conditions in Somaliland.MethodsWe performed a retrospective review of all children with congenital hydrocephalus and spina bifida admitted to the Edna University Hospital (EAUH) in Somaliland between 2011 and 2018. Patient demographics were analyzed with descriptive statistics and χ2test statistics. We defined delays in care for each condition based on standard care in high-income settings. Univariate and multivariate logistic regression were performed to evaluate predictors of delay in care. Statistical significance was set at p<0.05.ResultsA total of 344 children were admitted to EAUH with neurosurgical conditions from 2011 to 2018. The most common condition was congenital hydrocephalus (62%). Delays in care were found for 90% of patients and were associated with the type of diagnosis and region. The longest delay among children with spina bifida was 60 months, while the longest delay for children with congenital hydrocephalus was 36 months. Children with congenital hydrocephalus or spina bifida traveling from foreign countries had the highest waiting time to receive care, with a median delay of 8 months (IQR: 5–11 months) and 4 months (IQR: 3–7 months), respectively.ConclusionWe found significant delays in care for children with neurosurgical conditions in Somaliland. This country has an urgent need to scale up its surgical infrastructure, workforce, and referral pathways to address the needs of children with hydrocephalus and spina bifida.

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Section: Discussionsupporting

confidence: 78%

“…Rural residence might be associated with financial constraints since travel distances and transportation are significant challenges in Somaliland 15 36. Other sources of delay reported in sub-Saharan Africa include misdiagnosis, incorrect management, and financing 36…”

Section: Discussionmentioning

confidence: 99%

Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

Dahir

Cotache-Condor

Grimm

et al. 2023

World Jnl Ped Surgery

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“…20,21 Furthermore, even though such care is typically delivered through philanthropic efforts, the most destitute patients may be quite simply too poor to obtain even “free” subspecialty care, leading to delays in referral, poor postoperative follow up, and delays in identifying and managing postoperative complications. 17,18,24 Visiting surgeons must be attentive to the additional resources required to identify patients at highest risk. Adding yet another layer of complexity, prevailing local conception and stigmatization of pediatric neurologic disability, and confidence in the local healthcare system, have wide variability and sometimes dramatic influence on care delivery.…”

Section: Discussionmentioning

confidence: 99%

State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee

Davis

Rocque

Singhal

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVENeurosurgical services are increasingly recognized as essential components of surgical care worldwide. The degree of interest among neurosurgeons regarding international work, and the barriers to involvement in global neurosurgical outreach, are largely unexplored. The authors distributed a survey to members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Pediatric Neurosurgery to assess the state of global outreach among its members and to identify barriers to involvement.METHODSAn internet-based questionnaire was developed by the International Education Subcommittee of the AANS/CNS Joint Section on Pediatric Neurosurgery and distributed to pediatric neurosurgeons via the AANS/CNS Joint Section email contact list. Participants were surveyed on their involvement in global neurosurgical outreach, geographic location, nature of the participation, and barriers to further involvement.RESULTSA 35.3% response rate was obtained, with 116 respondents completing the survey. Sixty-one percent have performed or taught neurosurgery in a developing country, and 49% travel at least annually. Africa was the most common region (54%), followed by South America (30%), through 29 separate organizing entities. Hydrocephalus was the most commonly treated condition (88%), followed by spinal dysraphism (74%), and tumor (68%). Most respondents obtained follow-up through communications from local surgeons (77%). Seventy-one percent believed the international experience improved their practice, and 74% were very or extremely interested in working elsewhere. Interference with current practice (61%), cost (44%), and difficulty identifying international partners (43%) were the most commonly cited barriers to participation.CONCLUSIONSAny coordinated effort to expand global neurosurgical capacity begins with appreciation for the current state of outreach efforts. Increasing participation in global outreach will require addressing both real and perceived barriers to involvement. Creation and curation of a centralized online database of ongoing projects to facilitate coordination and involvement may be beneficial.

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“…However, the distribution of these professionals is uneven, primarily concentrated in urban areas, leaving rural regions underserved 14 . For example, in Kenya, the increase in neurosurgical personnel has not adequately addressed the service gaps in rural regions 15 , highlighting the persistent geographic and socio-economic barriers in accessing neurosurgery across the continent. Additionally, the geographical distribution of neurosurgical training opportunities across the continent presents another layer of complexity.…”

Section: Main Textmentioning

confidence: 99%

The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review

Ahmed,

Furqan,

Okon

et al. 2024

Annals of Medicine &Amp; Surgery

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The availability and accessibility of neurosurgical care across Africa remains limited despite recent advancements. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit. Access to adequate facilities and equipment is also lacking. Barriers like poverty, conflicts, and distance from care centers negatively impact patients’ ability to access services. However, training programs like the World Federation of Neurosurgical Societies Rabat Training Center have contributed to building local capacity. Use of technologies like neuro-endoscopy is expanding access to more cost-effective interventions for conditions such as hydrocephalus. Undergraduate medical education is also seeing a rise in African students interested in neurosurgery. Despite these advancements, workforce shortfalls, inadequate infrastructure, and challenges posed by geopolitical instability continue to hinder the provision of comprehensive neurosurgical care. Limited research and funding discourage experienced surgeons from practicing in their home countries. Increased international collaboration, support for education, and tackling of structural issues are needed to continue strengthening Africa’s neurosurgical capacity and reducing the disease burden. This narrative review aims to provide an overview of the current state of neurosurgery on the continent, highlight achievements, and identify persisting challenges.

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Sources of delayed provision of neurosurgical care in a rural kenyan setting

Cited by 13 publications

References 29 publications

Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

Delays in care for hydrocephalus and spina bifida at a tertiary hospital in Somaliland

State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee

The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review

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