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Introduction: Intracranial suppurations account for a significant proportion of intracranial masses in low- and middle-income countries (LMICs), particularly among children. The development of better imaging equipment, antibiotics, and surgical techniques has enabled significant progress in detecting and treating intracranial abscesses. However, it is unclear whether these advances are accessible and utilised by LMICs. In this review, we aimed to describe the landscape of paediatric intracranial suppurations in LMICs.Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, WHO Global Index Medicus, AJOL and Google scholar were searched for relevant articles from database inception to January 18th, 2021. Publications in English and French were included.Results: Of the 1,011 records identified, 75 were included. The studies, on average, included 18.8 (95% CI = 8.4–29.1) children (mean age: 8.2 years). Most children were male (62.2%, 95% CI = 28.7–95.7%). Intracranial suppurations were most commonly (46.5%) located in the supratentorial brain parenchyma. The most prevalent causative mechanism was otitis (37.4%) with streptococcus species being the most common causative organism (19.4%). CT scan (71.2%) was most commonly used as a diagnostic tool and antibiotics were given to all patients. Symptoms resolved in 23.7% and improved in 15.3% of patients. The morbidity rate was 6.9%, 18.8% of patients were readmitted, and the mortality rate was 11.0%.Conclusion: Most intracranial suppurations were complications of preventable infections and despite MRI being the gold standard for detecting intracranial suppurations, CT scans were mostly used in LMICs. These differences are likely a consequence of inequities in healthcare and have resulted in a high mortality rate in LMICs.

Implementing health-system strengthening policies remains a challenge in Africa. Past successes, predictable but unanticipated flaws, underutilization of health services, traditional medicine, global inequity and poor practice by local stakeholders are some of the reasons many African countries have made little progress towards attaining global health goals. As a result, Africa has the highest disease burden despite multiple efforts from the global health community. These raise the question: what has to change so that health systems strengthening efforts in Africa are successful?

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IntroductionHydrocephalus and myelomeningocele (MMC) place disproportionate burdens of disease on low-income and middle-income countries (LMICs). MMC-associated hydrocephalus and its sequelae result in a spectrum of severely devastating clinical manifestations, for which LMICs are disproportionately unprepared in terms of human, capital and technological resources. This study aims to review and compare the management and outcomes of infant MMC-associated hydrocephalus in LMICs and high-income countries.Methods and analysisThis systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The following databases will be searched without restrictions on language, publication date or country of origin: EMBASE, MEDLINE, The Cochrane Library, Global Index Medicus, African Journals Online and SciELO. All peer-reviewed studies of primary data reporting management and outcomes of infant MMC-associated hydrocephalus will be included. Where high-quality homogeneous studies exist, meta-analyses will be conducted to compare the management and outcomes of MMC-associated hydrocephalus across socioeconomic and geographical regions of the world. The primary outcome will be treatment failure of the first-line hydrocephalus treatment, which we defined operationally as the performance of a second intervention for the same reason as the first. Secondary outcomes include time to failure, rates of mortality and postoperative complications.Ethics and disseminationEthical approval was not applicable because this study does not involve human participants. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at conferences and an interactive web application to facilitate interaction with the findings and promote the discussion and sharing of findings on social media.PROSPERO registration numberCRD42021285850.

Folic acid, also known as Vitamin B9, is a water soluble vitamin used by pregnant women to reduce the risk of spina bifida and anencephaly (SBA) in their children.1 Neurosurgeons are experts in diagnosing, assessing, and surgically treating NTDs. Pediatric neurosurgeons  recognize that their  role spans beyond these aspects, to include advocacy for children with neurosurgical conditions.2 Neurosurgeons are well positioned to engage in advocacy related to pediatric neurosurgery, given their expertise in the field, the importance of primary prevention, and substantial social and professional networks that allow them to collaborate with individuals in other fields and take leadership roles.3,4   Despite clear evidence demonstrating the effectiveness of increasing folic acid intake in women of childbearing age, the formulation and adoption of effective policy has been challenging. Currently, only 23% of all folate-preventable cases of spina bifida and anencephaly are being prevented.5Although mandatory food fortification with folic acid is associated with markedly reduced birth prevalence of SBA, hospitalization rates, and deaths after discharge, only 56 countries have instituted mandatory folate fortification.3,5 The efficacy of folate supplementation is variable, dependent on patient knowledge and adherence.3 Greater well-coordinated advocacy efforts are necessary to facilitate the implementation of effective folate policy.

IntroductionThe protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa.Methods and analysisThe scoping review will be conducted in accordance with the Arksey and O’Malley’s framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description.Ethics and disseminationThis study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.

Objective: Medical students are important for the long-term efficacy of global pediatric neurosurgery initiatives. In this manuscript, we describe the rationale for mobilizing medical students in global pediatric neurosurgery, delineate the potential impact of this mobilization, and detail how to increase exposure of medical students to global pediatric neurosurgery.   Methods: A narrative review was conducted and supplemented with an anecdotal review.   Results: Medical students are a critical asset for global pediatric neurosurgery due to their motivation and diligence, time management and organizational skills, technological proficiency, innovative perspective, and resourcefulness. Fostering the next generation of global pediatric neurosurgeons is important to facilitate long-term engagement in pediatric neurosurgery, ensure the sustainability of global pediatric neurosurgery, develop capacities to collaborate with diverse partners, teach knowledge and skills for engaging in advocacy and capacity-building, and facilitate determination of effective strategies for making progress in global pediatric neurosurgery. Opportunities for medical student involvement include reading key manuscripts; finding mentors; becoming involved in university-based global neurosurgery groups, auxiliary organizations, World Federation of Neurosurgical Societies Global Neurosurgery Committee, InciSion, or general neurosurgery medical student and trainee interest groups.   Conclusion: Medical students represent a valuable asset for addressing the global burden of pediatric neurosurgical disease, ameliorating workforce and equipment deficits, and facilitating access to timely and affordable pediatric neurosurgical care. Involving medical students through existing opportunities and developing additional pathways specific to medical students will strengthen the impact and reach of global pediatric neurosurgical initiatives.