Background Before the COVID-19 pandemic, access to otolaryngology and head-and-neck surgery was limited in low- and middle-income countries (LMICs). The pandemic has increased the burden on LMIC health systems by causing unanticipated expenses, delayed care, and changes in research activity. We aimed to assess the landscape of global ENT research during the pandemic. Materials and methods The authors developed a search strategy composed of the following keywords: “otolaryngology,” “head and neck surgery,” and “low- and middle-income countries.” Then, they searched eleven citation databases via the Web of Science from January 01, 2020, to May 03, 2021. They imported the result as metadata into VosViewer and ran bibliometric analyses to identify the most influential institutions, countries, and themes. Results During the study period, 3077 articles were published. Two hundred eighty-nine articles (9%) mentioned COVID-19 explicitly. The second most common theme was pediatric ENT (223 articles, 7%). The United States had the most publications [1616 articles, 12,033 citations, and 2986 total link strength (TLS)], followed by China (336 articles, 10,981 citations, and 571 TLS). South Africa, the first African country, was fourth (302 articles, 699 citations, and 908 TLS), while Brazil, the first South American country, was seventh (158 articles, 582 citations, and 376 TLS). The most prolific institution was the National Institute of Allergy and Infectious Diseases (186 articles, 1110 citations, and 674 TLS). Conclusion COVID-19 was the most common research theme during the pandemic, surpassing pediatric ENT.
Background Africa bears >15% of the global burden of neurosurgical disease. Yet to date, Africa still has the lowest neurosurgical workforce density globally, and efforts to fill this gap by 2030 need to be multiplied. Although the past decade has seen an increase in neurosurgery residency programs in the continent, it is unclear how these residency programs are similar or viable. This study aims to highlight the current status of neurosurgical training in Africa as well as the differences within departments, countries or African regions. Methods A literature search using keywords related to ‘neurosurgery’, ‘training’, and ‘Africa’ and relevant names of African countries will be performed on PubMed and Google Scholar. If unavailable online, the authors will contact local neurosurgeons at identified training programmes for their curricula. The residency curricula collected will be analysed against a standardized and validated medical education curriculum viability tool. Results The primary aim will be the description of African neurosurgical curricula. In addition, the authors will perform a comparative analysis of the identified African neurosurgical curricula using a standardized and validated medical education curriculum viability tool. Discussion This study will be the first to evaluate the current landscape of neurosurgery training in Africa and will highlight pertinent themes that may be used to guide further research. The findings will inform health system strengthening efforts by local training programme directors, governments, policymakers and stakeholders.
Nuss et al 1 leveraged their research collaborative network of >180 otolaryngologists in >40 countries (the Global OHNS Initiative) to identify priority otolaryngology-head and neck surgery (OHNS) conditions and procedures.The study is relevant, novel, and rigorous, and its findings will become the foundation for global OHNS health policy and advocacy. Regarding the study's relevance, the authors answered a fundamental question: Given the large burden of diseases amenable to OHNS, which procedures and interventions should be prioritized? Before their publication, 1 the closest one would have been the World Bank's third edition of the Disease Control Priorities, 2 which lacks the granularity to answer this question. This document was designed with a broader focus in mind-specifically, to identify essential procedures for the global SOTA specialties (surgery, obstetrics, trauma, and anesthesia). At the time, this was the right approach, given that global SOTA awareness had not yet gained the traction and support that it has today.Nuss and colleagues' findings are very likely to be externally valid given the diversity of their expert panel. 1 All geographic regions were represented; 65% practiced in urban and rural settings; 50% had >10 years of experience; 50% were from low-and middle-income countries; and most OHNS subspecialties were represented. 1 In addition, the authors chose the Delphi consensus methodology, which imposes stringent agreement threshold values.Most of the top 10 OHNS priorities identified by Nuss et al 1 are emergency and infectious procedures and conditions. This finding sets the ground for intersectoral collaboration between global OHNS and other movements at the national and international levels. For example, acute and chronic OHNS infections are intimately linked to meningitis and lower respiratory infections in children-2 diseases that have been prioritized by the World Health Organization and ministries of health worldwide. 3,4 Also, local stakeholders may select which priority conditions can be safely managed through task shifting/task sharing and which ones have to be performed by specialized personnel or in centers of excellence. The conditions can also inform competency-based curriculum design in OHNS residencies. All this is made possible because the priority conditions and procedures are disaggregated by country income and geography. 1 By providing a bird's-eye view of the global OHNS service delivery priorities, the article 1 has set the stage for further discourse while leaving room for continued development of the subject matter.
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