Building neurosurgical capacity in low and middle income countries

Abstract

Neurosurgery capacity in low- and middle-income countries is far from adequate; yet burden of neurological diseases, especially neuro-trauma, is projected to increase exponentially. Previous efforts to build neurosurgical capacity have typically been individual projects and short-term missions. Recognizing the dual needs of addressing disease burden and building sustainable, long-term neurosurgical care capacity, we describe in this paper an ongoing collaboration between the Mulago Hospital Department of Neurosurgery (Kampala, Uganda) and Duke University Medical Center (Durham, NC, USA) as a replicable model to meet the dual needs. The collaboration employs a threefold approach to building capacity: technology, twinning, and training performed together in a top-down approach. Also described are lessons learned to date by Duke Global Neurosurgery and Neurosciences (DGNN) and applicability beyond Kampala.

Neurosurgical education in Egypt and Africa

“…10,11 The majority of neurosurgeons are located in only a few countries, with the remaining neurosurgeons distributed throughout the rest of the continent. 8,10,11,13 Of the 1165 neurosurgeons in Africa, 756 are located in North African countries and South Africa, which results in a neurosurgeon to population ratio of 1:300,913. The remaining 409 neurosurgeons exist in East, West, and Central African countries, with a neurosurgeon to population ratio of 1:2,237,016.…”

“…An important initiative was the development of a fellowship training program in 2005 by 5 African countries (Ethiopia, Kenya, Rwanda, Tanzania, and Uganda), i.e., the College of Surgeons of Eastern, Central, and Southern Africa. 10 Nevertheless, at present, many African countries do not have any local neurosurgical programs.…”

Global surgery for pediatric hydrocephalus in the developing world: a review of the history, challenges, and future directions

“…In Africa, there is an unequal distribution of neurosurgical resources across the continent, with 86% of practicing neurosurgeons located in South Africa and North Africa. 22 In subSaharan Africa, there is approximately 1 neurosurgeon per 5 million people and in East Africa 1 neurosurgeon per 10 million people, 5,20 compared with 1 neurosurgeon per 100,000 people in European countries. 22 Furthermore, in sub-Saharan Africa, it is estimated that more than 100,000 newborns annually develop hydrocephalus before 1 year of age.…”

“…22 In subSaharan Africa, there is approximately 1 neurosurgeon per 5 million people and in East Africa 1 neurosurgeon per 10 million people, 5,20 compared with 1 neurosurgeon per 100,000 people in European countries. 22 Furthermore, in sub-Saharan Africa, it is estimated that more than 100,000 newborns annually develop hydrocephalus before 1 year of age. 46 In Nigeria, hydrocephalus accounts for 32% of congenital neurosurgical conditions; 4 in Kenya, hydrocephalus represents the highest surgical burden of disease in male children; 78 and in Uganda, hydrocephalus accounts for 59% of neurosurgical conditions.…”

“…68 However, some residency training programs have endeavored to train neurosurgeons for countries in sub-Saharan Africa, including those at University of Cape Town, Mohamed V University in Morocco, and through the College of Surgeons of East, Central, and Southern Africa. 22,62 Other residency programs in under-resourced countries have residents rotate through more rural areas such as the program at the University of Nairobi where residents complete 1-3 months of pediatric neurosurgical training in rural Kijabe. 5,38 Nonetheless, until adequate infrastructure, residency training programs, and initiatives to retain local neurosurgeons are in place, the training of local general surgeons has been proposed.…”