Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda

Xu, Linda; Vaca, Silvia D; Nalwanga, Juliet; Muhumuza, Christine; Vail, Daniel; Lerman, Benjamin J; Kiryabwire, Joel; Ssenyonjo, Hussein; Mukasa, John; Muhumuza, Michael; Haglund, Michael M.; Grant, Gerald A.

doi:10.1016/j.wneu.2018.01.204

Cited by 17 publications

(20 citation statements)

References 19 publications

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“…Data collection was completed as previously described. 11 Briefly, phone surveys were developed based on literature review, survey design, content expert review, and Ugandan collaborator review for adaptation to this setting. Surveys inquired about caregiver demographics, follow-up healthcare, morbidity and mortality, quality of life, and access to home health resources.…”

Section: Data Collectionmentioning

confidence: 99%

“…Access to neurosurgical care in Uganda remains a barrier, resulting in a higher proportion of patients undergoing nonoperative treatment. 10,11 In one study, of the 23% of patients with TBI admitted for surgery at Mulago National Referral Hospital (MNRH), Uganda's main tertiary care center, nearly 22% failed to receive surgical care. 12 In the past decade, there have been efforts to improve neurosurgical care in Uganda.…”

mentioning

confidence: 99%

“…Because long-term follow-up in LMICs can be challenging due to a lack of established infrastructure, we utilized previously validated phone surveys to assess long-term recovery of neurocognitive function to understand the risk of subsequent TBI-related sequelae. 11,17,18…”

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confidence: 99%

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Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

Jin¹,

Kakusa²,

Ku³

et al. 2021

Journal of Neurosurgery

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OBJECTIVETraumatic brain injury (TBI) is a major cause of mortality and morbidity in Uganda and other low- and middle-income countries (LMICs). Due to the difficulty of long-term in-person follow-up, there is a paucity of literature on longitudinal outcomes of TBI in LMICs. Using a scalable phone-centered survey, this study attempted to investigate factors associated with both mortality and quality of life in Ugandan patients with TBI.METHODSA prospective registry of adult patients with TBI admitted to the neurosurgical ward at Mulago National Referral Hospital was assembled. Long-term follow-up was conducted between 10.4 and 30.5 months after discharge (median 18.6 months). Statistical analyses included univariable and multivariable logistic regression and Cox proportional hazards regression to elucidate factors associated with mortality and long-term recovery.RESULTSA total of 1274 adult patients with TBI were included, of whom 302 (23.7%) died as inpatients. Patients who died as inpatients received surgery less frequently (p < 0.001), had more severe TBI at presentation (p < 0.001), were older (p < 0.001), and were more likely to be female (p < 0.0001). Patients presenting with TBI resulting from assault were at reduced risk of inpatient death compared with those presenting with TBI caused by road traffic accidents (OR 0.362, 95% CI 0.128–0.933). Inpatient mortality and postdischarge mortality prior to follow-up were 23.7% and 9%, respectively. Of those discharged, 60.8% were reached through phone interviews. Higher Glasgow Coma Scale score at discharge (continuous HR 0.71, 95% CI 0.53–0.94) was associated with improved long-term survival. Tracheostomy (HR 4.38, 95% CI 1.05–16.7) and older age (continuous HR 1.03, 95% CI 1.009–1.05) were associated with poor long-term outcomes. More than 15% of patients continued to suffer from TBI sequelae years after the initial injury, including seizures (6.1%) and depression (10.0%). Despite more than 60% of patients seeking follow-up healthcare visits, mortality was still 9% among discharged patients, suggesting a need for improved longitudinal care to monitor recovery progress.CONCLUSIONSInpatient and postdischarge mortality remain high following admission to Uganda’s main tertiary hospital with the diagnosis of TBI. Furthermore, posttraumatic sequelae, including seizures and depression, continue to burden patients years after discharge. Effective scalable solutions, including phone interviews, are needed to elucidate and address factors limiting in-hospital capacity and access to follow-up healthcare.

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Section: Data Collectionmentioning

confidence: 99%

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confidence: 99%

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Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

Jin¹,

Kakusa²,

Ku³

et al. 2021

Journal of Neurosurgery

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show abstract

“…Data collection was completed as described by Xu et al 17 Briefly, phone surveys were developed after reviewing the literature and survey designs, consulting a content expert, and performing a Ugandan collaborator review for adaptation to this setting. Surveys inquired about caregiver demographics, follow-up healthcare, morbidity and mortality, quality of life, and access to home health resources.…”

Section: Data Collectionmentioning

confidence: 99%

Neural tube defects in Uganda: follow-up outcomes from a national referral hospital

Vaca

et al. 2018

Neurosurgical Focus

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OBJECTIVEChildren with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys.METHODSAll children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children’s caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources.RESULTSOf the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the patients had documented surgeries, with 5% receiving multiple procedures (n = 102, 51%): 80 defect closures (40%), 32 ventriculoperitoneal shunts (15%), and 1 endoscopic third ventriculostomy (0.5%). Phone surveys were completed for 53 patients with a median time to follow-up of 1.5 years. There were no statistically significant differences in demographics between the surveyed and nonrespondent groups. The 1-year mortality rate was 34% (n = 18). At the time of survey, 91% of the survivors (n = 30) have received healthcare since their initial discharge from MNRH, with 67% (n = 22) returning to MNRH. Hydrocephalus was diagnosed in 29 patients (88%). Caregivers reported physical deficits in 39% of patients (n = 13), clubfoot in 18% (n = 6), and bowel or bladder incontinence in 12% (n = 4). The surgical complication rate was 2.5%. Glasgow Outcome Scale–Extended pediatric revision scores were correlated with upper good recovery in 58% (n = 19) of patients, lower good recovery in 30% (n = 10), and moderate disability in 12% of patients (n = 4). Only 5 patients (15%) reported access to home health resources postdischarge.CONCLUSIONSThis study is the first to characterize the outcomes of children with NTDs that were treated at Uganda’s national referral hospital. There is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term settings to improve morbidity and mortality.

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“…Currently, the neurosurgeon provider ratio per 100,000 people is approximately 0.04 (more than 20-fold less than that of developed countries like the US). 1,14 With no structured neurosurgical care outside of the capital, Port-au-Prince, there is a significant need within the country for the development of formal neurosurgical training.…”

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confidence: 99%

Bridging the gap: creating a self-sustaining neurosurgical residency program in Haiti

Shah

Barthélemy

Lafortune³

et al. 2018

Neurosurgical Focus

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Given Haiti’s longstanding socioeconomic burden and recent environmental and epidemiological catastrophes, the capacity for neurosurgery within Haiti has been limited, and outcomes for patients with neurosurgical conditions have remained poor. With few formally trained neurosurgeons (4) in a country of 10.5 million inhabitants, there is a significant need for the development of formal structured neurosurgical training. To mitigate the lack of neurosurgical care within Haiti, the authors established the first neurosurgical residency program within the country by creating an integrated model that uniquely fortifies existing Haitian neurosurgery with government sponsorship (Haitian Ministry of Health and National Medical School) and continual foreign support. By incorporating web-based learning modules, online assessments, teleconferences, and visiting professorships, the residency aims to train neurosurgeons over the course of 3–5 years to meet the healthcare needs of the nation. Although in its infancy, this model aims to facilitate neurosurgical capacity building by ultimately creating a self-sustaining residency program.

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Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda

Cited by 17 publications

References 19 publications

Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

Neural tube defects in Uganda: follow-up outcomes from a national referral hospital

Bridging the gap: creating a self-sustaining neurosurgical residency program in Haiti

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