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Blackman B, Barnett S, Premkumar A, Sheth NP. Orthopaedic and trauma research in Tanzania: A scoping review. PLoS One 2024; 19:e0304218. [PMID: 38837974 DOI: 10.1371/journal.pone.0304218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Tanzania is disproportionately burdened by musculoskeletal injuries as it faces unique challenges when dealing with trauma care. This scoping review aims to summarize and assess the current state of orthopaedic and trauma research in Tanzania. By identifying key themes, trends, and gaps in the literature, this review seeks to guide future research initiatives catered specifically to the needs of Tanzania's healthcare system. Utilizing the PRISMA-ScR protocol, OVID Medline, PubMed, and CINAHL databases were searched from inception to June 17, 2023, using keywords such as "Orthopaedics" "Trauma" and "Tanzania". One hundred and ninety-two eligible studies were included and the Arksey and O'Malley framework for scoping studies was followed. There was a notable growth of relevant publications from 2015 onward, with peaks in growth in the years 2019, 2021, and 2020. The studies employed diverse research methodologies, with cross-sectional (n = 41, 21%) and prospective studies (n = 39, 20%) being the most prevalent, and randomized-controlled trials being the least prevalent methodology, making up eight studies (4.2%). The most common study themes were trauma (n = 101, 52.6%), lower extremity (n = 31, 16%), and spine-related issues (n = 27, 14%). Only three studies looked at work-related injuries (1.6%). Road traffic injuries (RTIs) were the most common mechanism of trauma in 77.0% of the trauma focused studies. Fifty-three percent of the studies were conducted by a majority of Tanzanian authors. This scoping review highlights various trends in orthopaedic and trauma research in Tanzania, with a particular emphasis on road traffic-related injuries. Various gaps are explored, including a lack of research on work-related injuries and a paucity of experimental research. Our findings underline areas where future research is warranted. The future of orthopaedic and trauma care in Tanzania depends on the efforts and collaboration of both local and international stakeholders.
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Affiliation(s)
| | - Sarah Barnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Neil P Sheth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Orthopaedic Surgery, Philadelphia, Pennsylvania, United States of America
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Okon II, Akilimali A, Chisvo NS, Al-Lami BS, Sebopelo LA, Gbayisomore TJ, Masunga DS, Temitope AE, Boasiako Nkansah-Poku KA, Edet EE, John OO, Ewelike SC, Bello IM, Precious FK, Mitchell UO, Erhayanmen MO, Lucero-Prisno Iii DE. Strengthening neurosurgical training programs in Sub-saharan Africa: a medical student's perspective. Neurosurg Rev 2024; 47:243. [PMID: 38806959 DOI: 10.1007/s10143-024-02469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/06/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
This article provides a nuanced exploration of the state and exigencies of neurosurgical training in sub-Saharan Africa (SSA), viewed through the discerning lens of a medical student. The region has a pronounced scarcity of neurosurgical services, further compounded by sociocultural intricacies and infrastructural inadequacies, resulting in elevated mortality and morbidity rates. The insufficiency of neurosurgeons, facilities, and training centers, particularly in remote areas, exacerbates this predicament. The imperative to fortify neurosurgical training programs is underscored, necessitating a multifaceted approach inclusive of international collaborations and innovative strategies. The challenges impeding neurosurgical training program implementation range from constrained infrastructure to faculty shortages and financial constraints. Recommendations encompass infrastructural investments, faculty development initiatives, and augmented community engagement. An exploration of neurosurgical training programs across diverse African regions reveals commendable strides and imminent deficits, warranting heightened international collaboration. Furthermore, technological innovations, including virtual reality, robotics, and artificial intelligence, are posited as transformative conduits for augmenting neurosurgical training in SSA. The article concludes with a sagacious compendium of recommendations, encompassing standardized curricula, mentorship paradigms, and stringent evaluation mechanisms, all combining efficaciously fortifying neurosurgical insight in SSA and producing transformative improvements in healthcare outcomes.
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Affiliation(s)
- Inibehe Ime Okon
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR, Congo.
- Department of Neurosurgery, Benjamin S. Carson (Snr) College of Health and Medical Sciences, IIishan-Remo, 121003, Ogun State, Nigeria.
| | - Aymar Akilimali
- Department of Research, Medical Research Circle (MedReC), Bukavu, DR, Congo
| | - Nathan Simbarashe Chisvo
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Lorraine Arabang Sebopelo
- Association of Future African Neurosurgeons, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
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Shakir M, Irshad HA, Khowaja AH, Altaf A, Enam SA. Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings. World Neurosurg X 2024; 22:100346. [PMID: 38444865 PMCID: PMC10914589 DOI: 10.1016/j.wnsx.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Background Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan. Methods A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15. Results The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad. Conclusions Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | | | | | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
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Wireko AA, Ahluwalia A, Ali SH, Shah MH, Aderinto N, Banerjee S, Roy S, Ferreira T, Tan JK, Berjaoui C, Guggilapu S, Quarshie LS, Bharadwaj HR, Adebusoye FT, Abdul-Rahman T, Atallah O. Insights into craniosynostosis management in low- and middle-income countries: A narrative review of outcomes, shortcomings and paediatric neurosurgery capacity. SAGE Open Med 2024; 12:20503121241226891. [PMID: 38249946 PMCID: PMC10798110 DOI: 10.1177/20503121241226891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Craniosynostosis, marked by premature cranial suture fusion, necessitates prompt intervention to avert developmental, neurological, and aesthetic issues. While high-income countries have advanced in managing this condition, low- and middle-income countries grapple with substantial healthcare access disparities. This narrative review explores current craniosynostosis management in low- and middle-income countries. The review focused on studies published between 2008 and 2023. The focus was neurosurgical outcomes, and the search utilised databases like PubMed, EMBASE, Google Scholar, the Cochrane Library and Scopus, incorporating specific keywords and phrases. An in-depth analysis of 21 included studies reveals noteworthy positive outcomes, including low mortality, successful corrections and sustained efficacy. These advancements stem from enhanced pre-operative strategies, surgical techniques and postoperative care. Nonetheless, challenges persist, encompassing complications, mortality, reoperations, and treatment disparities, particularly in low- and middle-income countries constrained by financial and expertise limitations. The enhancement of clinical practice and the formulation of effective policies in the future entail several key strategies. These include the reinforcement of specialised healthcare infrastructure and diagnostic capabilities, the ongoing training and retention of neurosurgeons, the improvement of funding mechanisms, and the promotion of equitable access. Additionally, a crucial focus is placed on fortifying paediatric neurosurgical care in low- and middle-income countries. The recommendations underscore the importance of collaborative initiatives, the development of specialised healthcare infrastructure, and the implementation of strategic policies to not only advance pediatric neurosurgical care but also to address existing gaps in management.
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Affiliation(s)
| | | | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nicholas Aderinto
- Internal Medicine Department, Lautech Teaching Hospital, Ogbomosho, Nigeria
| | | | - Sakshi Roy
- School of Medicine, Queen’s University Belfast, Belfast, UK
| | - Tomas Ferreira
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Saibaba Guggilapu
- Faculty of Medicine, Bangalore Medical College and Research Institute, Bangalore, India
| | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
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