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Pichardo-Rojas PS, Palacios-Cruz M, Calderón-Magdaleno LF, Coria-Medrano A, Flores-López SI, Garcia-Mijangos PC, Esquenazi Y. Evaluating Neurosurgical Care Perception Across Mexico: Insights from a Nationwide Survey. World Neurosurg 2024; 188:e41-e52. [PMID: 38735568 DOI: 10.1016/j.wneu.2024.05.001] [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: 01/09/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Most of the scientific and healthcare resources in Mexico are limited to the large major cities. However, many communities with complex socioeconomic and cultural backgrounds have limited access to neurosurgical care. A cross-sectional study aiming to evaluate the population's perception regarding neurosurgical care was conducted. METHODS A nationwide online survey, conducted starting February 2023, assessed public perception of neurosurgical care. Data analysis was performed based on sociodemographic characteristics such as age, socioeconomic status, religion, and education. Pearson's chi-square and odds ratio were employed for statistical comparisons of categorical variables. RESULTS A total of 508 participants consented to the survey. Younger participants and higher education levels correlated with greater perceived knowledge about neurosurgery (P = <0.001) and higher confidence in neurosurgical healthcare personnel (P = 0.021 and P = 0.022, respectively). Lower educational levels were prone to perceive neurosurgical care as less safe and effective (P = 0.002) and preferred to seek initial alternative/traditional treatments for neurosurgical issues (P = 0.012). A higher income level was associated with a preference for private healthcare over public services P = <0.001). Odds ratio analysis corroborated these findings. Healthcare personnel emerged as the most common source of information for neurosurgical diseases (71.4%). CONCLUSIONS Our findings suggest that sociodemographic factors such as age, education, and income correlate with the population's self-perceived knowledge, trust and beliefs about safety and effectiveness regarding neurosurgical care in Mexico. These findings can be instrumental for developing healthcare policies that address the needs of Mexico's patient population.
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Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas.
| | | | | | - Adrian Coria-Medrano
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Shadia I Flores-López
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad en Ciencias de la Salud, Universidad Anáhuac México, Estado de México, Mexico
| | - Paulina C Garcia-Mijangos
- Facultad de Ciencias de la Salud, Universidad Autónoma de Baja California, Baja California, Mexico; Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Yoshua Esquenazi
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas
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Nugroho AW. The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN). Surg Neurol Int 2024; 15:53. [PMID: 38468665 PMCID: PMC10927227 DOI: 10.25259/sni_1026_2023] [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: 12/27/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
Background Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. Methods In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. Results There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. Conclusion A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.
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Barthélemy EJ, Diouf SA, Silva ACV, Abu-Bonsrah N, de Souza IAS, Kanmounye US, Gabriel P, Sarpong K, Nduom EK, Lartigue JW, Esene I, Karekezi C. Historical determinants of neurosurgical inequities in Africa and the African diaspora: A review and analysis of coloniality. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001550. [PMID: 36962931 PMCID: PMC10021312 DOI: 10.1371/journal.pgph.0001550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The movement to decolonize global health challenges clinicians and researchers of sub-disciplines, like global neurosurgery, to redefine their field. As an era of racial reckoning recentres the colonial roots of modern health disparities, reviewing the historical determinants of these disparities can constructively inform decolonization. This article presents a review and analysis of the historical determinants of neurosurgical inequities as understood by a group of scholars who share Sub-Saharan African descent. Vignettes profiling the colonial histories of Cape Verde, Rwanda, Cameroon, Ghana, Brazil, and Haiti illustrate the role of the colonial legacy in the currently unmet need for neurosurgical care in each of these nations. Following this review, a bibliographic lexical analysis of relevant terms then introduces a discussion of converging historical themes, and practical suggestions for transforming global neurosurgery through the decolonial humanism promulgated by anti-racist practices and the dialogic frameworks of conscientization.
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Affiliation(s)
- Ernest J. Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, United States of America
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
| | - Sylviane A. Diouf
- Center for the Study of Slavery & Justice, Brown University, Providence, Rhode Island, United States of America
| | | | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Research Department, Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | | | - Ulrick Sidney Kanmounye
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Phabinly Gabriel
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Kwadwo Sarpong
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Edjah K. Nduom
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jean Wilguens Lartigue
- Society of Haitian Neuroscientists, Inc., New York, New York, United States of America
- Department of Surgery, Mirebalais University Hospital, Zanmi Lasante, Mirebalais, Haiti
| | - Ignatius Esene
- Department of Neurosurgery, Division of Neurosurgery, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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Awuah WA, Kalmanovich J, Mehta A, Huang H, Yarlagadda R, Kundu M, Nasato M, Toufik AR, Olatunbosun PP, Isik A, Sikora V. Harnessing artificial intelligence to bridge the neurosurgery gap in low-income and middle-income countries. Postgrad Med J 2022:7147067. [PMID: 35927019 DOI: 10.1136/pmj-2022-141992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | - Jacob Kalmanovich
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Aashna Mehta
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Helen Huang
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rohan Yarlagadda
- Faculty of Medicine, Rowan University School of Osteopathic Medicine, Stratford, Virginia, USA
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan University, Bhubaneswar, Orissa, India
| | - Matthew Nasato
- Faculty of Medicine, St George's University, St George's, St George's, Grenada
| | | | | | - Arda Isik
- Department of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey
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Ikwuegbuenyi CA, Umutoni A, Atabe Ngwene NN, Ngoma P, Nyalundja AD, Nteranya DS, Olobatoke TA, Ogunfolaji O, Sichimba D, Najjuma J, Sebopelo LA, Ndajiwo A, Bamimore MA, Adegboyega G, Kanmounye US. Public awareness, knowledge of availability, and willingness to use neurosurgical care services in Sub-Saharan Africa: A cross-sectional study. PLoS One 2022; 17:e0264955. [PMID: 35298488 PMCID: PMC8929639 DOI: 10.1371/journal.pone.0264955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/20/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Low- and middle-income countries bear the majority of neurosurgical disease burden and patients face significant barriers to seeking, reaching, and receiving care. We aimed to understand barriers to seeking care among adult Africans by evaluating the public perception, knowledge of availability, and readiness to use neurosurgical care services. METHODS An e-survey was distributed among African adults who are not in the health sector or pursuing a health-related degree. Chi-square test and ANOVA were used for bivariate analysis and the alpha value was set at 0.05. Odds ratios and their 95% confidence intervals were calculated. RESULTS Six hundred and sixty-two adults from 16 African countries aged 25.4 (95% CI: 25.0, 25.9) responded. The majority lived in urban settings (90.6%) and were English-speaking (76.4%) men (54.8%). Most respondents (76.3%) could define neurosurgery adequately. The most popular neurosurgical diseases were traumatic brain injury (76.3%), congenital brain and spine diseases (67.7%), and stroke (60.4%). Unwillingness to use or recommend in-country neurosurgical services was associated with rural dwelling (β = -0.69, SE = 0.31, P = 0.03), lack of awareness about the availability of neurosurgeons in-country (β = 1.02, SE = 0.20, P<0.001), and believing neurosurgery is expensive (β = -1.49, SE = 0.36, P<0.001). CONCLUSION Knowledge levels about neurosurgery are satisfactory; however, healthcare-seeking is negatively impacted by multiple factors.
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Affiliation(s)
| | - Alice Umutoni
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Placide Ngoma
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - Tunde A. Olobatoke
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joanitor Najjuma
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Aliyu Ndajiwo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Michael A. Bamimore
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
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Ferraris KP, Yap MEC, Bautista MCG, Wardhana DPW, Maliawan S, Wirawan IMA, Rosyidi RM, Seng K, Navarro JE. Financial Risk Protection for Neurosurgical Care in Indonesia and the Philippines: A Primer on Health Financing for the Global Neurosurgeon. Front Surg 2021; 8:690851. [PMID: 34568413 PMCID: PMC8461295 DOI: 10.3389/fsurg.2021.690851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
Which conditions treated by neurosurgeons cause the worst economic hardship in low middle-income in countries? How can public health financing be responsive to the inequities in the delivery of neurosurgical care? This review article frames the objectives of equity, quality, and efficiency in health financing to the goals of global neurosurgery. In order to glean provider perspectives on the affordability of neurosurgical care in low-resource settings, we did a survey of neurosurgeons from Indonesia and the Philippines and identified that the care of socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. Additionally, the surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, conditional cash transfers similarly leverages on financial incentives on the part of patients to reward certain health-seeking behaviors that significantly influence clinical outcomes. These health financing strategies are formulated in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.
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Affiliation(s)
- Kevin Paul Ferraris
- Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
- Department of Surgery, Las Piñas General Hospital and Satellite Trauma Center, Las Piñas, Philippines
| | | | - Maria Cristina G. Bautista
- Department of Economics, Finance and Accounting, Graduate School of Business, Ateneo de Manila University, Makati, Philippines
| | - Dewa Putu Wisnu Wardhana
- Faculty of Medicine, Division of Neurosurgery, Department of Surgery, Udayana University Hospital, Udayana University, Bali, Indonesia
| | - Sri Maliawan
- Faculty of Medicine, Division of Neurosurgery, Department of Surgery, Sanglah General Hospital, Udayana University, Bali, Indonesia
| | - I Made Ady Wirawan
- Faculty of Medicine, Department of Public Health, Udayana University, Bali, Indonesia
| | - Rohadi Muhammad Rosyidi
- Faculty of Medicine, Department of Neurosurgery, West Nusa Tenggara Province Hospital, Mataram University, Mataram, Indonesia
| | - Kenny Seng
- Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
- Division of Neurosurgery, Department of Neurosciences, University of the Philippines–Philippine General Hospital, University of the Philippines College of Medicine, Manila, Philippines
| | - Joseph Erroll Navarro
- Section of Neurosurgery, Department of Surgery, Jose R. Reyes Memorial Medical Center, Manila, Philippines
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