Neurosurgical capacity building in the developing world through focused training

Clinical article

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  • 1 Centra Neuroscience Institute;
  • 2 Madaktari Africa, Lynchburg, Virginia;
  • 3 Duke University, Durham, North Carolina;
  • 4 Haydom Lutheran Hospital, Haydom, Tanzania; and
  • 5 Medical University of South Carolina, Charleston, South Carolina
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Object

In Tanzania, there are 4 neurosurgeons for a population of 46 million. To address this critical shortage of neurosurgical care, the authors worked with local Tanzanian health care workers, neurosurgeons, the Ministry of Health and Social Welfare, and the Office of the President of Tanzania to develop a train-forward method for sustainable, self-propagating basic and emergency neurosurgery in resource-poor settings. The goal of this study was to assess the safety and effectiveness of this method over a 6-year period.

Methods

The training method utilizes a hands-on bedside teaching technique and was introduced in 2006 at a remote rural hospital in northern Tanzania. Local health care workers were trained to perform basic and emergency neurosurgical procedures independently and then were taught to train others. Outcome information was retrospectively collected from hospital records for the period from 2005 (1 year before method implementation) through 2010. Analysis of de-identified data included descriptive statistics and multivariable assessment of independent predictors of complications following a patient's first neurosurgical procedure.

Results

By 2010, the initial Tanzanian trainee had trained a second Tanzanian health care worker, who in turn had trained a third. The number of neurosurgical procedures performed increased from 18 in 2005 to an average of 92 per year in the last 3 years of the study period. Additionally, the number of neurosurgical cases performed independently by Tanzanian health care providers increased significantly from 44% in 2005 to 86% in 2010 (p < 0.001), with the number of complex cases independently performed also increasing over the same time period from 34% to 83% (p < 0.001). Multivariable analysis of clinical patient outcome information to assess safety indicated that postoperative complications decreased significantly from 2005 through 2010, with patients who had been admitted as training progressed being 29% less likely to have postoperative complications (OR 0.71, 95% CI 0.52–0.96, p = 0.03).

Conclusions

The Madaktari Africa train-forward method is a reasonable and sustainable approach to improving specialized care in a resource-poor setting.

Abbreviations used in this paper:AMO = assistant medical officer; HLH = Haydom Lutheran Hospital; MD = medical doctor.

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Contributor Notes

Address correspondence to: Joyce S. Nicholas, Ph.D., 1901 Tate Springs Rd., Lynchburg, VA 24501. email: joyce.nicholas@centrahealth.com.

Please include this information when citing this paper: published online September 12, 2014; DOI: 10.3171/2014.7.JNS122153.

  • 1

    Attebery JE, , Mayegga E, , Louis RG, , Chard R, , Kinasha A, & Ellegala DB: Initial audit of a basic and emergency neurosurgical training program in rural Tanzania. World Neurosurg 73:290295, 2010

    • Search Google Scholar
    • Export Citation
  • 2

    Basso A, , Previgliano I, , Duarte JM, & Ferrari N: Advances in management of neurosurgical trauma in different continents. World J Surg 25:11741178, 2001

    • Search Google Scholar
    • Export Citation
  • 3

    Bergen DC, & Silberberg D: Nervous system disorders: a global epidemic. Arch Neurol 59:11941196, 2002

  • 4

    Black PM: The future of neurosurgery: a call to leadership. Clin Neurosurg 54:185191, 2007

  • 5

    Cadotte DW, , Viswanathan A, , Cadotte A, , Bernstein M, , Munie T, & Freidberg SR: The consequence of delayed neurosurgical care at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. World Neurosurg 73:270275, 2010

    • Search Google Scholar
    • Export Citation
  • 6

    de Villiers JC: A place for neurosurgery in a developing country?. Surg Neurol 46:403407, 1996

  • 7

    Debas HT, , Gosselin R, , McCord C, & Thind A, Surgery. Jamison DT, , Breman JG, & Measham AR: Disease Control Priorities in Developing Countries ed 2 New York, Oxford University Press, 2006. 12451260

    • Search Google Scholar
    • Export Citation
  • 8

    Dupuis CC: Humanitarian missions in the third world: a polite dissent. Plast Reconstr Surg 113:433435, 2004

  • 9

    El Khamlichi A: African neurosurgery: current situation, priorities, and needs. Neurosurgery 48:13441347, 2001

  • 10

    El Khamlichi A: Neurosurgery in Africa. Clin Neurosurg 52:214217, 2005

  • 11

    El Khamlichi A, , Derraz S, , El Ouahabi A, , Aghzadi A, , Jamily A, & El Azouzi M: Pattern of cerebral aneurysms in Morocco: review of the concept of their rarity in developing countries: report of 200 cases. Neurosurgery 49:12241230, 2001

    • Search Google Scholar
    • Export Citation
  • 12

    Haglund MM, , Kiryabwire J, , Parker S, , Zomorodi A, , MacLeod D, & Schroeder R, : Surgical capacity building in Uganda through twinning, technology, and training camps. World J Surg 35:11751182, 2011

    • Search Google Scholar
    • Export Citation
  • 13

    Hayden MG, , Hughes S, , Hahn EJ, , Aryan HE, , Levy ML, & Jandial R: Maria Auxiliadora Hospital in Lima, Peru as a model for neurosurgical outreach to international charity hospitals. Childs Nerv Syst 27:145148, 2011

    • Search Google Scholar
    • Export Citation
  • 14

    Lindsay KW: Neurosurgical training in the United Kingdom and Ireland: assessing progress and attainment. Neurosurgery 50:11031113, 2002

    • Search Google Scholar
    • Export Citation
  • 15

    Mæstad O, & Mwisongo A: Haydom Lutheran Hospital—Final Project Review Bergen, Norway, CMI, 2009. (http://www.cmi.no/publications/publication/?3488=haydom-lutheranhospital-final-project-review) [Accessed August 3, 2014]

    • Search Google Scholar
    • Export Citation
  • 16

    Mainthia R, , Tye GW, , Shapiro J, , Doppenberg EMR, & Ward JD: A model for neurosurgical humanitarian aid based on 12 years of medical trips to South and Central America. Clinical article. J Neurosurg Pediatr 4:49, 2009

    • Search Google Scholar
    • Export Citation
  • 17

    Taira BR, , Kelly McQueen KA, & Burkle FM Jr: Burden of surgical disease: does the literature reflect the scope of the international crisis?. World J Surg 33:893898, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    World Health Organization, World Federation of Neurology: Atlas: Country Resources for Neurological Disorders, 2004 Geneva, World Health Organization, 2004. (http://www.who.int/mental_health/neurology/epidemiology/en/index.html) [Accessed August 3, 2014]

    • Search Google Scholar
    • Export Citation
  • 19

    Wright IG, , Walker IA, & Yacoub MH: Specialist surgery in the developing world: luxury or necessity?. Anaesthesia 62:Suppl 1 8489, 2007

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