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Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration

  • Original Article - Neurosurgery general
  • Published:
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Abstract

Background

The unmet need for neurosurgery in sub-Saharan Africa is staggering. Resolving this requires strategies that synergize salient local resources with tailored foreign help. This study is a trial of a twinning model adopted by the Swedish African Neurosurgical Collaboration (SANC).

Methods

A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), developed through a collaboration between African and Swedish neurosurgical teams was adopted for a neurosurgical mission in March 2019. The pioneering steps are evaluated together with data of treated patients prospectively acquired using SPSS Chicago Inc., Version 23. Associations were analyzed using chi-square tests, while inferences were evaluated at 95% level of significance.

Results

The SANC global neurosurgery mission targeted microsurgical brain tumor resection. Fifty-five patients were operated on during the mission and subsequent 3 months. Patients’ ages ranged from 3 months to 69 years with a mean of 30.6 ± 2.1 years 95% CL. Seven cases were performed during the first mission, while 48 were performed after the mission. Compared to 3 months before SANC when only 9 brain tumors were resected, more tumors were resected (n = 25) within the 3 consecutive months from the mission (X2 = 14.2, DF = 1, P = 0.000). Thirty-day mortality following tumor resection was also lower, X2 = 4.8, DF = 1, P = 0.028.

Conclusion

Improvements in capacity and short-term outcome define our initial pioneering application of a neurosurgical twinning paradigm pioneered by SANC.

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Acknowledgments

We wish to appreciate the invaluable investment of funds and resources by the Swedish Neurosurgical Society and Swedish Neurosurgical Nursing Society in the SANC project. We also wish to appreciate the Uppsala University Hospital as well as all donors, volunteers, and facilitators of SANC. We thank the management of University of Nigeria Teaching Hospital for approving and supporting SANC. We also appreciate our unit residents and nursing staff for their invaluable role in SANC.

Author information

Authors and Affiliations

  1. Neurosurgery unit, Department of Surgery, University of Nigeria Ituku/Ozalla Campus, Enugu, Nigeria

    Enoch O. Uche, Wilfred C. Mezue, Ephraim Onyia & Izuchukwu Iloabachie

  2. University of Nigeria Teaching Hospital , Ituku/Ozalla Enugu, 40001, Nigeria

    Enoch O. Uche & Christopher C. Amah

  3. Department of Anaesthesia, University of Nigeria Ituku/Ozalla Campus , Enugu, Nigeria

    Obinna Ajuzieogu

  4. Department of Neurosurgery, Uppsala University Hospital, 751.85, Uppsala, Sweden

    Mats Ryttlefors

  5. Department of Neurosurgery, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden

    Magnus Tisell

Authors
  1. Enoch O. Uche
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  2. Wilfred C. Mezue
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  3. Obinna Ajuzieogu
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  4. Christopher C. Amah
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  5. Ephraim Onyia
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  6. Izuchukwu Iloabachie
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  7. Mats Ryttlefors
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  8. Magnus Tisell
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Corresponding author

Correspondence to Enoch O. Uche.

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Conflict of interest

EOU, the lead author, was awarded the 2019 travel grant of the Swedish Neurosurgical Society. Other authors have no conflict of interest.

Research involving human participants and/or animal

All procedures involving human participants in this study were performed in accordance with the ethical standards approved by the Institutional review board of the University of Nigeria Teaching Hospital Ituku/Ozalla Enugu Nigeria.

Informed consent

All participants in this study gave consent for enrollment as well as publication of the results of the study.

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Comments

In recent years, there has been a tremendous increase of interest on what we call “Global Neurosurgery.” In essence, we are considering the efforts by Western Institutions to improve the quality of management of neurosurgical patients in areas of the world where the number of neurosurgeons and available facilities are limited. There are different ways to reach this goal: the World Federation of Neurosurgical Societies has established in Africa full training centers which train many neurosurgeons in sub-Sahara Africa (1) thus reducing the ration neurosurgeon/population in this area (5).

Another different approach has been established by a different Western University: as the authors reported the system of “Twin Universities.” There are many different examples like Bergen University and Ethiopia, Valencia University and Kenia, Duke University and Uganda, and Cornell University and Tanzania (2, 3, 4, 6). These approaches can be summarized as a long-lasting structured collaboration resulting an increased capacity of the African Institution to perform more and higher quality surgery and also to publish its experience in peer-reviewed Journals.

I would also stress the value of publishing together not only clinical but also epidemiological/demographical data which are extremely useful to plan further interventions.

The authors of this paper have reported their experience with a structured and in some way innovative approach in 5 different steps. The other very important innovation in this paper is that the institution on the Western side is NOT a single University but the Swedish Neurosurgical Society.

The improvement of management was proved by scoring neurosurgical operations before and after the visit of the Swedish team and, even more important, by showing the tremendous increased number of available nurses with some neurosurgical knowledge. Future steps are already organized.

This is only the start of an important road that the Swedish Society and the Nigerian Institution wish to run together and an example for many other “Western” Neurosurgical Societies.

Franco Servadei

Milan, Italy

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Uche, E.O., Mezue, W.C., Ajuzieogu, O. et al. Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration. Acta Neurochir 162, 973–981 (2020). https://doi.org/10.1007/s00701-019-04207-6

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