Neurosurgery in Sub-Sahara: Quo vadis?
Introduction: Sub-Sahara Africa (SSA) represents 17% land, 14% population, and 1% GDP of the world. Initial reports indicated that only 81 of all the 500 African neurosurgeons (16.2%) worked in SSA, alias 1:8,000,000 neurosurgeon: inhabitants. Over the past decade, efforts have been made to improve neurosurgery availability in SSA.
Objective: The aim of this study is to provide data on neurosurgeons who trained in Africa and went back to practice in SSA.
Methods: We surveilled 18 neurosurgeons who graduated from the WFNS Rabat Training center over 10years.
Results: Surveillance response rate was 100%. Women were 11%. After training in North Africa, neurosurgeons returned to work in 13 different SSA countries with a cumulative population of 452 Million and 146 neurosurgeons, resulting in 1:3,000,000 neurosurgeon: inhabitants.16/18 work in low income and 2 in lower-middle income countries, defined by the World Bank as per-capita GNI US$ <995 and US$996-3895, respectively. Employment comprises 55% in public hospitals, 17% in military, 17% in academic, 11% in private practice. 72% of neurosurgeons performs >100 neurosurgical procedures/year, with the majority reporting an even split between spine and cranial and between trauma and elective surgeries. Equipment available includes CT scanner 78%, MRI 33%, microscope 33%, endoscope 17%, none of the above 17%.
Conclusions: Neurosurgery availability in SSA has significantly improved over the past decade thanks to the dedication of Senior African neurosurgeons, organizations, and volunteers who believed in forming the new neurosurgery generation in the same continent where they practice. Challenges include limited resources. Focus on affordable and low-maintenance technology is needed.