Identifying Barriers to Providing Emergent Neurologic Life Support in Low- and Middle-income Sub-Saharan African Countries
Celia Fung1, Jean-Luc Rolland2, Ismail Hassan3, Halima Salisu-Kabara3, Mustapha Miko Mohammed Abdullahi3, Leila Modupe Ilupeju4, Meron Gebrewold5, Hanna Demissie Belay5, Vittal Byabshaija6, Gambo Isa Mohammed3, Mundih Njohjam7, Sarah Wahlster8, Susan Yeager9, Sarah Livesay10, Aimee Aysenne11, Yasser Abulhasan12, Morgan Prust13
1Yale New Haven Hospital, 2Johns Hopkins Hospital, 3Aminu Kano Teaching Hospital, 4University of Ghana Medical Centre, 5Addis Ababa University, 6Case Hospital, 7University of Cheikh Anta Diop, 8University of Washington, 9Ohio State University Wexner Medical Center, 10Rush University, 11Tulane University, School of Medicine, 12Health Sciences Center, Kuwait University, 13Yale University School of Medicine
Objective:
Using a mixed-method survey design, we aim to identify key gaps in neurocritical care resources in Sub-Saharan Africa.
Background:
Emergency Neurologic Life Support (ENLS) guidelines provide standardized approaches to managing neurologic emergencies in low- and middle-income countries (LMICs), where the burden of acute neurologic illness is high and neurocritical care expertise is limited. Most LMIC healthcare settings, however, lack the resources required to fully implement ENLS. Here, we aimed to characterize existing practices, barriers, and resource gaps for neurocritical care in sub-Saharan Africa.
Design/Methods:
We recruited a cohort of 189 participants comprising of healthcare workers from 18 LMICs in sub-Saharan Africa. Participants completed a 2-day live ENLS training and completed qualitative and quantitative surveys assessing existing practices and common challenges for neurologic emergencies at their institutions. Descriptive statistics were generated for quantitative data and qualitative data were thematically coded by two independent reviewers.
Results:
Of the 189 survey participants, the majority were from Nigeria (113, 59.8%) and Zambia (24, 12.7%). Qualitative analysis identified key barriers to be pre-hospital delays, out-of-pocket costs, workforce underdevelopment, limited diagnostic and treatment modalities, lack of protocolized care, and absence of dedicated neurocritical care spaces. The most common neurologic emergencies were ischemic stroke, (91.5% of participants had managed a case within 3 months), intracranial hemorrhage (81.0%), and traumatic brain injury (70.4%). While most participants reported at least some access to CT scanners (61.4%), most did not have access to CT angiography (79.4%), CT perfusion (75.8%), or MRI (74.1%) within the first hour of presentation. The majority of participants did not have the option to provide mechanical thrombectomy (87.3%), CSF diversion (65.9%), coagulopathy reversal (37.2%) or continuous infusions of anti-hypertensive medications (51.9%).
Conclusions:
Survey-based needs assessment among sub-Saharan African healthcare workers can inform the development of context-appropriate protocols that are sensitive to neurocritical care resource gaps.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.