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

Acta Neurochir (Wien). 2020 May;162(5):973-981. doi: 10.1007/s00701-019-04207-6. Epub 2020 Jan 4.

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.

Keywords: Global surgery; International collaboration; Neurosurgery twinning; Sub-Saharan Africa.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara
  • Aged
  • Brain Neoplasms / surgery
  • Child
  • Child, Preschool
  • Female
  • Health Services Accessibility*
  • Health Services Needs and Demand*
  • Humans
  • Infant
  • Male
  • Microsurgery*
  • Middle Aged
  • Neurosurgery
  • Neurosurgical Procedures*
  • Sweden
  • Young Adult