Abstract
Rationale: Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa.Methodology: A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable.Results: Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist.Conclusion: This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.
Highlights
Subarachnoid hemorrhage (SAH) accounts for up to 8.9% of the total global stroke burden [1]
We found that almost every neurosurgical center had access to a computed tomography (CT) scan in their radiology department or at an external site in their city and nearly half of the centers diagnosed SAH via a CT scan within 1–2 h of presentation
The findings of this study demonstrate a lack of availability and accessibility of diagnostic and management tools for aneurysmal subarachnoid hemorrhage (aSAH) in the surveyed African neurosurgical centers
Summary
Subarachnoid hemorrhage (SAH) accounts for up to 8.9% of the total global stroke burden [1]. Some African centers report needing to transfer patients to departments that can provide treatment for aSAH and this is true for endovascular treatment [3, 11] This can sometimes result in patients being transferred to other countries or even another continent for appropriate treatment; albeit the literature does not mention the mode of transportation [12]. Due to these factors and the delay in presentation, aSAH patients experience limited access to and significant delays in receiving endovascular treatment and surgical clipping, and this is true for public hospitals compared to private hospitals [4]. It is reported that patients with aSAH are often treated medically instead of procedurally in some African countries [15]
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