Starting a neurosurgical service in a Southern Nigeria rural community. Prospect, challenges, and future\u2014the Irrua experience

E Morgan,C Nwatuzor

doi:10.1186/s41984-020-00081-y

Abstract

Neurosurgical services is an essential component of tertiary level of health care, this field is still evolving in Nigeria with lack of material and manpower. There is a near complete absence of neurosurgeons in the rural communities in Nigeria with over 95% resident in urban area. Starting a neurosurgical services takes a huge sacrifice from the neurosurgeon who is faced with a decision to do something in the presence of a near absence of material and manpower, and in turn circumvent processes with extra burden so as to ensure he/she provides leadership with respect to patients care and assists in the training of allied surgeons and other healthcare staffs to mitigate against morbidity and mortality. Our research is aimed to highlight the total number of patients attended to in the neurosurgical unit, challenges, prospect, and future.

Highlights

Our data emanated from a prospective neurosurgery database over an 18 months period from May 2017-November 2018
Starting a neurosurgical service in a rural setting portend a great challenge and it is tasking, our setup has been likened to other similar settings as seen in the research by Rabiu et al [11] at Oshogbo, Nigeria, where the following were encountered
Challenges The challenges of starting a neurosurgical center in the rural area are quite enormous, though there are paucity of literature [2, 8, 11] on these challenges. These challenges include, ineffective coordination between all health care staffs with significant time wasted in attending to patients, manpower, critical care, materials for intervention, limited theater space, and post-operative care and which can result in significant mortality due to a variety of factors discussed below: Manpower There are few neurosurgeon practicing in the rural area in Nigeria, and this is the usual trend worldwide as earlier pointed out in literatures [2, 3, 8]

Summary

Introduction

Methodology Our data emanated from a prospective neurosurgery database over an 18 months period from May 2017-November 2018. Patient data obtained include the following: the biodata, aetiologies of the trauma (road traffic accident, domestic fall, fall from height, gunshot injury to the head, trivial head banging, and others), and other specific neurosurgical pathologies, intervention, and outcome assessment. Data obtained was analyzed using SPSS version 21 using a simple descriptive statistic tool to present results in table mainly. Domestic fall (14.9%), fall from height (3.3%), gunshot injury to the head (2.3%), and trivial head banging in elderly (3.4%). Majority of these patients sustained mild traumatic brain injury (TBI) and others sustained either moderate or severe TBI which is similar to findings from rural communities in developing countries [10] (Table 2)

Methods

Findings

Discussion

Conclusion