Introduction: In Tanzania, there are 4 neurosurgeons for 46 million people, with a large proportion of cases being children. To address this need, we have developed an intensive, hands-on, bedside neurosurgery training program, with local health workers trained to operate independently and then trained to train others. This report quantifies increasing self-sufficiency in the neurosurgical care of children in a remote, rural Tanzanian hospital.
Methods: Hospital records were abstracted retrospectively for all patients aged 17 years or less who underwent neurosurgery from one year prior to program implementation (2005) through 2010. Analysis of de-identified data utilized descriptive statistics and multivariable modeling, including an assessment of Tanzanian independence, case complexity, and patient safety. “Independent” surgery was defined as performed by a Tanzanian alone, or a Tanzanian with a Tanzanian trainer. Complex cases consisted of shunt placement or revision, burr holes for tumor biopsy, craniotomies for any reason, myelomeningocele or encephalocele repair, spinal decompressions, diskectomy, fusions, or tumor excision.
Results: Over the time period, the initial neurosurgery trainee trained a second, who in turn trained a third. Over half of the patients (77 of 140) were under 1 year of age. The most common diagnoses, allowing for multiple diagnoses in a single patient, (n>10 of 173) were hydrocephalus (62), spinal bifida (51), head trauma (20), and brain tumor (11). Tanzanian independence increased over time (12.5% in 2005 to 96% in 2010, p<0.001), with the number of complex cases performed independently also increasing from 0% to 100% (p<0.001). Multivariable analysis to assess patient safety indicated that post-operative complications decreased, with patients admitted as training progressed 49% less likely to have post-operative complications (odds ratio 0.51, 95% confidence interval 0.36-0.71, p=0.00).
Conclusions: This training method was an effective approach to increasing neurosurgical self-sufficiency and improving patient outcomes in this resource-poor setting.
Patient Care: This training program has been shown to increase self-sufficiency and patient outcomes in resource-poor settings.
Learning Objectives: By the conclusion of this session, participants should be familiar with an effective neurosurgery training program for resource-poor settings.