• Elie Sader, Philip Yee, and Mojgan Hodaie.
• Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
• World Neurosurg. 2017 Feb 1; 98: 682-688.e3.

BackgroundQuantitative estimates of surgical capacity and infrastructure and perceived care limitations in low-resource countries are essential baseline measures that can provide strategies for improving access to surgical care. Information about these barriers in Africa is scarce, particularly with respect to neurosurgery. We conducted a survey to better understand the unmet surgical need and resources available for the care of neurosurgery patients in Sub-Saharan Africa.MethodsUsing SurveyMonkey, we administered a neurosurgery-specific survey to neurosurgery attending surgeons and residents in Sub-Saharan African countries. Key outcome measures included workforce, access to imaging modalities and instruments, volume and breakdown of neurosurgical cases, and perceived limitations of care.ResultsWe obtained a 41% survey response (129/314 sent). In addition to the expected large gap in workforce between low- and high-income countries, we found a dramatic paucity of neurosurgical resources in Central Africa, whereas specific pockets in West and South Africa have better neurosurgical care. Access to neuroimaging was not a major limitation in Sub-Saharan African countries. The most commonly perceived limitations of care included infrastructure, anesthesia/nursing availability, wait times, and strength of training.ConclusionsThis large survey defines important self-perceived limitations to care within neurosurgery and highlights the importance of infrastructure and allied professions in this role. A clear understanding of areas of focus will enable a more efficient and sustainable response to the limitations in surgical care in low-resource areas.Copyright © 2016 Elsevier Inc. All rights reserved.

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