Building Sustainable Neurosurgical Systems in Developing Countries (2025-2026)
Neurosurgical care in low- and middle-income countries is often constrained by a lack of trained staff, modern technology and reliable data. As a result, fewer patients receive care and opportunities for research and training are limited. Public and population health approaches are needed to better use available resources, reduce inequities and address the large unmet need for neurosurgical care.
Building on the work of the 2024–2025 project team, this team examined challenges in neurosurgical care in Nigeria and Uganda.
Team Nigeria analyzed an existing database to document care practices for pediatric traumatic brain injury (TBI). Team members assessed prehospital factors such as distance traveled to care and delays between injury and hospital arrival, as well as presentation characteristics including symptoms on arrival and TBI severity. The project team also identified limited documentation of mental health outcomes and minimal follow-up, highlighting the need for improved post-injury care.
Team Uganda studied a cohort of newborns treated for neural tube defects (NTDs) at Mulago Regional Referral Hospital (MRRH). NTDs are largely preventable, but they remain a health concern in many low- and middle-income countries. The team analyzed new data for surgical outcomes and the factors associated with receiving surgical versus nonsurgical care. They found that many infants with NTD were born to mothers with gaps in prenatal care, including late folic acid initiation, lack of ultrasounds and fewer than recommended prenatal visits. Infants referred to MRRH were much more likely to receive surgery, and certain NTD locations and types were also associated with surgical intervention.
Through this work, team members developed experience collaborating across cultures, time zones and professional perspectives. The project also strengthened long-term partnerships aimed at improving neurosurgical care for patients in these regions.
Timing
Fall 2025 – Summer 2026
Outputs
Building sustainable neurosurgical capacity: lessons from the Duke Division of Global Neurosurgery and Neurology (Journal of Neurosurgery, vol. 58, 2025)
See earlier related team, Building Sustainable Neurosurgical Systems in Developing Countries (2024-2025).
Image: Previous team members pose with partners on Zoom, courtesy of Alvan Ukachukwu