Team profile by Allan Bakesiga and Yesel Trillo Ordonez

Low- and middle-income countries (LMICs) account for a significant percentage of the global burden of neurosurgical disease. In high-income countries, these factors are readily assessed and addressed to maintain a swift patient flow and positive neurosurgical outcomes.

However, in low- and middle-income countries, the infrastructure pertaining to emergency neurosurgical triage is often poorly managed and understood. Data surrounding practices in emergency neurosurgical triage in LMICs is necessary for addressing fundamental economic, workforce, education and geographic problems that play a vital role in shaping patient outcomes.

In Fall 2023, our team studied neurosurgical systems in Nigeria and Uganda through the lens of the World Health Organization’s six building blocks framework for health systems. We worked in three subteams of about eight students each, which included Duke graduate and undergraduate students and international students from Nigeria, Uganda and the Democratic Republic of the Congo (DRC). The DRC team chose to work on a systematic review of neurosurgical literature in the country.

Each week, the subteams reviewed existing literature to understand a different aspect of the neurosurgical system and triage structures, fortifying the project proposal. Team members presented the project proposal to Duke Global Neurosurgery and Neurology (DGNN). The students also received didactic lectures from Duke and international experts in the field, covering such topics as neurosurgical disease burden, service delivery, workforce and training, infrastructure/equipment/technology, health financing, data management, and leadership and governance.

At the end of the semester, each subteam created a project proposal for IRB submission based on the corresponding country assignment. Each subteam’s project identified and aimed to address challenges in the neurosurgical triage system identified throughout the semester.

In the spring semester, both the Uganda and Nigeria subteams chose to focus on studying the presence, extent and impact of challenges to neurosurgical triage in Uganda and Nigeria. Teams aimed to:

1. Assess the current patient triage system in neurosurgical care and identify its strengths and weaknesses
2. Determine the key factors affecting patient triage decisions in neurosurgical care
3. Design a patient triage model that accounts for criticality, resource availability, and healthcare costs

These projects will be carried out in Nigeria and Uganda, utilizing a mixed methods approach involving quantitative surveys of patients/caregivers and qualitative interviews with neurosurgical providers. Teams of three Duke students will travel to Nigeria and Uganda, respectively, to collect data alongside our international student team members in those countries. The goal is for data collection to be done in May through June 2024 with subsequent data analysis and dissemination in the successive months. The DRC team will complete the literature analysis and subsequent manuscript writing for publication.

Barriers to Neurosurgical Service Delivery in Sub-Saharan Africa

Poster by Heather Raslan and Eugene Cho

Enhancing Patient Triage for Neurosurgical Care: A Mixed Methods Approach

Poster by OyinOluwa Adaramola, Allan Bakesiga, Peter Bahati, Conor Bohrer, Eugene Cho, Olaoluwa Ezekiel Dada, Nina Dao, Ifeanyi Iwuagwu, Alice Kateregga, Beatrice Katusiime, Margaret Kyamulabi, Imran Mukiibi, Patricia Najobe, Arsene Daniel Nyalundja, Tobi Olajide, Julian Orrego, Portia Osuji, Abigail Oyedokun, Diya Patel, Heather Raslan, Joseph Mary Ssembatya and Yesel Trillo-Ordonez