2024_Pediatric Neuro-anesthesia in resource stricken countries _.pptx

This is a topic where you won't find much about and this presentation might serve as a good starting point.
Pediatric Neuro-anesthesia is in its infancy specially in resource stricken countries where many of the sub Saharan African countries reside in. But there is not much written on that topic. and this presentation encourages further publications on the topic

1. Pediatric N euroanesthesia in Resource Stricken C ountries Anteneh Yifru(Pediatric Anesthesiologist )

2. Disclosure There is limited literature on this topic!

3. Outline Anesthesia work force Pediatrics neurosurgery and neuroanesthesia Challenges Potential solutions S ummary

4. Anesthesia workforce An estimated 1.7 billion children globally lack access to safe, high-quality surgical care and anesthesia, most of whom live in low- and middle-income countries (LMICs ). Many African countries cannot meet the recommended minimum physician-anesthesia provider ratio of 5 per 100,000 population . Most African countries have fewer than 0.5 providers per 100,000 population . WFSA world anesthesia workforce survey 2017

5. Global Burden In the Lancet Commission’s Global Surgery 2030, 143 million additional surgical procedures are needed each year worldwide. A significant burden on the pediatric population is part of this 143 million procedure deficit . Two thirds of the world’s children (1.7 billion) lack access to appropriate surgical and anesthesia care. Only 8% of children in LMICs have timely access to surgical care, and injuries alone kill more children globally than human immunodeficiency virus, tuberculosis, and malaria combined - Meara et al Global Surgery 2030 - Mullapudi et al Estimates of number of children and adolescents without access to surgical care. Bull World Health Organ 2019

6. Burden in LMICs Children comprise more than 50% of the overall population in many low- and middle-income countries. 85 % of these children will require a surgical operation before their fifteenth birthday . Surgical admissions account for 6 to 12% of all pediatric hospitalizations in Sub Saharan Africa, although this may be even higher in urban settings or areas of conflict Bickler et al: Surgical services for children in developing countries.2002 Bickler et al: Need for paediatric surgery care in an urban area of The Gambia. 2003

7. Neurosurgical Burden Obtaining a reliable estimate of the volume of neurosurgical disease requires addressing numerous challenges including Sparse epidemiological data Heterogeneous literature reporting C ompeting definitions of disease entities

8. Neurosurgical Burden An estimated 13.8 million essential neurosurgical cases and 22.6 million new consultative cases exist world wide each year, of which more than 80% arise in low- and middle-income countries Africa is expected to endure nearly 2 million neurosurgical cases, in contrast to about 665,000 cases in the US and Canada . While Africa accounts for 15% of the global volume of neurosurgical disease, African hospitals and health care networks have access to less than 1 % of the neurosurgeon community Dewan et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care 2019.

9. There are significant disparities between LMICs and HICs in terms of prevalent clinico -pathological entities . Neurotrauma associated with fall from height is commoner than high-speed injuries seen in developed countries

10. Pediatrics Perioperative M ortality M eta-analysis from the pediatric surgical literature reported an overall pediatric perioperative mortality rate in African countries from 2005 to 2014 as 29.4 %. Poor outcomes may be due to an inability to refer to appropriate centers, lack of surgical and anesthetic expertise, and lack of specialized equipment and appropriate postoperative care. Ekenze et al: Neonatal surgery in Africa: A systematic review and meta-analysis of challenges of management and outcome. Lancet 2015 Newton et al Pediatric perioperative mortality in Kenya: A prospective cohort study from twenty-four hospitals. Anesthesiology 2019

11. Pediatric Neurosurgical conditions cross categories like Trauma C ongenital anomalies Infection Cancer Pathology is often advanced because of delayed presentation in many low- and middle-income countries

12. Role of Sub specialization Sub specialization in pediatric neurosurgery and critical care results in more favorable outcomes. These claims have been bolstered by data from several pediatric hospitals in the United States indicating neurosurgeons with advanced training in pediatric neurosurgery have a significant reduction in morbidity and volume of residual tumors in infants and children . Chumas et al. Subspecialisation in neurosurgery-does size matter? 2011 . Tasker et al. Severe head injury in children: intensive care unit activity and mortality in England and Wales . Br J Neurosurg 2011

13. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit.

14. The Big Question Who has the training and skills to manage pediatric neurosurgical patients? Neuroanesthesiologist or Pediatric Anesthesiologists?

15. There is a positive trend of an increase in the neurosurgical workforce. At the current growth rate of 7.03% per annum, Africa is on course to have 3418 neurosurgeons by 2030. This anticipated increase is essential in addressing the current deficit in specialized neurosurgical care . Ukachukwu  et al. 2019  

16. Fellowship Training At present, official training (fellowship) in neuroanaesthesiology is not available. Dr. Anthony Reed, a neuroanesthesiology fellow from Southampton and the Vice-Chairperson of SASNACC has trained three fellows from Kenya and one from South Africa at the University of Cape Town. The SASNACC initiated a program during early 2020 to observe and compile different program syllabi and curricula of various teaching departments of anesthesiology. The aim was to establish a national standard for training and competence in neuroanesthesiology . South Africa Society of Neuroscience and Critical care(SASNACC)_ news letter 2021

17. Post Neurosurgical Morbidity And Mortality There are many patients with post infectious hydrocephalus and neural tube defects whose poor outcome could be attributed to Perinatal mother-child care Out of hospital deliveries Late presentation to the hospital T here is a social stigma associated with the neurologically impaired child which makes them less valued by their kin. Hence , only a few complete the treatment and come for regular follow-ups making it impossible to record postsurgical morbidity and mortality.

18. Challenges Lack of Trained workforce Lack of equipment Population growth Lack of training sites

19. S olutions Establishing training sites Incorporating in national health policies Providing more evidence with research

20. Summary A ll national and international platforms must join hands to formulate guidelines for standardization of pediatric neuroanesthesia services. The laying down of bare minimal requirements in terms of; Staffing and equipment Support services like preanesthetic clinic Acute pain service Blood transfusion Training and education Financial analysis Provision for regular audits

21. “Safe pediatric neuroanesthesia for all is now a dream, but tomorrow it will be a reality” Chashmajot Bawa

22. Thank you !! Ngiyabonga !! Dankie !! Enkosi !!