ABSTRACT
Background: Surgical site infection (SSI) is accountable for a third of postoperative deaths and for 8% of all deaths due to hospital-acquired infections. There is a wide disparity in the incidence and burden of SSI in low and high-income countries. Objectives: To assess the rates and risk factors of SSI in a tertiary hospital in a resource-limited sub-Saharan African country and generate institutional baseline data for future monitoring and interventions. Materials and Methods: This was a descriptive prospective cohort study done at John F Kennedy Memorial Hospital, a tertiary hospital in Monrovia, Liberia, from October 18 to December 18, 2021. Consecutive participants, including children and adults that had surgical operations within the study period, were recruited. Criteria for diagnosis of SSI were as defined by the Centre for Disease Control (1999). Data were collected on the demography of the participants, type of surgery done, presence of SSI, comorbidities, and risk factors for SSI. Results: Of the 111 patients analyzed, thirty-two patients had SSI giving a hospital incident rate of 28.8%. This comprises superficial SSI (22/31; 71.0%), deep SSI (6/31; 19.4%), and organ/space SSI (3/31; 9.7%). Twelve out of 42 females (28.6%) and 20 of 69 males (29.0%) had SSI. There is no statistically significant difference in gender SSI rate (P = 0.963). SSI occurred more in dirty wounds (13/23; 56.5%), compared to contaminated wounds (6/11, 54.6%), clean contaminated (7/22; 31.8%), and clean wounds (6/55, 10.9%). There is a statistical difference in the rate of SSI among the wound classes (P = 0.001). The infection rate is also more in emergency surgeries (18/39, 46.2%) compared to elective surgeries (14/72, 19.4%), and it is significant (P = 0.003). Statistically, there was no significant difference between the two skin preparation agents used (P = 0.351). The abdomen was the most common site of surgical incision and had the highest rate of SSI (24/79; 30.4%) (P = 0.045). There was no statistical difference in SSI rate between those whose hairs were removed in the ward or in the theatre (P = 0.114); length of incision (P = 0.297), or duration of surgery (P = 0.715) (see table for classification and rates). Conclusion: The SSI rate in our study is high at 28.8%. Abdominal surgeries, emergencies, and wound class accounted for the majority of the SSIs. The baseline data will be useful in developing infection control strategies.
ABSTRACT
Introduction: We evaluated salient initiatives invested in global neurosurgery over a 60-year period. Research question: What are the Phases, Achievements, Challenges, and Lessons of Global Neurosurgery. Methods: A 60-year retrospective study from 1960 to 2020 analyzing the major phases, lessons, and progress notes. We reviewed the foundational need questions and innovated tools used to answer them. Results: Three phases defining our study period were identified. In the early phase, birthing academic units and the onset of individual volunteerism were dominant concepts. The 2nd phase is summarized by the rise of volunteerism and surgical camps.The third phase is heralded by advocacy and strategies for achieving care equity. The defining moment is the Lancet commission for global surgery summit in 2015. Lessons include the need for evaluation of the resources of recipient and donor locations using novel global surgery tools. Conclusion: Global neurosurgery over the 60-year study period is summarized by indelible touchstones of personal and group efforts as well as triumphs derived from innovations in the face of formidable challenges.
ABSTRACT
Introduction Liberia recently employed the first neurosurgeon in the country's history. In a country with a population of 4.7 million people and staggering rates of cranial and spine trauma, as well as hydrocephalus and neural tube defects, neurosurgery is considered a luxury. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty practice in Liberia. Methods Our institutions, in collaboration with the Korle-Bu Neuroscience Foundation, spent 10 days in Liberia, based in Tappita, and performed 18 surgeries in addition to seeing several hundred clinic patients. This is a retrospective review of the cases performed along with outcomes to investigate obstacles in providing neurosurgical services in the country. Results Before arriving in Liberia, we evaluated, planned, and supplied staff and materials for treating complex neurosurgical patients. Sixteen patients underwent 18 surgeries at a hospital in Tappita, Liberia, in November 2018. Their ages ranged from 1 month to 72 years (average 20 years). Five patients (28%) were female. Ten patients (56%) were under the age of 18. Surgeries included ventriculoperitoneal shunting (VP-shunt), lumbar myelomeningocele repair, encephalocele repair, laminectomy, and a craniotomy for tumor resection. Ten patients (55%) underwent VP-shunting. Two patients (11%) had a craniotomy for tumor resection. Three patients (17%) had laminectomy for lumbar stenosis. Two patients (11%) had repair of lumbar myelomeningocele. Conclusion After an aggressive and in-depth approach to planning, conducting, and supplying complex neurosurgical procedures in Liberia, the greatest limiting factor to successful outcomes lie in real-time is access to health care, which is largely limited by overall infrastructure. Our study documents the experience of a team of neurosurgeons, critical care nurses, scrub technicians, nurses, and biomedical engineers who carried out a series of neurosurgical clinics and complex brain and spine surgeries in Liberia. Specifically, we aim to highlight some of the larger obstacles, beyond staff and equipment, facing the development of a neurosurgical or any other specialty procedural practice in the country of Liberia. Most notably, we focus on infrastructure factors, including power, roads, water, education, and overall health care.
ABSTRACT
Introduction: Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice. Methods: African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and a P-value < 0.05 was considered to be statistically significant. Results: 112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P = 0.023, Phi = 0.26), lack of access to journals (P = 0.002, Phi = 0.332), and limited access to conferences (P = 0.019, Phi = 0.369) were associated with the country income category. Conclusion: This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.
