Improving access to pediatric hydrocephalus care for all: the role of maternal health literacy and socioeconomic status.

OBJECTIVE: Limited research has addressed the barriers impeding access to surgical care for pediatric patients with hydrocephalus. To identify priorities for enhancing access to pediatric hydrocephalus surgical care and to address healthcare disparities, it is essential to understand the level of access to care and the influence of socioeconomic status (SES) and maternal health literacy. In this study, the authors aimed to assess the level of access to surgical care; determine the frequency of more than a 2-week delay in seeking, reaching, and receiving care; and investigate the influence of parental SES and maternal health literacy on these delays. METHODS: This observational prospective cohort study involved data collection from a sample of 100 pediatric patients aged ≤ 5 years with hydrocephalus and their mothers, including information on family SES (education, occupational, and economic status). Maternal health literacy was assessed using the Brief Health Literacy Screen (BHLS) questionnaire. The Three Delays framework from the Lancet Commission on Global Surgery, categorizing delays in seeking care, reaching care, and definitive care, provided a structured approach for analyzing access delays. Statistical significance was set at p < 0.05. RESULTS: Among the pediatric patients, there was a male-to-female ratio of 1.7:1, with a median age of 1.5 months. None of the patients had insurance coverage that included surgical treatment. A significantly low number of patients accessed care within 2 weeks for seeking care duration (34%), reaching care duration (15%), and definitive care duration (1%). The median time to definitive surgical treatment for the entire study population was 14 weeks (upper SES: median 6.3 weeks, middle SES: median 9.8 weeks, lower SES: median 16.7 weeks). Through Cox proportional hazards regression, a hazard ratio of 0.046 (95% CI 0.010-0.210) was obtained. Multiple linear regression analysis identified BHLS Brief D (ß = -0.335, p = 0.001) and SES (ß = 0.389, p < 0.001) as predictor variables for delays in seeking care and definitive care, respectively. SES (ß = 0.446, p < 0.001) and Evans index (ß = 0.233, p = 0.010) were predictor variables for delays in reaching care. CONCLUSIONS: Maternal health literacy and SES were identified as factors associated with delays in accessing neurosurgical care for pediatric patients with hydrocephalus. To reduce disparities in pediatric hydrocephalus care, it is essential to implement strategies that promote education, improve healthcare infrastructure, and provide support to families encountering challenges related to low SES and limited maternal health literacy.

Spontaneous Surgical Intracranial Haemorrhages Associated with SARS-Cov-2 Infection: Case Report.

Spontaneous surgical acute and chronic intracranial haemorrhage in patients with SARS-Cov-2 infection is a theoretical possibility. We report two cases of SARS-CoV-2 infection that was associated with spontaneous surgical acute and chronic intracranial haemorrhage. The two patients had successful surgical intervention. Surgical haemorrhages should be considered in patients with SARS-COV-2 infection especially if there is an associated altered sensorium.

A tropical tertiary neurosurgical centre response to COVID-19 pandemic and its effect on neurosurgical practices.

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics.

A tropical tertiary neurosurgical center response to COVID-19 pandemic and its effect on neurosurgical practices

Background: COVID-19 pandemic may decrease the quantum of care for patients with neurosurgical conditions. Objectives: To determine outpatient clinic (OPC) patient load, neurosurgical procedures volume and disease spectrum following the institution of a new care protocol during the ongoing COVID-19 pandemic and compare with previous practice data in our institution. Methods: A monocentric retrospective analysis of all patients requiring neurosurgical care over a 2-year period. Results: There was a 42.4% reduction in OPC attendance and 41.8% reduction in surgical procedures in 2020 compared to 2019. There was >60 percent reduction in the volume of surgery that was done at the onset and peak of the pandemic, but this has normalized in November 2020 despite the resurgence of COVID-19, after the institution of a new care protocol. Neurotrauma procedures (29.6%) were the most common neurosurgical operation in 2020 while congenital malformation surgery (37.3%) was the most common procedure performed in 2019. Conclusions: The ongoing COVID-19 pandemic initially led to significant decrease in quantum and spectra of patients who presented at the OPC and for neurosurgical procedures. Instituted local protocol and Teleclinics, if added to clinical care armamentarium, may help to improve on the low patient attendance during pandemics

Outcome of Cerebral Aneurysm Clipping in Nigeria: A Single-Centre Experience.

Background: Ruptured cerebral artery aneurysms (RCAA) are devastating diseases with high morbidity and mortality rates if not promptly managed. In Nigeria, access to timely neurosurgical services remains a challenge and aneurysm coiling is still not possible in virtually all centres in Nigeria. The aim of this study is to report on our 9 years' experience with clipping of cerebral aneurysm and on the attendant clinical outcomes. Methodology: A retrospective analysis of all consecutive operated RCAA between March 2012 and June 2021 was conducted. Patients' demographic parameters, World Federation of Neurosurgical Societies (WFNS) grade, Hunt and Hess (HH) grade, aneurysm location, timing of surgery and outcome were analysed. Outcome was measured using Glasgow Outcome Scale (GOS) score. Results: A total 29 were included in the study. The most common age group affected was between 50-59 years. RCAA were mainly in the region of the middle cerebral artery and posterior communicating artery (PComA) territories. All the patients presented after 24 hours of the ictus. Two (6.9%) patients had multiple aneurysms. Early clipping (<72hours after presentation) was possible in 8 (27.6%) patients. At least one episode of a rebleed occurred in 19 (65.5%) patients prior to surgery. Mortality rate was 17.2%. None of the patients with PComA aneurysm died. The patients' pre-operative WFNS and HH grades were significantly associated with GOS. Conclusion: Modifiable factors like under diagnoses, delayed referral, cultural belief and financial challenges may account for the low number of patients presenting for neurosurgical care. The possibility of a sizeable number of patients dying due to these factors is a strong possibility for the low number of patients presenting for neurosurgical care.