Neurocritical Care Organization in the Low-Income and Middle-Income Countries.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY Neurocritical Care Pub Date : 2025-02-07 DOI:10.1007/s12028-025-02210-7

Hemanshu Prabhakar, Abhijit V Lele, Indu Kapoor, Charu Mahajan, Gentle S Shrestha, Chethan Venkatasubba Rao, Jose I Suarez, Sarah L Livesay, Faraz Shafiq, Konstantin Popugaev, Dhania Santosa, Obaidullah Naby Zada, Wanning Yang, Hosne Ara Nisha, Julio C Mijangos-Mendez, Peter Kaahwa Agaba, Juan Luis Pinedo Portilla, Yalew Hasen Tuahir, Puvanendiran Shanmugam, Yanet Pina Arruebarrena, Walter Videtta, Sebastián Vásquez-García, M Samy Abdel Raheem, Fasika Yimer, Llewellyn C Padayachy, Luis Silva Naranjo, Pedro Arriaga, Chann Myei, Sarah Shali Matuja, Tarig Fadalla, Tanuwong Viarasilpa, Ganbold Lundeg, Halima M Salisu-Kabara, Samuel Ern Hung Tsan, Simon P Gutierrez, Leroy P Yankae, Aidos Konkayev, Nophanan Chaikittisilpa, Gisele Sampaio, Tuan Van Bui, Geraldine Seina L Mariano, Gisselle Aguilar Sabillon, Pablo Blanco, Williams Ortiz, Angel Jesus Lacerda Gallardo, Oguzhan Arun, Kalaivani Mani

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Abstract

Background: This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement.

Methods: We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)].

Results: Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively).

Conclusions: The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.