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Abstract Details

Identifying Barriers to Providing Emergent Neurologic Life Support in Low- and Middle-income Sub-Saharan African Countries
Neuro Trauma and Critical Care
P12 - Poster Session 12 (11:45 AM-12:45 PM)
7-009
Using a mixed-method survey design, we aim to identify key gaps in neurocritical care resources in Sub-Saharan Africa.

Emergency Neurologic Life Support (ENLS) guidelines provide standardized approaches to managing neurologic emergencies in low- and middle-income countries (LMICs), where the burden of acute neurologic illness is high and neurocritical care expertise is limited. Most LMIC healthcare settings, however, lack the resources required to fully implement ENLS. Here, we aimed to characterize existing practices, barriers, and resource gaps for neurocritical care in sub-Saharan Africa.  
We recruited a cohort of 189 participants comprising of healthcare workers from 18 LMICs in sub-Saharan Africa. Participants completed a 2-day live ENLS training and completed qualitative and quantitative surveys assessing existing practices and common challenges for neurologic emergencies at their institutions. Descriptive statistics were generated for quantitative data and qualitative data were thematically coded by two independent reviewers.  
Of the 189 survey participants, the majority were from Nigeria (113, 59.8%) and Zambia (24, 12.7%). Qualitative analysis identified key barriers to be pre-hospital delays, out-of-pocket costs, workforce underdevelopment, limited diagnostic and treatment modalities, lack of protocolized care, and absence of dedicated neurocritical care spaces. The most common neurologic emergencies were ischemic stroke, (91.5% of participants had managed a case within 3 months), intracranial hemorrhage (81.0%), and traumatic brain injury (70.4%). While most participants reported at least some access to CT scanners (61.4%), most did not have access to CT angiography (79.4%), CT perfusion (75.8%), or MRI (74.1%) within the first hour of presentation. The majority of participants did not have the option to provide mechanical thrombectomy (87.3%), CSF diversion (65.9%), coagulopathy reversal (37.2%) or continuous infusions of anti-hypertensive medications (51.9%).  

Survey-based needs assessment among sub-Saharan African healthcare workers can inform the development of context-appropriate protocols that are sensitive to neurocritical care resource gaps.  

 
Authors/Disclosures
Celia Fung, MD (Yale New Haven Hospital)
PRESENTER 		Dr. Fung has nothing to disclose.
Jean-Luc Rolland, MD (Johns Hopkins Hospital) Mr. Rolland has nothing to disclose.
Ismail Hassan, MBBS Dr. Hassan has nothing to disclose.
Halima Moji Salisu-Kabara, PhD, RN Dr. Salisu-Kabara has nothing to disclose.
Mustapha M. Abdullahi, MD Dr. Abdullahi has nothing to disclose.
Leila Modupe Ilupeju, MBChB, MSc (Oxon) Miss Ilupeju has nothing to disclose.
Meron Gebrewold, MD (Addis Ababa University) Dr. Gebrewold has nothing to disclose.
Hanna D. Belay, MD Dr. Belay has nothing to disclose.
Vittal Byabashaija, RN Mr. Byabashaija has nothing to disclose.
Gambo Isa Muhammad, RN Mr. Isa Muhammad has nothing to disclose.
Mundih N. Njohjam, MD (University of Cheikh Anta Diop) Dr. Njohjam has nothing to disclose.
Sarah Wahlster, MD Dr. Wahlster has nothing to disclose.
Susan Yeager, NP Dr. Yeager has nothing to disclose.
Sarah Livesay, RN, NP, DNP (Rush University) Dr. Livesay has received personal compensation for serving as an employee of Lombardi Hill/stroke challenges LLC. Dr. Livesay has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Neurocritical Care Society. Dr. Livesay has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Baptist Health South Florida . Dr. Livesay has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Scott and Patton. Dr. Livesay has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for PCVA Law .
Aimee M. Aysenne, MD, MPH (Tulane University, School of Medicine) Dr. Aysenne has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Ceribell. Dr. Aysenne has received stock or an ownership interest from Teledoc. Dr. Aysenne has received stock or an ownership interest from Pfizer.
Yasser B. Abulhasan, MD Dr. Abulhasan has nothing to disclose.
Morgan Prust, MD (Yale University School of Medicine) Dr. Prust has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Edelman & Edelman, PC.