Barriers to Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review of the Service Delivery Challenges

Muhammad Shakir; Syeda Fatima Shariq; Hammad Atif Irshad; Aly Hamza Khowaja; Izza Tahir; Ali I Rae; Radzi Hamzah; Saksham Gupta; Kee B Park; Syed Ather Enam

doi:10.1016/j.wneu.2024.05.044

Barriers to Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review of the Service Delivery Challenges

World Neurosurg. 2024 May 11:S1878-8750(24)00797-6. doi: 10.1016/j.wneu.2024.05.044. Online ahead of print.

Authors

Affiliations

¹ Section of Neurosurgery, Department Aga Khan University Hospital, Karachi, Pakistan. Electronic address: muhammad.shakir@alumni.aku.edu.
² Medical School of Aga Khan University, Karachi, Pakistan.
³ Program for Global Surgery and Social Change (PGSSC)-Harvard Medical School.
⁴ Section of Neurosurgery, Department Aga Khan University Hospital, Karachi, Pakistan.

PMID: 38740084
DOI: 10.1016/j.wneu.2024.05.044

Abstract

Introduction: Brain tumors pose a major challenge in low- and middle-income countries (LMICs) due to limited resources and high costs, resulting in an hampered service delivery of neurosurgical care and significant disparities in patient outcomes compared to high-income nations. Therefore, our systematic review aims to identify barriers to service delivery in providing adequate surgical care for the management of brain tumors in LMICs.

Methods: We searched Scopus, PubMed, Google Scholar, and CINAHL, from inception to October 20, 2022. The data from the eligible studies was extracted and analyzed qualitatively.

Results: The final analysis included 35 articles, which highlighted significant challenges in providing adequate surgical care for brain tumors in LMICs. Among the cited studies, 10% reported lack of multidisciplinary team structures, 61% noted delayed patient presentation, 16% highlighted delays in neuroimaging, 10% reported delays in scheduling surgery, lack of training for specialized surgery (3%), lack of intra-operative facilities (19%), power supply interruption (6%), and lack of advanced diagnostic and specialized surgery facilities (19%). Strategies for addressing these challenges include cross-border collaboration (7%), public education, and awareness (13%), establishing multidisciplinary teams (20%), utilizing alternative surgical techniques (13% awake craniotomy, 7% intraoperative ultrasound, 13% intraoperative cytology smear), and establishing satellite hospitals for low-risk care (7%), standard operating procedure and infection control (13%).

Conclusion: Targeted interventions considering economic constraints are essential to improve the availability, affordability, and quality of neuro-oncological services in developing countries. International collaborations and building capacity are vital for improving patient outcomes and service delivery, as well as forming multidisciplinary teams and utilizing resource-saving, innovative methods.

Keywords: Brain Tumors; Global Neurosurgery; LMICs; NSOAP; Service Delivery; Surgical Care.

Publication types

Review