Continental Survey of Access to Diagnostic Tools and Endovascular Management of Aneurysmal Subarachnoid Hemorrhage in Africa.
Continental Survey of Access to Diagnostic Tools and Endovascular Management of Aneurysmal Subarachnoid Hemorrhage in Africa.
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DOI：
10.3389/fsurg.2021.690714
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发表时间：
2021
影响因子：
1.8
通讯作者：
Kanmounye US
中科院分区：
文献类型：
--
作者：
Dokponou YCH;Kotecha J;Bandyopadhyay S;Erhabor J;Ooi SZY;Egiz A;Boutarbouch M;Dalle DU;Higginbotham G;Thioub M;Sichimba D;Bankole NDA;Kanmounye US
理由：介入神经血管手术可有效降低动脉瘤性蛛网膜下腔出血（aSAH）引起的死亡率和并发症的负担。尽管高收入国家广泛采用介入神经血管手术，但低收入和中等收入国家获得护理的机会仍然有限，而且对非洲的可及性知之甚少。在这项调查中，我们决定评估非洲的aSAH诊断工具和治疗的可及性。方法：在2021年1月4日至3月21日期间，向非洲神经外科中心分发了一份谷歌表格的电子调查。收集了非洲中心关于诊断工具、治疗方法和介入神经放射学人员可及性的数据。为每个变量计算95%的置信区间。结果：数据来自16个非洲国家的36个神经外科中心（16/ 54,30 %）。大多数中心都是公共机构。94%的中心有必要的资源进行腰椎穿刺（LP）和诊断aSAH的实验室。大多数中心至少有一台计算机断层扫描（CT）扫描仪，81%的中心可以进行CT血管造影，一些中心可以进行常规血管造影。47%的中心可以在紧急情况出现后2小时内进行头部CT检查。61%的中心提供颅内动脉瘤夹闭，而只有22%的中心可以进行血管内治疗。64%的中心没有血管内专家。结论：该调查突出了aSAH患者在获得血管内治疗方面的健康不平等。缺乏诊断工具来识别动脉瘤和缺乏合格的血管内专家是主要原因。我们的发现可以为加强卫生系统的政策提供信息，包括在非洲购置设备和能力建设。
Rationale: Interventional neurovascular procedures are effective in lowering the burden of mortality and complications resulting from aneurysmal subarachnoid hemorrhage (aSAH). Despite the wide uptake of interventional neurovascular procedures in high-income countries, access to care in low- and middle-income countries remains limited, and little is known about accessibility in Africa. In this survey, we decided to assess access to diagnostic tools and treatment of aSAH in Africa. Methodology: A Google form e-survey was distributed to African neurosurgery centers accepting responses from January 4th to March 21st 2021. Data on accessibility to diagnostic tools, treatment methodologies, and interventional neuroradiology personnel in African centers were collected. Ninety five percent confidence intervals were computed for each variable. Results: Data was received from 36 neurosurgical centers in 16 African countries (16/54, 30%). Most centers were public institutions. Ninety four percent of the centers had the necessary resources for a lumbar puncture (LP) and a laboratory for the diagnosis of aSAH. Most centers had at least one computed tomography (CT) scanner, 81% of the centers had access to CT angiography and some had access to conventional angiography. Forty seven percent of the centers could obtain a head CT within 2 h of presentation in an emergency. Sixty one percent of centers provided clipping of intracranial aneurysms whilst only 22% of centers could perform the endovascular treatment. Sixty four percent of centers did not have an endovascular specialist. Conclusion: This survey highlights health inequity in access to endovascular treatment for aSAH. Lack of diagnostic tools to identify an aneurysm and a shortfall of qualified endovascular specialists are prime reasons for this. Our findings can inform health system strengthening policies including the acquisition of equipment and capacity building in Africa.
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影响因子：
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作者：
Germans, Menno R.;Hoogmoed, Jantien;Verbaan, Dagmar
通讯作者：
Verbaan, Dagmar
影响因子：
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Molyneux, AJ;Kerr, RSC;Sandercock, P
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Browne, John P.
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Macdonald, R. Loch
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作者：
Ahanogbe, K. M. H.;Belo, M.;Doleagbenou, K. A.
通讯作者：
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