ABSTRACT
BACKGROUND: Despite global efforts to improve surgical care access, many low- and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only 1 fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. OBJECTIVE: We aim to document the history and current state of neurosurgery in the Gambia to raise awareness and promote neurosurgery development. METHODS: The study reviews the Gambia's health care system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian health care. RESULTS: Neurosurgery in the Gambia began in the 1970s, facing constraints due to competing health care demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro Missions and the establishment of a dedicated neurosurgery unit. We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of computer tomography scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. CONCLUSIONS: Neurosurgery in the Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.
ABSTRACT
BACKGROUND: Venous thromboembolism is a common and preventable cause of morbidity and mortality in hospitalized patients. There is a lack of data on the distribution of risk factors and prophylaxis practices in sub-Saharan Africa. AIM: To assess the prevalence of venous thromboembolism risk in hospitalized patients and to determine the proportion of at-risk patients who receive prophylaxis. METHODS: The study was a cross-sectional hospital-based survey. On the basis of the global ENDORSE methodology, patients aged≥40 years admitted to a medical ward or those aged≥18 years admitted to a surgical ward were assessed for risk of venous thromboembolism by hospital chart review. Distribution of risk factors and coverage of prophylaxis in at-risk patients were determined using the 2004 American College of Chest Physicians evidence-based consensus guidelines. RESULTS: From October to November 2008, 520 patients (278 medical; 242 surgical) were enrolled in 12 hospitals across Senegal. Two hundred and ninety-eight (57%) were at risk of venous thromboembolism; 152 (57.4%) medical patients and 146 (60.3%) surgical patients. Among those at risk, 48 (31.6%) medical patients and 52 (35.6%) surgical patients received a prescription for prophylaxis. Among patients without contraindication to anticoagulants, 33.8% (46/136) on medical wards and 37.5% (48/128) on surgical wards received prophylaxis. CONCLUSION: The risk of venous thromboembolism was frequent in hospitalized patients in Senegal but only a few received the recommended prophylaxis. There is a need to implement a programme to improve venous thromboembolism awareness and prophylaxis.
