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