Sabangan, April

BACKGROUND AND OBJECTIVES: Stroke has the largest proportion of the global burden of neurological disorders with projected mortality rates to increase more rapidly in low- and middle-income countries than in high-income countries, and people of African descent are at greater risk. To better understand the burden, risk factors, and care pathways, this study aimed to review the risk factors, clinical presentation, and outcomes of patients presenting with stroke or stroke-like symptoms in a tertiary hospital in Sierra Leone. METHODS: A retrospective chart review was conducted of all patients presenting with neurological or neurosurgical conditions from January 2019 through December 2023 and those with stroke or stroke-like symptoms were included in this study. RESULTS: One thousand two hundred ninety-seven patients were diagnosed with stroke. Of these, a small majority were male (712, 54.9%), and the mean age was 57.8 years. About a third (38.1%) of the stroke patients were aged 60 years and above, and 562 (43.3%) were between 41 and 60 years. A majority of stroke patients (68.6%) had a prior diagnosis of hypertension, while significantly fewer had a documented diagnosis of diabetes (8.8%) and 4.6% of patients had a known prior stroke. Only half (50.8%) with ordered computed tomography scan were able to complete the ordered imaging. From these imaging findings, 123 patients (9.6%) were diagnosed with hemorrhagic stroke, while the remainder were diagnosed with ischemic stroke or transient ischemic attack vs hypertensive urgency. 32.9% experienced in-hospital mortality, while only 6.5% followed up. CONCLUSION: This study documents the significant stroke burden in Sierra Leone, much of which is unaddressed due to lack of specialty resources including inadequate community engagement to raise awareness of risk factors and preventative measures. Poor health-seeking behavior and access to medical services also contribute to this burden. These data are imperative to identify systems gaps and help support ongoing capacity building efforts.

OBJECTIVE Unmet global neurosurgical needs pose a significant challenge, as do unequal opportunities for neurosurgical education and training across the globe. Mission:BRAIN is a nonprofit organization working to provide neurosurgical expertise and resources to both patients and healthcare providers in underserved areas. It operates globally, with local chapters involving primarily medical students. Its presence in Europe has expanded in the last few years with initiatives that contribute to shaping an international approach to global neurosurgery challenges. The authors aim to investigate the impact of student-led organizations, such as Mission:BRAIN, on global neurosurgery, with a focus on low-income countries and low- to middle-income countries, while also assessing the changes observed within the European group during its initial 2 years. METHODS Quantitative and qualitative analyses were employed to investigate changes in the number of chapters, members, and events. The perceived impact was evaluated using a Likert scale survey administered to European members. RESULTS Between 2022 and 2023, the number of European chapters increased by 150% (n = 10) and memberships doubled. Of the 102 survey respondents, 56.9% were female and 42.2% were male. Similarly, the number of events grew by 240%, with a significant increase in educational events (325%, p = 0.007). Participation in events increased by 10.13%, reflecting growing interest and engagement. For most members (72.6%), the activities in the European region have increased global awareness of the importance of neurosurgical care in underserved areas; for 45.1% of them, outreach events have effectively communicated the importance of neurosurgical care to nonmedical audiences. For 67.6% of the members, European chapters have contributed to fostering collaboration and knowledge sharing among medical students and healthcare providers. Furthermore, 59% agreed that Mission:BRAIN initiatives have contributed to addressing disparities in neurosurgical care and education. CONCLUSIONS Mission:BRAIN’s growth in Europe showcases the pivotal role of medical students. The impact of the organization’s activities demonstrates the students’ potential to contribute to the overarching effort of bridging worldwide gaps in healthcare and education and calls for their active participation and recognition.