Knowledge, attitudes, and exposure to neurocritical care among neurosurgical providers in sub- Saharan Africa: A cross-sectional survey of physicians

When a person suffers a severe injury to the brain, such as from a car accident, a stroke, or an infection, the damage does not stop once the surgery is over. The brain remains fragile, vulnerable to a second wave of injury caused by swelling, pressure, or a lack of oxygen. To survive this critical window, patients need a specialized kind of care that monitors their brain function minute by minute, adjusts their breathing, and manages their blood pressure with extreme precision. This field, known as neurocritical care, acts as a safety net for the most vulnerable neurological patients, bridging the gap between the operating room and recovery. In wealthy nations, this care is often delivered in dedicated units staffed by doctors trained specifically for these high-stakes scenarios. However, in sub-Saharan Africa, where the burden of brain injuries is immense, the path to this life-saving support is often blocked by a shortage of specialized training and equipment. The question facing medical leaders in the region is not just whether doctors know the theory, but whether they have had the chance to practice these skills in real hospitals.

To answer this, a team of researchers from across the continent and beyond conducted a wide-ranging survey of neurosurgeons and their trainees. They reached out to doctors affiliated with major surgical colleges in West, East, Central, and Southern Africa, asking them to share their experiences through an online questionnaire. The goal was to map out the current landscape of knowledge, attitudes, and actual exposure to intensive care for brain patients. The study focused on 52 participants, a mix of doctors still in training and fully qualified specialists, to see if their understanding of critical care matched their daily reality. The researchers wanted to know if these providers felt confident managing life-threatening brain conditions, how much time they had spent in intensive care units, and whether they had access to the specific tools needed to monitor brain pressure.

The results revealed a striking contrast between what these doctors knew and what they had experienced. The vast majority of the participants demonstrated a strong grasp of the theoretical principles of neurocritical care. Nearly all of them could correctly answer questions about how to treat brain swelling, manage seizures, or determine the right blood pressure targets for a patient with a brain bleed. Their knowledge was high, suggesting that medical education in the region has successfully transmitted the core science of saving these patients. Furthermore, the doctors held very positive attitudes toward the field; they believed that specialized training was necessary and expressed confidence in their ability to manage complex cases. They were eager to apply these principles and felt that dedicated care units would improve patient outcomes.

However, when the researchers looked at the practical side of things, the picture changed. Despite their strong theoretical knowledge, the doctors reported very limited hands-on experience in dedicated neurocritical care units. The median time spent training in a general intensive care unit was around 10 weeks, but the time spent specifically in a unit designed for brain patients was much shorter, often just a few weeks. Many of the doctors, particularly those still in training, had not completed a formal rotation focused solely on neurocritical care. In many hospitals, these specialists were managing critically ill brain patients in general intensive care units simply because there were no dedicated neuro units available. While they were confident in their skills, the gap between knowing the rules and having practiced them in a specialized setting was wide. The study found that simply having more years of experience or a higher theoretical score did not predict who had better practical exposure; the availability of training opportunities varied significantly depending on where a doctor worked, with some regions having far fewer resources than others.

The researchers concluded that while the doctors in sub-Saharan Africa are well-educated on the science of neurocritical care, the system lacks the structured, hands-on training needed to turn that knowledge into consistent, life-saving practice. The study suggests that the current model of learning is insufficient because it relies too heavily on theory without enough supervised practice in specialized environments. To fix this, the authors propose that training programs must evolve to include mandatory rotations in neurocritical care units, where doctors can learn to use advanced monitoring equipment under the guidance of experts. They also suggest using simulation training to practice skills when real patients are not available and building networks where doctors from smaller hospitals can learn from larger, better-equipped centers. The path forward is clear: the doctors have the knowledge, but the region needs to build the bridges that allow them to apply it fully, ensuring that every patient with a severe brain injury receives the specialized attention they need to survive.