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Review
. 2023 Jul;39(7):1821-1829.
doi: 10.1007/s00381-023-05988-z. Epub 2023 May 18.

Spina bifida management in low- and middle-income countries - a comprehensive policy approach

Jogi V Pattisapu  1 , Vigneshwar Raj Veerappan  2 , Colette White  3 , M V Vijayasekhar  4 , Nebiyat Tesfaye  5 , B Hayagriva Rao  6 , Kee B Park  7
Affiliations
Review

Spina bifida management in low- and middle-income countries - a comprehensive policy approach

Jogi V Pattisapu et al. Childs Nerv Syst. 2023 Jul.

Abstract

Introduction: Globally, spina bifida (SB) occurs more often in low- and middle-income countries, where the healthcare demands are often quite challenging. Several social/societal issues and/or lack of government support makes for incomplete SB management in many areas. Clearly, neurosurgeons should be knowledgeable about initial closure techniques and the basics of SB management, but must also advocate for the patients outside our immediate scope of care.

Methods: Recently, the Comprehensive Policy Recommendations for the Management of Spina Bifida and Hydrocephalus in Low- and Middle-Income Countries (CHYSPR) and the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders (IGAP) publications emphasized the need for a more unified approach to SB care. Although both documents discuss other neurological conditions, they support SB as a congenital malformation needing attention.

Results: We identified several similarities for comprehensive SB care in these approaches - including education, governance, advocacy, and the need for continuum of care. Prevention was recognized as the most important aspect for SB going forward. A significant return of investment was noted, and both documents recommend more active neurosurgical involvement (i.e., folic acid fortification).

Conclusion: A new call for holistic and comprehensive care for SB management is recognized. Neurosurgeons are called upon to use solid science to educate governments and actively participate to advocate for better care and most importantly, prevention. Folic acid fortification schemes are mandatory and neurosurgeons should advocate for global strategies.

Keywords: Advocacy; CHYSPR; Intersectoral global action plan; LMICs; Prevention; Spina bifida.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Matrix of selected CHYSPR policy recommendations and strategic objectives of the WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031 (IGAP). SB, spina bifida; HC, hydrocephalus
See this image and copyright information in PMC

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