My name is Catherine Zimmerman, and I'm a medical student at the University of Alabama in Birmingham. I'm excited to share with you a project titled Policy Recommendations for the Treatment of Hydrocephalus and Spina Bifida in Low- and Middle-Income Countries. This project was truly a collaborative effort, driven by neurosurgeons, residents, and medical students from across the country and the globe. Hydrocephalus and Spina Bifida are a major cause of morbidity and mortality worldwide, and are among the most common neurosurgical disorders in children. As low- and middle-income countries begin to adopt national surgical obstetric and anesthesia plans and SOAPs, it is essential that pediatric neurosurgical care be included. The purpose of this study was to provide evidence-based policy recommendations for addressing these pediatric neurosurgical diseases. Review of the literature was conducted to compile evidence regarding capacity required to treat pediatric hydrocephalus and spina bifida globally. Specific policy recommendations were determined for the following phases of care. Prevention, Screening and Surveillance, Pre-hospital, Surgical Systems, Rehabilitation, and Transitional and Follow-up Care. For each phase of care, recommendations were made in the following domains of the NSOAP. Infrastructure, Workforce, Service Delivery, Financing, Information Management, and Governance. And I'll now highlight a few key recommendations for each phase of care. For Prevention, under Infrastructure, we recommend universal folic acid fortification and availability of folic acid supplementation. For Screening and Surveillance, under Information Management, we recommend tracking of regional incidence data and web-based platforms to host data collection. For Pre-hospital Recommendations, under Workforce, we recommend educating mothers, midwives, OBGYNs, and primary health care providers on how to identify neonates and infants with spina bifida and hydrocephalus and promote referral to local tertiary care centers. We also recommend training community health care workers in early recognition, navigating the referral network, and knowing where to take patients for surgical care. For Surgical Systems, under Workforce, we recommend that training centers are needed to address the workforce deficit and that task sharing and task shifting is acceptable For Treatment of Hydrocephalus and Spina Bifida Repair. For Rehabilitation, under Infrastructure, we recommend space and resources for rehabilitation in hospitals which treat hydrocephalus and spina bifida, and disabled-friendly transportation for access to rehabilitation centers. For Transitional and Follow-up Care Recommendations, we recommend under Workforce, empowering nurses and community health workers to extend the reach of physicians and augment the quality and accessibility of spina bifida and hydrocephalus care. We also recommend establishing referral networks between transitional care coordinators and all the different health care professionals that deliver care to this population. In conclusion, evidence-based strategies to strengthen health care systems are essential to address pediatric neurosurgical disease worldwide.

Hydrocephalus

Spina Bifida

low- and middle-income countries

policy recommendations

neurosurgical disorders