Camilla Grøver Aukrust

BackgroundEach year, nearly 400,000 new cases of paediatric hydrocephalus are estimated to occur worldwide, and almost half of these cases are expected to affect children in Africa. At Queen Elizabeth Central Hospital (QECH), an urban tertiary hospital in Blantyre, Malawi, located in south-east Africa, around 200 children received neurosurgical treatment for hydrocephalus in 2023. These children require lifelong follow-up and care, which places significant demands on their caregivers.Objectives The following research objectives guided the study: 1) To explore how mothers of children with hydrocephalus perceive the condition. 2) To examine the care pathways that mothers and their children with hydrocephalus engage in. 3) To identify the implications of having a child with hydrocephalus.Methods We applied a qualitative method with an explorative design. We conducted 15 in-depth interviews and two focus group discussions among 16 mothers (aged 20-35 years) of inpatient or outpatient children with hydrocephalus at QECH. Convenience sampling was used to recruit the 16 participants. We conducted a thematic analysis. Results 1) Mothers referred to various disease explanations, often switching between attributing the condition to God, supernatural causes such as bewitchment, and biomedical factors. 2) The care pathways for mothers and their children with hydrocephalus at QECH are fraught with challenges, creating strenuous trajectories that hinder access to care and present significant challenges. 3) Having a child with hydrocephalus has extensive social implications, including stigma and disruption of daily living.Conclusions Our findings highlight the need for intersectoral action to optimise treatment and reduce stigma. This involves educational programs and awareness-raising campaigns to improve maternal health literacy. Additionally, targeted initiatives are urgently needed to improve healthcare infrastructure, transportation, and pathways to care. Since hydrocephalus management is a lifelong process, the possibility of conducting follow-up through outreach clinics or telemedicine and community-based rehabilitation should be further explored. Finally, to improve management for children with hydrocephalus in Blantyre and across Malawi includes efforts to bolster the educational, economic, social, and legal position of women.

Neurosurgical advocates for global surgery/neurosurgery at the 75th World Health Assembly gathered in person for the first time after the COVID-19 pandemic in Geneva, Switzerland, in May 2022. This article reviews the significant progress in the global health landscape targeting neglected neurosurgical patients, emphasizing high-level policy advocacy and international efforts to support a new World Health Assembly resolution in mandatory folic acid fortification to prevent neural tube defects. The process of developing global resolutions through the World Health Organization and its member states is summarized. Two new global initiatives focused on the surgical patients among the most vulnerable member states are discussed, the Global Surgery Foundation and the Global Action Plan on Epilepsy and other Neurological Disorders. Progress toward a neurosurgery-inspired resolution on mandatory folic acid fortification to prevent spina bifida-folate is described. In addition, priorities for moving the global health agenda forward for the neurosurgical patient as it relates to the global burden of neurological disease are reviewed after the COVID-19 pandemic.

Aim: To explore what competencies and skills Malawian nurses gained after participating in an institutional health and training programme in Norway and how they viewed these competencies applicable upon return to Malawi. Furthermore, to examine facilitators and challenges experienced on the exchange programme and opportunities and obstacles to make the competencies usable in own local hospital context.Design: Qualitative study with an explorative design.Methods: Fourteen interviews and one focus group discussion were conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, from August to September 2018.Results: Competencies gained in Norway included clinical skills, teamwork, coordination and strengthened professionalism. The main finding was that the exchange programme was a transformative experience. Upon return to Malawi, the competencies gained on the exchange were helpful. However, the return was characterized by mixed emotions due to the considerable difference between the two clinical settings.