Romani Roman Sabas

Study Design: Scoping Review. Objective: Spine research is resource-intensive and thus often performed in high-income countries. Consequently, findings may not be generalizable to low-resource areas. This study aimed to assess the current state of primary clinical spine disease research in Sub-Saharan Africa. Methods: All spine studies published in English or French in Sub-Saharan Africa in the past 50 years with at least ten patients were included. A study quality variable was created that identified randomized studies, prospective studies, and studies that include a control group as having a higher level of scientific rigor. Results: A total of 154 spine studies have been published from at least 26 countries since 1975 (some included multiple). There was a significant increase in research productivity after 2005 (p<0.001). The highest number of publications came from Nigeria with 52 (34%), followed by Tanzania (25 papers, 16%) and Ethiopia (12 papers, 8%). Nearly half of studies involved collaborative partnerships. On univariate analysis, lower-income countries were more likely to engage in collaboration with other countries (OR 3.2, 95% CI: 1.2-9.8) and to receive external funding (OR 7.0, 95% CI: 2.3-20.4). Further, collaborative studies were found to produce higher quality academic publication (OR 2.0, 95% CI: 0.94-4.2). Conclusion: There is a relative paucity of spine literature from Sub-Saharan Africa. Higher research quality was associated with collaborative engagement. These results support the development of global health partnerships that may foster high-quality research aimed at addressing the burden of spine disease in Africa.

Study Design: Prospective observational pilot study. Objectives: Introducing endoscopic spine surgery in low- and middle-income countries (LMICs) poses logistical and clinical challenges, yet offers potential patient benefits. This study describes the implementation of a pilot endoscopic spine surgery program in Tanzania and reports early outcomes from the first patient cohort. Methods: Weill Cornell Medicine and the University of California, Irvine facilitated the introduction of endoscopic spine surgery techniques in Tanzania through theoretical and hands-on training, equipment donations, and live surgical mentorship. Fourteen patients with lumbar pathology refractory to conservative treatment underwent endoscopic microdiscectomy and/or decompression. Outcomes were assessed using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, measured preoperatively and postoperatively up to 3 months. All fourteen patients (100%) completed the 3-month assessment. Results: A structured 5-day program integrating didactic instruction, simulation-based training, and supervised live surgeries successfully introduced spine endoscopy in Tanzania. Fourteen patients underwent endoscopic lumbar decompression (FESS n = 8; UBE n = 6). At short-term follow-up, marked early reductions were observed in back-pain VAS ( P < 0.001, Kendall’s W = 0.53), leg-pain VAS ( P < 0.001, W = 0.59), and ODI ( P < 0.001, W = 0.79). All preoperative-versus-postoperative pairwise comparisons survived Benjamini-Hochberg false-discovery-rate adjustment (q = 0.05). These results reflect feasibility and early safety only and should not be interpreted as evidence of sustained benefit or comparative effectiveness. Conclusion: This pilot study demonstrates the successful implementation of endoscopic spine surgery in an LMIC setting through structured international collaboration. The clinical outcomes reported are short-term and observed under selected pilot conditions; larger studies with longer follow-up are needed to evaluate durability, comparative effectiveness, and external validity.

Paediatric spine deformity, often arising from congenital or neuromuscular causes, can significantly impair cardiopulmonary and intra-abdominal function. Early identification and timely management are crucial to slowing curve progression. However, in LMICs, patients present late with severe curvatures exceeding 90°. Preoperative reduction is useful to mitigate surgical risks. This study assessed the feasibility of a modified halo-pelvic distraction device, focusing on major curve correction and complication rates. Patients with severe scoliosis were enrolled from November 2023-October 2024, each undergoing treatment with a modified halo-pelvic Ilizarov distraction device over a 13-week period. Radiographic major curve changes, neurological function, and complication rates were assessed at defined treatment intervals. Seven patients were included, with a median age of 15 years (IQR 14-20); four were male. The baseline median major curve was 110° (IQR 92°-120°), including three cases of adolescent idiopathic scoliosis (AIS). Following 13 weeks of distraction, the median curve improved to 69°, representing a 63% correction (p = 0.027). One patient developed transient lower limb weakness (MRC 2/5), and another experienced superior mesenteric artery syndrome; both resolved after adjustment of traction forces and subsequent removal of the device. Definitive corrective surgery was performed in six patients, achieving a final curve correction to 49° (32°-55°). The modified halo-pelvic Ilizarov distraction technique can be a feasible preoperative strategy for achieving meaningful correction in severe spinal deformities. Expanding the use of this technique especially in LMICs could offer greater insight into its potential benefits and safety.

Objectives To evaluate factors associated with clinic follow-up after traumatic spinal injury (TSI) in Tanzania, focusing on demographic, injury-related and hospital variables. We hypothesised that socioeconomic and injury-specific factors would predict follow-up adherence. Design Retrospective observational cohort study. Setting Tertiary government referral centre for neurosurgery and orthopaedics in Dar es Salaam, Tanzania. Participants 443 adults with TSI admitted between September 2016 and October 2021. Inclusion criteria included survival to discharge and availability of the discharge date. Patients with missing data were excluded. Primary and secondary outcome measures Primary outcomes were any clinic follow-up and 1-year follow-up post-discharge. Secondary outcome was time to loss of follow-up. Logistic regression was used to identify factors associated with follow-up, and Kaplan-Meier survival analysis assessed follow-up duration. Results Of 443 patients (85.8% male, median age 34 years), 52.4% returned for follow-up. Independent factors associated with return included private insurance (adjusted OR (aOR) 2.69, 95% CI 1.38 to 5.45, p=0.005), involvement in a road traffic accident (aOR 2.15, 95% CI 1.22 to 3.83, p=0.009), lumbar injuries (aOR 2.26, 95% CI 1.30 to 4.00, p=0.004), neurological improvement at discharge (aOR 3.52, 95% CI 1.72 to 7.64, p=0.001) and hospital stays shorter than 24 days (aOR 1.63, 95% CI 1.07 to 2.47, p=0.022). Among those who returned, only 25.4% completed 1 year of follow-up. Predictors of 1-year follow-up included being female (aOR 4.87, 95% CI 2.31 to 10.56, pConclusion Follow-up after TSI in this low- and middle-income country setting is poor, with fewer than one in eight patients completing 1 year. Private insurance, injury mechanism, neurological improvement and female sex predicted follow-up. Targeted efforts are needed to improve long-term care engagement.

BACKGROUND AND OBJECTIVES: Free and open access to research data and findings promotes equity in access to healthcare knowledge and equity in patient care and treatment. To benefit the health care of the population studied, research findings must be accessible to clinicians, academics, and policymakers serving those populations. The aim of this study was to assess the extent of published Tanzanian neurosurgical data and its accessibility to those practicing within the country. METHODS: A systematic review of all published neurosurgical studies from Tanzania was conducted. Authorship, funding, and open-access status were recorded. Tanzanian neurosurgeons were surveyed by telephone or in person about their methods of accessing literature. RESULTS: We identified 96 Tanzanian neurosurgical studies published in 42 journals between 1982 and 2023 with an exponentially increasing number of publications per year. Fifty-nine studies (62%) are available open access at the publisher. Open access publication is associated with Tanzanian first authorship (odds ratio = 2.6, 95% CI: 1.0-6.8) or last authorship (odds ratio = 2.7, 95% CI: 1.0-7.1). However, overall only 34 of 96 studies (35%) had Tanzanian first authors and 32 of 96 (33%) had Tanzanian last authors. We contacted 26 of 27 neurosurgeons working in Tanzania. None had in-country institutional library service access. One used a research initiative login to access neurosurgical literature, and 2 used institutional logins from outside Tanzania. Ten neurosurgeons (38%) reported alternative methods of accessing literature behind a paywall such as Sci-Hub or direct contact with authors. These methods could have given access to all but 9 of 96 neurosurgical studies (9%). CONCLUSION: Only 62% of Tanzanian neurosurgical literature is easily freely accessible to Tanzanian neurosurgeons, and 9% of all Tanzanian neurosurgical literature is extremely challenging to access for neurosurgeons working in Tanzania. Expanding open-access publishing, repositories, and publisher and institutional initiatives for equitable data and publication access are crucial for improving access to local data to improve patient care.

Traumatic spinal injuries are common in resource-limited environments and cause severe consequences such as pain, weakness, numbness, impaired bladder, bowel and sexual function, financial burdens, and psychological issues. In-person follow-up is challenging due to financial constraints, physical disability, and limited transportation. Our study aimed to explore the feasibility of using electronic patient-reported outcome measures (PROMs) following spinal injuries in Tanzania.From March to June 2023, we prospectively recruited 50 consecutive inpatients with traumatic spinal injuries at Muhimbili Orthopedic Institute in Tanzania. We recorded mobile phone and internet access and administered the Kiswahili-validated version of the SF-8 quality-of-life (QoL) questionnaire. We compared completion rates between in-person and electronic versions in-hospital and assessed postdischarge completion for electronic questionnaires.A total of 50 participants were included (mean age: 33 years [standard deviation, SD: 14], 43/50 [86%] male). Most had access to a mobile phone (47/50, 94%), and 27/50 (54%) had access to a smartphone. Only 10 participants (20%) completed the electronic PROM. Reasons for lack of completion were: no internet-enabled device (23/50, 46%), internet connectivity (9/50, 18%), unfamiliarity to the electronic forms (5/50, 10%), and lack of motivation to respond (3/50, 6%). All participants completed the in-person SF-8. Post-injury scores were lower than those reported pre-injury (Physical Component Summary Mean: 37(SD:14) v 95(SD:8), Mental Component Summary Mean: 52(SD:19) vs.98(SD:4)).Electronic PROMs following spinal injuries have low completion rates in Tanzania. In-person inpatient QoL assessment highlighted the significant impact of spinal injuries, emphasizing the importance of developing methods of QoL assessment.

INTRODUCTION: Low birth weight (LBW) remains a devastating adverse pregnancy outcome in low and middle income countries (LMICs). There is evidence showing that maternal demographic and pregnancy-related characteristics are associated with LBW. Little attention is given to paternal characteristics, which may be associated with a higher risk of LBW. This study aimed to assess the effect of paternal characteristics on LBW among singleton deliveries at Kilimanjaro Christian Medical Centre (KCMC) zonal referral hospital in Kilimanjaro region, northern Tanzania. METHODS: this was a secondary analysis of a hospital-based cohort study from maternally-linked medical birth registry data at KCMC between 2000 and 2018. A total of 47,035 singleton deliveries were included in this study. Data analysis was performed using statistical package for social sciences (SPSS), version 20 (IBM Corp., Armonk, NY). Relative risk and corresponding 95% confidence intervals (CI) were used to determine association between LBW and paternal characteristics using log-binomial regression models, with robust standard errors to account for clustering of deliveries within mothers. RESULTS: the proportion of LBW during the study period was 9.6%. After adjusting for maternal characteristics, higher risk of LBW was among fathers with low education level (RR=1.72, 95% CI: 1.22, 2.41, p=0.002), aged ≤24 years old (RR=1.37, 95% CI: 1.21, 1.55), and those unemployed (RR= 1.11, 95% CI: 1.01, 1.21). Lower risk of LBW was among fathers aged ≥40 years (RR=0.97, 95% CI: 0.88, 1.08), but this association was not statistically significant. CONCLUSION: the study confirmed paternal young age (≤24 years old), paternal low education level and unemployment as predictors for LBW . Current evidence on the effect of paternal characteristics on LBW might suggest that programs and policies should target their engagement as a key strategy for improving birth outcomes during the perinatal period. Future studies should assess how paternal factors are associated with the risk of adverse birth outcomes.