Neurocritical Care Organization in the Low-Income and Middle-Income Countries

Hemanshu Prabhakar; Abhijit V. Lele; Indu Kapoor; Charu Mahajan; Gentle S. Shrestha; Chethan Venkatasubba Rao; Jose I. Suarez; Sarah L. Livesay; Faraz Shafiq; Konstantin Popugaev; Dhania Santosa; Obaidullah Naby Zada; Wanning Yang; Hosne Ara Nisha; Julio C. Mijangos-Mendez; Peter Kaahwa Agaba; Juan Luis Pinedo Portilla; Yalew Hasen Tuahir; Puvanendiran Shanmugam; Yanet Pina Arruebarrena; Walter Videtta; Sebastián Vásquez-García; M. Samy Abdel Raheem; Fasika Yimer; Llewellyn C. Padayachy; Luis Silva Naranjo; Pedro Arriaga; Chann Myei; Sarah Shali Matuja; Tarig Fadalla; Tanuwong Viarasilpa; Ganbold Lundeg; Halima M. Salisu-Kabara; Samuel Ern Hung Tsan; Simon P. Gutierrez; Leroy P. Yankae; Aidos Konkayev; Nophanan Chaikittisilpa; Gisele Sampaio; Tuan Van Bui; Geraldine Seina L. Mariano; Gisselle Aguilar Sabillon; Pablo Blanco; Williams Ortiz; Angel Jesus Lacerda Gallardo; Oguzhan Arun; Kalaivani Mani

doi:10.1007/s12028-025-02210-7

Neurocritical Care Organization in the Low-Income and Middle-Income Countries

Hemanshu Prabhakar, Abhijit V. Lele, Indu Kapoor, Charu Mahajan, Gentle S. Shrestha, Chethan Venkatasubba Rao, Jose I. Suarez, Sarah L. Livesay, Faraz Shafiq, Konstantin Popugaev, Dhania Santosa, Obaidullah Naby Zada, Wanning Yang, Hosne Ara Nisha, Julio C. Mijangos-Mendez, Peter Kaahwa Agaba, Juan Luis Pinedo Portilla, Yalew Hasen Tuahir, Puvanendiran Shanmugam, Yanet Pina ArruebarrenaWalter Videtta, Sebastián Vásquez-García, M. Samy Abdel Raheem, Fasika Yimer, Llewellyn C. Padayachy, Luis Silva Naranjo, Pedro Arriaga, Chann Myei, Sarah Shali Matuja, Tarig Fadalla, Tanuwong Viarasilpa, Ganbold Lundeg, Halima M. Salisu-Kabara, Samuel Ern Hung Tsan, Simon P. Gutierrez, Leroy P. Yankae, Aidos Konkayev, Nophanan Chaikittisilpa, Gisele Sampaio, Tuan Van Bui, Geraldine Seina L. Mariano, Gisselle Aguilar Sabillon, Pablo Blanco, Williams Ortiz, Angel Jesus Lacerda Gallardo, Oguzhan Arun, Kalaivani Mani

Department of Anaesthesia, Medical College, Pakistan

Research output: Contribution to journal › Article › peer-review

Abstract

Background: This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. Methods: We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)]. Results: Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively). Conclusions: The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

Original language	English
Article number	e1343
Journal	Neurocritical Care
DOIs	https://doi.org/10.1007/s12028-025-02210-7
Publication status	Accepted/In press - 2025

Keywords

Intensive care unit
Low-income countries
Middle-income countries
Neurocritical care
Organization
Protocols

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10.1007/s12028-025-02210-7

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Prabhakar, H., Lele, A. V., Kapoor, I., Mahajan, C., Shrestha, G. S., Rao, C. V., Suarez, J. I., Livesay, S. L., Shafiq, F., Popugaev, K., Santosa, D., Zada, O. N., Yang, W., Nisha, H. A., Mijangos-Mendez, J. C., Agaba, P. K., Portilla, J. L. P., Tuahir, Y. H., Shanmugam, P., ... Mani, K. (Accepted/In press). Neurocritical Care Organization in the Low-Income and Middle-Income Countries. Neurocritical Care, Article e1343. https://doi.org/10.1007/s12028-025-02210-7

@article{7985d3536fc74903b3dd9c39a425ca00,

title = "Neurocritical Care Organization in the Low-Income and Middle-Income Countries",

abstract = "Background: This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. Methods: We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)]. Results: Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively). Conclusions: The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.",

keywords = "Intensive care unit, Low-income countries, Middle-income countries, Neurocritical care, Organization, Protocols",

author = "Hemanshu Prabhakar and Lele, {Abhijit V.} and Indu Kapoor and Charu Mahajan and Shrestha, {Gentle S.} and Rao, {Chethan Venkatasubba} and Suarez, {Jose I.} and Livesay, {Sarah L.} and Faraz Shafiq and Konstantin Popugaev and Dhania Santosa and Zada, {Obaidullah Naby} and Wanning Yang and Nisha, {Hosne Ara} and Mijangos-Mendez, {Julio C.} and Agaba, {Peter Kaahwa} and Portilla, {Juan Luis Pinedo} and Tuahir, {Yalew Hasen} and Puvanendiran Shanmugam and Arruebarrena, {Yanet Pina} and Walter Videtta and Sebasti{\'a}n V{\'a}squez-Garc{\'i}a and Raheem, {M. Samy Abdel} and Fasika Yimer and Padayachy, {Llewellyn C.} and Naranjo, {Luis Silva} and Pedro Arriaga and Chann Myei and Matuja, {Sarah Shali} and Tarig Fadalla and Tanuwong Viarasilpa and Ganbold Lundeg and Salisu-Kabara, {Halima M.} and Tsan, {Samuel Ern Hung} and Gutierrez, {Simon P.} and Yankae, {Leroy P.} and Aidos Konkayev and Nophanan Chaikittisilpa and Gisele Sampaio and {Van Bui}, Tuan and Mariano, {Geraldine Seina L.} and Sabillon, {Gisselle Aguilar} and Pablo Blanco and Williams Ortiz and Gallardo, {Angel Jesus Lacerda} and Oguzhan Arun and Kalaivani Mani",

note = "Publisher Copyright: {\textcopyright} Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2025.",

year = "2025",

doi = "10.1007/s12028-025-02210-7",

language = "English",

journal = "Neurocritical Care",

issn = "1541-6933",

publisher = "Humana Press",

}

Prabhakar, H, Lele, AV, Kapoor, I, Mahajan, C, Shrestha, GS, Rao, CV, Suarez, JI, Livesay, SL, Shafiq, F, Popugaev, K, Santosa, D, Zada, ON, Yang, W, Nisha, HA, Mijangos-Mendez, JC, Agaba, PK, Portilla, JLP, Tuahir, YH, Shanmugam, P, Arruebarrena, YP, Videtta, W, Vásquez-García, S, Raheem, MSA, Yimer, F, Padayachy, LC, Naranjo, LS, Arriaga, P, Myei, C, Matuja, SS, Fadalla, T, Viarasilpa, T, Lundeg, G, Salisu-Kabara, HM, Tsan, SEH, Gutierrez, SP, Yankae, LP, Konkayev, A, Chaikittisilpa, N, Sampaio, G, Van Bui, T, Mariano, GSL, Sabillon, GA, Blanco, P, Ortiz, W, Gallardo, AJL, Arun, O & Mani, K 2025, 'Neurocritical Care Organization in the Low-Income and Middle-Income Countries', Neurocritical Care. https://doi.org/10.1007/s12028-025-02210-7

TY - JOUR

T1 - Neurocritical Care Organization in the Low-Income and Middle-Income Countries

AU - Prabhakar, Hemanshu

AU - Lele, Abhijit V.

AU - Kapoor, Indu

AU - Mahajan, Charu

AU - Shrestha, Gentle S.

AU - Rao, Chethan Venkatasubba

AU - Suarez, Jose I.

AU - Livesay, Sarah L.

AU - Shafiq, Faraz

AU - Popugaev, Konstantin

AU - Santosa, Dhania

AU - Zada, Obaidullah Naby

AU - Yang, Wanning

AU - Nisha, Hosne Ara

AU - Mijangos-Mendez, Julio C.

AU - Agaba, Peter Kaahwa

AU - Portilla, Juan Luis Pinedo

AU - Tuahir, Yalew Hasen

AU - Shanmugam, Puvanendiran

AU - Arruebarrena, Yanet Pina

AU - Videtta, Walter

AU - Vásquez-García, Sebastián

AU - Raheem, M. Samy Abdel

AU - Yimer, Fasika

AU - Padayachy, Llewellyn C.

AU - Naranjo, Luis Silva

AU - Arriaga, Pedro

AU - Myei, Chann

AU - Matuja, Sarah Shali

AU - Fadalla, Tarig

AU - Viarasilpa, Tanuwong

AU - Lundeg, Ganbold

AU - Salisu-Kabara, Halima M.

AU - Tsan, Samuel Ern Hung

AU - Gutierrez, Simon P.

AU - Yankae, Leroy P.

AU - Konkayev, Aidos

AU - Chaikittisilpa, Nophanan

AU - Sampaio, Gisele

AU - Van Bui, Tuan

AU - Mariano, Geraldine Seina L.

AU - Sabillon, Gisselle Aguilar

AU - Blanco, Pablo

AU - Ortiz, Williams

AU - Gallardo, Angel Jesus Lacerda

AU - Arun, Oguzhan

AU - Mani, Kalaivani

N1 - Publisher Copyright: © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2025.

PY - 2025

Y1 - 2025

N2 - Background: This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. Methods: We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)]. Results: Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively). Conclusions: The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

AB - Background: This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. Methods: We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)]. Results: Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively). Conclusions: The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

KW - Intensive care unit

KW - Low-income countries

KW - Middle-income countries

KW - Neurocritical care

KW - Organization

KW - Protocols

UR - http://www.scopus.com/inward/record.url?scp=85218836233&partnerID=8YFLogxK

U2 - 10.1007/s12028-025-02210-7

DO - 10.1007/s12028-025-02210-7

M3 - Article

C2 - 39920547

AN - SCOPUS:85218836233

SN - 1541-6933

JO - Neurocritical Care

JF - Neurocritical Care

M1 - e1343

ER -

Neurocritical Care Organization in the Low-Income and Middle-Income Countries

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