Brain tumour patients die waiting for surgery in Africa — Study

Some brain tumour patients in Africa are dying before they can undergo surgery because of inadequate hospital resources, late diagnosis and a severe shortage of neurosurgeons, a review published in the Egyptian Journal of Neurosurgery, has found.

The review found that 26.4 percent of patients considered suitable for brain tumour surgery in one study could not undergo the procedure because of inadequate resources. Another 24 patients reportedly died while waiting for surgery.

Titled: Surgical outcomes of brain tumours in Africa: challenges, progress, and future perspectives, the review examined surgical outcomes, treatment complications, and barriers to care across the continent.

The researchers identified the shortage of neurosurgeons as a major obstacle, particularly in sub-Saharan Africa, where there is approximately one neurosurgeon for every 2.62 million people.

They noted that effective brain tumour treatment requires not only skilled surgeons, but also diagnostic imaging, specialised anaesthesia, well-equipped operating theatres, pathology services, intensive care and rehabilitation. Shortage of MRI and CT scanners, financial constraints and geographical barriers further delay treatment.

The researchers warned that many patients reach specialist hospitals only after tumours have grown substantially or caused serious neurological complications. Symptoms may include persistent headaches, seizures, visual disturbances and weakness.

Nigerian studies cited in the review illustrated the consequences of late presentation. In one study, surgery improved vision in 14 patients with giant pituitary tumours despite their advanced condition. Another study reported vision loss in 85.7 per cent of patients with cranial meningiomas and a six-month postoperative mortality rate of 20 per cent, with deaths associated with raised pressure inside the skull.

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Despite these challenges, the review found evidence that surgery can improve outcomes, even in resource-constrained settings.

One study of awake craniotomy with brain mapping for glioma removal recorded an average tumour removal rate of 89.5 per cent, with total or subtotal removal achieved in 85 per cent of cases. Seizures were the main presenting symptom in 70 per cent of patients.

The researchers said variations in surgical outcomes across African countries reflected differences in disease severity at presentation, available facilities, surgical expertise and postoperative care.

They also raised concerns about inadequate data on the continent’s brain tumour burden. Only 11 per cent of Africa’s population was covered by cancer registries, according to figures cited in the review, making it difficult to establish reliable incidence and mortality rates.

The review estimated that sub-Saharan Africa recorded approximately 9,169 new brain tumour cases in 2020, representing about three per cent of global cases. Nigeria reportedly recorded 1,798 cases that year. Common tumour types included astrocytomas, meningiomas and pituitary adenomas.

The authors cautioned that limited diagnostic capacity and incomplete cancer registration could mean the actual burden is higher than reported. They also called for more genomic research involving African populations to improve understanding of genetic risk factors.

To improve outcomes, the researchers urged governments to invest in specialised neurosurgical facilities, modern equipment and training for healthcare professionals. They also recommended partnerships with international institutions to strengthen skills, research and access to advanced surgical techniques.

Other priorities include expanding access to diagnostic imaging, pathology and radiotherapy, using telemedicine to connect underserved communities with specialists, and establishing national and regional brain tumour registries.

The authors further advocated public awareness campaigns to encourage early diagnosis, improved health insurance coverage to reduce patients’ financial burden and regular audits to strengthen surgical safety and quality.

They concluded that coordinated action by governments, healthcare professionals and international partners is essential to expand access to timely diagnosis, specialised surgery and postoperative care, reduce preventable deaths and improve the quality of life of people living with brain tumours across Africa.