Edward Francis Small Teaching Hospital (EFSTH) is a tertiary referral hospital in Banjul, the capital city of The Gambia. It is the largest hospital in the country, originally founded by British colonialists in 1853. Until 2013, it was known as the Royal Victoria Teaching Hospital (RVTH).
Between June and September 2022, an outbreak of acute kidney injury (AKI) among children in The Gambia caused 66 deaths among 82 cases, linked to medicines contaminated with diethylene glycol (DEG) and ethylene glycol. Clinical heterogeneity in DEG poisoning remains poorly characterized, limiting risk stratification and resource allocation in outbreak settings. We used latent class analysis to identify distinct clinical phenotypes and their predictors. We conducted a secondary analysis of a case-cohort study involving 63 AKI cases and 258 controls aged ≤ 8 years. Latent class analysis, a statistical approach that identifies naturally occurring patient subgroups based on symptom patterns, used 13 binary symptom indicators to identify clinical phenotypes via an expectation–maximization algorithm. We compared models with 2–5 classes using the Bayesian Information Criterion and entropy. Multinomial logistic regression examined predictors of phenotype membership. Four distinct phenotypes were identified: Classic Kidney–Fever (30.2
OBJECTIVE:Artificial intelligence (AI) and robotics are transforming neurosurgical care; however, the application of these technologies in low- and middle-income countries (LMICs), where the burden of neurosurgical diseases is highest, is not well-characterized. In this scoping review, we sought to map the current landscape of AI and robotics in global neurosurgery to identify themes and gaps that can catalyze the expansion of safe neurosurgical care worldwide. METHODS:A systematic search was conducted across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore. This review followed the Population, Concept, and Context (PCC) framework, including studies that utilized AI or robotics for neurosurgical diagnosis, decision-making, or treatment in global developing or low-resource settings. RESULTS:A total of 22 studies were identified, with a rapid acceleration in research observed since 2023. Geographically, the majority of applications were in Africa (n = 13), followed by Asia (n = 6) and South America (n = 4). Trauma was the predominant field (n = 11), where machine learning was frequently used for triage and prognostication. Other common applications included AI for brain tumor classification and segmentation, automated stroke detection, and image-guided surgical robotics, with models trained on local data outperforming those imported from other settings. Nineteen of the 22 studies included coauthors from the region of application, and 16 included coauthors from a HIC. CONCLUSION:AI and robotics are demonstrating increasing utility in supporting global neurosurgery by augmenting workforce capacity and improving efficiency of care. However, success depends heavily on data representation. Future work should focus on supporting local research capacity and leadership and expanding applications to postoperative care.
Abstract Maternal and newborn mortality in The Gambia remains high despite expanded coverage of essential interventions, and progress towards SDG targets 3.1 and 3.2 has stalled. The National Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy (2017 to 2026) ends in 2026, and a successor plan is in development. We aimed to identify and rank nationally defined maternal and newborn health (MNH) research priorities in The Gambia to inform the successor RMNCAH plan and align research investment with national health system needs. We conducted a national, stakeholder-led MNH research prioritisation exercise in October 2023 using an adapted Child Health and Nutrition Research Initiative (CHNRI) method. Forty-six participants, including Ministry of Health policymakers and programme managers, clinicians, midwives, researchers, and development partners, took part in a two-day workshop. A starting set of 46 questions from the 2019 African Academy of Sciences (AAS) continental MNH prioritisation exercise and four questions from The Gambia’s National Health Research Agenda was expanded through facilitated discussion to a final list of 61 questions, organised by MNH grand challenge area and CHNRI research domain. Participants independently scored each question against four weighted criteria, and national rankings were compared descriptively with AAS continental and West African subregional rankings. The priority list was dominated by delivery-focused research (49 of 61 questions, 80 percent), concentrated in better care during pregnancy and better postnatal care. The five highest-ranked priorities addressed management of obstetric emergencies before referral, retention and equitable distribution of the MNH workforce, neonatal resuscitation at peripheral facilities, maternal recognition of danger signs, and kangaroo mother care. Pre-transfer emergency obstetric management was the top national priority but was not prominent in AAS continental or West African subregional rankings. This first national MNH research priority-setting exercise in The Gambia identifies a coherent set of implementation and health systems research priorities and surfaces context-specific questions, particularly pre-transfer emergency management, that were under-emphasised in continental rankings. The agenda provides an evidence base for the successor RMNCAH plan and for partner alignment in The Gambia and comparable high-burden settings.
Despite low human immunodeficiency virus (HIV) prevalence in The Gambia (estimated adult prevalence 1.29
A growing ageing population in Africa underscores the need to reorient health systems to provide care for non-communicable conditions impacting older populations such as hip fractures. In The Gambia, the number of hip fractures are expected to quadruple for both men and women in the next 30 years. This is comparable to hip fracture incidence rates in other South and West African countries. Moreover, mortality rates post-hip fracture are 2-3 fold higher in populations from the African Region than for those in other high-income countries. Globally, in many countries including in The Gambia, musculoskeletal conditions are treated in a pluralistic medical system by both biomedical healthcare professionals and traditional bone setters (TBS). Further research is required to understand the interactions between these different therapeutic modalities in the treatment of fractures, including hip fractures - a life changing injury. Such evidence is important for developing collaborative initiatives between traditional and biomedical practitioners. This study sought to describe the practices and procedures used by TBS to treat hip fractures and their interactions between with biomedical care in The Gambia. In-depth interviews were conducted with 16 TBS and 38 healthcare professionals involved in hip fracture care provision in both rural and urban regions of the country. Data were analysed using an inductive thematic analysis. TBS used different modalities to identify a hip fracture. Most TBS misidentified and treated hip fractures as dislocations. On account of this, treatment consisted of pulling, massaging, and kneading the limb back into the hip socket. During this process, TBS applied concoctions of herbs and butters followed by splinting and tying the limb. Few TBS provided pain relief medication during treatment and most advised an extensive period of immobilisation of the limb. Follow up visits reviewed recovery. The narratives of both TBS and healthcare professionals further highlighted the informal referral of hip fracture patients from TBS to biomedical care to receive radiographs, analgesia, and for other ailments. While some biomedical healthcare professionals maintained that TBS should have no role in hip fracture care, others noted the importance of regulation of TBS practices and training initiatives. Considering these findings, we propose short-, medium- and long-term recommendations for the integration of traditional and biomedical sectors in the treatment of hip fractures in The Gambia. This includes the need to establish regulatory mechanisms for TBS practices and patient referral pathways between biomedical and TBS care.
