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

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. Arruebarrena Y.P. Videtta W. Vásquez-García S. Raheem M.S.A. Yimer F. Padayachy L.C. Naranjo L.S. Arriaga P. Myei C. Matuja S.S. Fadalla T. Viarasilpa T. Lundeg G. Salisu-Kabara H.M. Tsan S.E.H. Gutierrez S.P. Yankae L.P. Konkayev A. Chaikittisilpa N. Sampaio G. Van Bui T. Mariano G.S.L. Sabillon G.A. Blanco P. Ortiz W. Gallardo A.J.L. Arun O. Mani K.
August 2025 Springer

Neurocritical Care
2025 #43 Issue 1 141 - 156 pp.

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.

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

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Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, United States
Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
Departments of Neurology and Neurosurgery and Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
Department of Adult and Gerontological Nursing, Rush University, Chicago, IL, United States
Department of Anaesthesiology, The Aga Khan University, Karachi, Pakistan
Anaesthesia and Intensive Care, Burnazian State Research Centre, Moscow, Russian Federation
Department of Anesthesiology and Reanimation, Dr Soetomo General Academic Hospital, Surabaya, Indonesia
Department of Anesthesia, French Medical Institute for Mothers and Children, Kabul, Afghanistan
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Square Hospital Limited, Dhaka, Bangladesh
Department of Medical Clinics, University Centre for Health Sciences, University of Guadalajara, Guadalajara, Mexico
Department of Anaesthesia and Intensive Care, Mulago National Superspecialized Referral Hospital, Kampala, Uganda
Department of Emergency and Critical Care, Almanzor Aguinaga Asenjo Hospital, Chiclayo, Peru
Debre Tabor University, Debra Tabor, Ethiopia
Intensive Care Unit, Peradeniya Teaching Hospital, Peradeniya, Sri Lanka
Intensive Care Unit Department, Greater Accra Regional Hospital, Accra, Ghana
Department of Intensive Care, Posadas Hospital, Buenos Aires, Argentina
Neurosciences and Intensive Care Department, Clínica del Country, Bogotá, Colombia
Department of Anaesthesiology and Intensive Care, Asyut University Hospitals, Asyût, Egypt
Department of Medical Sciences, Hage Geingob Campus School of Medicine, University of Namibia, Windhoek, Namibia
Brain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
Intensive Care Unit, Hospital General Ambato, Ambato, Ecuador
Critical Care, Karl Heusner Memorial Hospital, Belize City, Belize
Department of Anaesthesia and Intensive Care, Defence Services General Hospital, Yangon, Myanmar
Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
Department of Neurosurgery, Soba University Hospital, Khartoum, Sudan
Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
Anesthesiology/Intensive Care Unit/Theatres, Aminu Kano Teaching Hospital, Kano, Nigeria
Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, University of Malaysia, Sarawak, Malaysia
Intensive Care, Hospital de Especialidades Materno Infantile, La Paz, Bolivia
Department of Neurology, University Teaching Hospitals, Lusaka, Zambia
Department of Anesthesia and Intensive Care, Astana Medical University, Astana, Kazakhstan
Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol, Bangkok, Thailand
Department of Neurology, Universidade Federal de São Paulo and Hospital Israelita Albert Einstein, São Paulo, Brazil
Neurosurgical Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
Critical Care Services, St. Luke’s Medical Centre, Quezon City, Philippines
Hospital Mario Catarino Rivas, San Pedro Sula, Honduras
Hospital Dr Luis Razetti, Anzoátegui, Barcelona, Venezuela
Hospital Ingavi, San Lorenzo, Paraguay
Hospital General Docente Roberto Rodríguez Fernández, Morón, Cuba
Department of Anesthesiology and Reanimation, Faculty of Medicine, Selcuk University, Konya, Turkey
Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

Department of Neuroanaesthesiology and Critical Care
Department of Anesthesiology and Pain Medicine
Department of Critical Care Medicine
Departments of Neurology and Neurosurgery and Center for Space Medicine
Division of Neurosciences Critical Care
Department of Adult and Gerontological Nursing
Department of Anaesthesiology
Anaesthesia and Intensive Care
Department of Anesthesiology and Reanimation
Department of Anesthesia
Department of Anesthesiology
Square Hospital Limited
Department of Medical Clinics
Department of Anaesthesia and Intensive Care
Department of Emergency and Critical Care
Debre Tabor University
Intensive Care Unit
Intensive Care Unit Department
Department of Intensive Care
Neurosciences and Intensive Care Department
Department of Anaesthesiology and Intensive Care
Department of Medical Sciences
Brain Tumor and Translational Neuroscience Centre
Intensive Care Unit
Critical Care
Department of Anaesthesia and Intensive Care
Department of Internal Medicine
Department of Neurosurgery
Division of Critical Care
Department of Critical Care and Anaesthesia
Anesthesiology/Intensive Care Unit/Theatres
Department of Anaesthesiology and Intensive Care
Intensive Care
Department of Neurology
Department of Anesthesia and Intensive Care
Department of Anesthesiology
Department of Neurology
Neurosurgical Intensive Care Unit
Critical Care Services
Hospital Mario Catarino Rivas
Hospital Dr Luis Razetti
Hospital Ingavi
Hospital General Docente Roberto Rodríguez Fernández
Department of Anesthesiology and Reanimation
Department of Biostatistics

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