Neurocritical Care in Tanzania: An Interview With
Dr. Hamisi K Shabani
By Faheem Sheriff, MD, and Hamisi K. Shabani, MD
The Muhimbili National
Hospital is the largest
referral hospital in
Tanzania, handling
a broad spectrum of
pathology, including
critically ill neurologic
and neurosurgical
cases of the highest
complexity. It is affiliated
with the Muhimbili Orthopedic Institute (MOI), which is the only
tertiary center for neurosurgery and orthopedics in Tanzania. The
World Health Organization recommends that all countries have
one neurosurgeon for each 100,000 residents. In Tanzania, the
ratio is 1 to 13 million.1
In addition, Tanzania has only seven practicing neurologists
(serving a population of 53 million), with a small number of
trainee neurologists in various stages of their training at home
or abroad.2 Lack of expertise is compounded by a high incidence
of emergent neurologic conditions ranging from TBI to ischemic
and hemorrhagic stroke requiring expert neurocritical and
neurosurgical care. As an example, the incidence of ischemic stroke
in Dar es Salaam (largest city in Tanzania) was 315.9 per 100,000
(281.6-352.3) compared with urban United States - 93 per
100,000 in whites and 223 per 100,000 for blacks in the Northern
Manhattan Stroke study.3 There is high in-hospital mortality
among these patients (33.3 percent in first 30 days) according to a
recent study,4 with sepsis and aspiration pneumonia being major
contributors. Even if patients survive the acute period, there is
significant socioeconomic burden and long term mortality (82.3
percent in seven years) primarily driven by severity of disability.5
Neurosurgery Operating Room at Muhimbili Orthopedic Institute
Compounding lack of expertise and paucity of resources, a lack
of transport infrastructure and referral networks often mean
many patients with neurovascular and neurotrauma emergencies
arrive too late. Despite the multiple hurdles, given evidence
for benefit of intra-arterial stroke therapies in the extended
window as well as reduction of morbidity and mortality with
decompressive hemicraniectomy in malignant MCA stroke
within 48 hours6,7, there may be reason to believe that expert
stroke, neurocritical and neurosurgical care may change the
outlook in an otherwise grim situation.
We communicated with Dr. Hamisi Shabani, the chair of
neurosurgery at MOI and Muhimbili National Hospital, who is
dedicated to improving the state of neurocritical care in Tanzania.
These were his responses:
Faheem Sheriff, MD Hamisi K. Shabani, MD
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