{"id":"1eea076d-d9e5-4355-b8b1-5b831a19beae","slug":"sni-17-590","title":"Access to myelomeningocele care in Sub-Saharan Africa","authors":["Sergio Neto","Moises Cinco Reis","Mayanda Ndombele Inocente"],"abstract":"Background: Neural tube defects (NTDs), particularly myelomeningocele, account for one of the highest disease burdens in Sub-Saharan Africa. The pooled birth prevalence of spina bifida on the continent is around 13/10,000 births, with Eastern Africa reaching approximately 33/10,000 and Ethiopia approaching 60/10,000. Myelomeningocele is associated with Chiari II malformation and secondary hydrocephalus in up to 80–90% of cases. Mandatory folic acid food fortification remains unevenly implemented across the continent, with Angola and most Portuguese-speaking African countries (PALOP) lacking such policies. This review aimed to systematically map the determinants of access to surgical treatment for myelomeningocele in Angola and across Sub-Saharan Africa, integrating primary prevention, surgical models, and clinical outcomes. Methods: This scoping review followed Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guideline. Ten international and regional databases, together with gray literature, were searched in four languages (English, Portuguese, French, and Spanish) between January 01, 1990 and June 19, 2026. Two independent reviewers conducted study selection and data extraction (Cohen’s kappa 0.82). Results: Twenty-eight sources were included (21 primary studies and 7 reviews/reports/gray literature sources). Seven domains of access determinants emerged: geographical, economic, systemic, sociocultural, temporal, follow-up, and primary prevention. Scientific output is concentrated in Eastern and Western Africa, with a near-complete absence of data from the PALOP. Postnatal closure largely occurs outside the optimal 48–72-h window, with median ages at surgery of 7–11 days in series from Nigeria, Zambia, and Ethiopia, hospital mortality between 5% and 15%, and postoperative infection rates between 12% and 30%. Folic acid fortification coverage is heterogeneous: South Africa reduced NTD prevalence by more than 30% after policy adoption in 2003, whereas Angola and most PALOP still lack mandatory fortification. Conclusion: Surgical outcomes for myelomeningocele in Sub-Saharan Africa are shaped largely outside the operating theater. They depend on primary prevention, early identification, neonatal surgical capacity, and integrated long-term follow-up. For Angola and other PALOP, generating local primary evidence, evaluating mandatory folic acid fortification, and organizing dedicated neonatal referral pathways are urgent priorities.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/sni-17-590/figures/SNI-17-590-g003.jpg","publishDate":"2026-10-16T00:00:00.000Z","doi":"10.25259/SNI_756_2026","categories":["Pediatric Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/1eea076d-d9e5-4355-b8b1-5b831a19beae/pdf"}