Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
Neurocrit Care. 2024 Dec;41(3):730-738. doi: 10.1007/s12028-024-02040-z. Epub 2024 Jul 3.
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
“城乡差距”包含多个方面，一直是任何国家的重要关注点。经济差距、基础设施匮乏、缺乏医学专家、教育、培训和医疗保健机会有限、卫生条件较差以及地理位置的隔离效应加深了这一差距，尤其是在低收入和中等收入国家（LMICs）。本文概述了 LMICs 中与神经危重症护理（NCC）相关的设施方面的城乡差异。还讨论了与常见临床病症相关的问题，如中风、创伤性脑损伤、重症肌无力、癫痫、结核性脑膜炎和气管切开术。为了在资源有限的情况下提供 NCC，提出了一些策略，包括加强预防措施、关注基础、采用多学科方法、促进培训和教育，以及开展具有成本效益的研究和合作努力。由于农村地区获得预防保健服务的机会有限、获得性脑损伤发病率高、无法及时管理神经急症以及资源匮乏的卫生中心缺乏专科服务，因此 LMICs 的农村地区受到的影响最大。增加农村地区的卫生预算拨款、对劳动力进行 NCC 教育和培训以及提供远程医疗服务以进行快速诊断、管理和神经康复，这些都是一些非常有帮助的措施。
