A Novel Resource-Adapted Neurocritical Care Education Program in Tanzania: Implementation, Outcomes, and a Framework for Sustainable Training

Neurologic emergencies contribute disproportionately to morbidity and mortality in sub-Saharan Africa, yet structured neurocritical care training remains limited. Emergency Neurologic Life Support (ENLS) standardizes early management of neurologic emergencies, but implementation in resource-limited settings requires contextual adaptation. Limited access to neuroimaging and monitoring compounds diagnostic uncertainty. Portable neuroultrasound (NeuroUS) offers a feasible bedside adjunct. We developed, implemented, and evaluated Tanzania's first resource-adapted neurocritical care educational program, including hands-on NeuroUS training in a low- and middle-income country (LMIC) setting.

We conducted a prospective observational study during a 2-day in-person training program (October 2025). Multidisciplinary healthcare professionals caring for neurocritical care patients completed pre- and postcourse assessments evaluating medical knowledge, self-reported knowledge, and confidence across ENLS and NeuroUS domains (5-point Likert scale). Ordinal Likert outcomes were summarized using median and interquartile range (IQR) and compared using two-sided Mann-Whitney U tests. Correct-response proportions were compared using Fisher exact tests. Benjamini-Hochberg false-discovery-rate adjustment was applied within each outcome family.

Twenty-two participants completed precourse assessments; 17 completed postcourse assessments. Self-reported medical knowledge improved across 15 of 16 domains. The largest effects were observed for NeuroUS knowledge, which increased from a median of 1.5 (IQR, 1-2) to 4 (IQR, 4-5; rank-biserial, r = 0.85; 95% CI, 0.64-1.00; q < 0.001); Broad-Reaching Acute Interventions in Neurocritical Care, from 3 (IQR, 2-3) to 4 (IQR, 4-5; r = 0.73; 95% CI, 0.48-0.93; q < 0.001); and intracranial hypertension and herniation, from 3 (IQR, 3-4) to 5 (IQR, 4-5; r = 0.70; 95% CI, 0.45-0.89; q < 0.001). Confidence scores were higher in eight of 16 domains after adjustment. Both NeuroUS diagnostic-application items demonstrated large postcourse differences (q < 0.001). Correct-response proportions increased across all six exploratory knowledge items, but none remained statistically significant after adjustment for multiple comparisons. Ninety-four percent found the program relevant to their practice.

Implementation of resource-limited ENLS integrated with structured neuroultrasound is feasible and significantly improved knowledge and confidence. This hybrid approach represents a scalable education model for LMICs.