Comprehensive neurointervention training and service capacity in the Middle East & North Africa (NITA-MENA) study

Objective: The Middle East and North Africa (MENA) region faces a critical neurointervention workforce shortage, with an estimated 115,000-130000 preventable deaths annually from treatable neurovascular conditions. We quantified training capacity, service availability, and implementation barriers across 19 countries encompassing 688.2 million inhabitants. Methods: We conducted a cross-sectional survey of 168 eligible hospitals with 24-hour emergency services, neuroimaging capability, and ≥100 annual neurovascular admissions between May-August 2024. Primary outcomes were Neurointervention Training Access (annual fellowship positions/population-based demand using 2.5 operators per million standard) and Neurointervention Operator Availability (current operators/regional requirements). Multivariable regression identified training capacity predictors. Results: Among 131 responding institutions (78%response rate), current capacity reached only 19.1% of required neurointerventionists for the region. Training capacity met 4.4%of projected needs, varying from 12.1%in high-income to 0%in low-income countries (p < 0.001). While 80.9% of hospitals performed neurointervention procedures, only 33.6% qualified as comprehensive centers. Among comprehensive centers, 72.7% hosted fellowship programs and 68.2%maintained 24/7 coverage. Significant predictors of higher training capacity included per-capita GDP (β = 0.012, p < 0.001), formal certification pathways (β = 0.285, p = 0.002), and emergency medical services protocols (β = 0.252, p = 0.01). Primary barriers were funding limitations (82.4%), equipment shortages (70.2%), and faculty scarcity (65.6%). Current training infrastructure produced 96 annual graduates against a projected regional deficit of 1434specialists. Discussion: The MENA neurointervention capacity meets less than 20% of population needs, with pronounced socioeconomic disparities resulting in substantial preventable mortality and disability. Strategic expansion to 28 regional training hubs producing 171 annual fellows may achieve workforce adequacy within 8.4 years, requiring coordinated international investment and policy reform.