# Trends in neuropathology training in Sub-Saharan Africa – current curricula, resource gaps, and the potential of virtual microscopy and telemedicine

## TL;DR

Neuropathology training in Sub-Saharan Africa is limited due to few specialists and poor resources, but digital tools like virtual microscopy and telepathology offer promising solutions.

## Contribution

This scoping review identifies training gaps in neuropathology across Sub-Saharan Africa and highlights the potential of digital tools to address these challenges.

## Key findings

- There are extremely low numbers of neuropathologists in Sub-Saharan Africa, with ratios as high as 1.7 million inhabitants per unspecialized pathologist.
- Telepathology and virtual microscopy have shown improved diagnostic accuracy and training outcomes, such as a 35% increase in accuracy in Tanzania.
- International collaborations and digital innovations are feasible and effective in enhancing neuropathology training and diagnostics.

## Abstract

Introduction: Neuropathology is important in the diagnosis of
neurologic and neuro-oncologic diseases. But despite its immense importance, it
remains underrepresented in medical training across different parts of
Sub-Saharan Africa. Training in this region is limited by a low number of
specialists (e.g., a ratio of 1.7 million inhabitants per an unspecialized
pathologist), fragmented data, poor infrastructure, and minimal exposure. Most
times, neuropathology is embedded in general pathology curricula with limited
mentorship, specialized facilities, and tailored subspecialty pathways (e.g.,
Nigeria, Tanzania). But despite these prevailing challenges, digital tools like
telepathology and virtual microscopy may help bridge those gaps.

Aim: This scoping review aims to understand the structure of
existing neuropathology training and identify important gaps in structure and
resources across Sub-Saharan Africa. It also seeks to explore how regional and
global collaborations and digital innovations can be integrated to bridge these
gaps.

Methodology: Using PRISMA-ScR guidelines, we searched literature
published between 2000 and 2025 across major databases such as PubMed, Scopus,
Web of Science, AJOL, and grey sources. We included and thematically analyzed
studies that focused on training in neuropathology, workforce, and digital tools
in Sub-Saharan Africa. We mapped out data to capture country, program type,
curriculum content, resource availability, and digital tool integration.
Quantitative synthesis summarized the frequency and geographic distribution of
programs, while qualitative thematic analysis identified recurring patterns in
training gaps, infrastructural limitations, and the application of virtual
microscopy and telepathology.

Result: We reviewed eleven studies that indicate limited
neuropathology programs, an extremely low number of neuropathologists (e.g.,
0.4–0.6 per million in many Sub-Saharan Africa nations), inadequate mentorship,
and limited training resources. However, telepathology and virtual microscopy
show improved accuracy in diagnosis and quality training (e.g., Tanzania
recorded a 35 % increment in accuracy by specialized pathologists using
telepathology over general pathologists). Strengthening international
collaborations also demonstrates feasibility and enhanced quality training.

Conclusion: Neuropathology in Sub-Saharan Africa is underdeveloped
and fragmented; however, the increasing access to newer digital solutions
presents low-cost options as practical alternatives for overcoming diagnostic
and training obstacles. To narrow these gaps, the track toward becoming a
subspecialist in neuropathology should be formed, accessible digital libraries
of learning materials must be developed, and regional and international
telepathology networks should be strengthened.