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

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.