Friday, April 19, 2024
featured storyHEALTH

The high rate of neurological diseases in Africa burdens the continent.

Across the world, 43 percent of the population, or 3.4 billion people, live with a neurological disease. The main question turns around why the rates are the highest in Africa and how is the issue is being tackled. The high prevalence of neurological diseases is having a devastating impact on local communities in Africa.

“Mental health and neurological diseases are often misunderstood in Kenya,” said Penny Wangari Jones, founding member of Hidden Voices, a Kenya-based mental health charity. “People are often taken to churches and prayed for, or told they are possessed. Patients are often neglected, locked in houses, or left to die in institutes. It’s harrowing.”

Neurological conditions are now the leading cause of ill-health worldwide, some 3.4 billion people live with a neurological condition, but neurological diseases disproportionately affect sub-Saharan Africa compared to other parts of the world.

50 percent of people who go to the emergency room in Africa have some sort of neurological complication, and neurological disease rates are often double those in higher-income regions. Prevalence of epilepsy, for example, is two to three times higher in sub-Saharan Africa than in Europe.

“Because there are often no health services or sources of help for people, local communities have no way to deal with caring for people with neurological or mental health conditions,” Wangari-Jones told DW.

Why does Africa have such a high prevalence of neurological diseases?

The biggest factors contributing to neurological health conditions are stroke, neonatal encephalopathy (brain injury), neuropathic or nerve pain, Alzheimer’s disease and other forms of dementia.

One reason for the higher prevalence in Africa: infectious diseases like HIV, meningitis and malaria, which can cause neurological complications like encephalitis, an inflammation of the brain.

But the issues also stem from multiple socioeconomic and public health factors, according to Jo Wilmshurst, head of pediatric neurology at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.

“You might have a child with neurological conditions, who is more likely to be born in socioeconomically deprived settings where the mother might be HIV exposed. They might have also tuberculosis. And then you have all the access-to-care barriers,” said Wilmshurst.

Neurological issues often start before birth, she added, where complications or infections during birth can cause permanent neurological damage. Lack of neonatologists means the damage often isn’t diagnosed or treated in time to prevent permanent neurological damage.

“Then there’s maternal health. In Western Cape we have pandemic-level proportions of toxin exposure from fetal alcohol syndrome, which causes neurological conditions in children,” Wilmshurst told DW.

Fixing Africa’s medical ‘brain drain’

Currently there aren’t enough specialist doctors and other medical staff in Africa to deal with the scale of the burden of neurological disease.

“The main problem is that specialist medical training hasn’t caught a firm foothold in Africa. You can actually map the highest prevalence of neurological conditions in regions which lack neurologists,” said Wilmshurst.

There is the striking disparity in the number of neurologists between African nations and European ones, there are 0.03 neurologists per 100,000 people in Africa, compared to Europe’s 8.45 neurologists per 100,000.

Wilmshurst said things are improving. She’s been working to build neurological medical services around Africa from the ground up. Part of that is training specialist doctors.

“We take a clinician from around Africa for two years and do intensive training in South Africa. The first trainee to go back to Tanzania was the first child neurologist in the whole country,” she said.

While the program has trained only around 200 specialist doctors in the last 16 years, the impact they are having is huge.

“We had one trainee who went back to Kenya, where they advocated and lobbied to get vaccine rollout of rotavirus. We know that [after] implementing rotavirus vaccination, … mortality rates from rotavirus complications plummeted. He saved a couple of million lives there,” Wilmshurst said.

Community support for neurological conditions

Wangari-Jones said that to tackle the burden of neurological diseases, it’s important that support programs integrate into local people’s communities.

“There’s a lot of fear and anxiety around medication or modern medicine, often due to past trauma from colonial times. One of the challenges is not over-medicalizing neurological conditions so they alienate how local communities have traditionally approached care,” she said.

Wangari-Jones works with Hidden Voices to reduce stigma and fear around neurological and mental health conditions, often by talking in local church groups and schools in Kenya.

“People often come forward in these talks with their issues and incidents with family members. It’s a way of reaching people in the local community and helping them access sources of health and social care,” she said.

Community health is also a key target for Wilmshurst, who organizes critical mass training programs. Community health and care workers are trained to recognize and manage neurological diseases. Often this training is piggybacked onto existing programs to treat diseases like HIV or tuberculosis.

“People are busy in Africa. The workload is huge and people have a lot of commitments. The only way to change the situation is to have solutions which are viable and adaptable in the setting they’re working in,” said Wilmshurst.

The hope is to alleviate Africa’s burden with neurological diseases by working both top down with public health programs and bottom up with local communities.

 

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