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Approximately 43% of the population worldwide, or 3.4 billion people, are living with a neurological disease. Why are rates highest in Africa, and how are countries dealing with the problem? The high prevalence of neurological diseases is having a devastating impact on local communities in Africa. “Mental health and neurological illnesses are often misunderstood in Kenya,” said Penny Wangari-Jones, founding member of Kenya-based mental health charity Hidden Voices. “People are often taken to churches and prayed for or told that they are possessed. Patients are often neglected, locked in homes or left to die in institutions. It is given. It is painful.”
Neurological conditions are now the leading cause of poor health worldwide, with approximately 3.4 billion people living with neurological conditions. However, neurological diseases disproportionately affect sub-Saharan Africa compared to other parts of the world. About 50% of people who visit emergency rooms in Africa have some type of neurological complication, and rates of neurological disease are often twice as high as in higher income areas. For example, the prevalence of epilepsy 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 care for people with neurological or mental health conditions,” Wangari-Jones told DW. Why is the prevalence of neurological diseases so high in Africa? 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 high prevalence in Africa is infectious diseases such as HIV, meningitis and malaria, which can cause neurological complications such as encephalitis, an inflammation of the brain. But these issues also arise from a number of socio-economic and public health factors, according to Jo Wilmshurst, head of pediatric neurology at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa.
“You can have a baby [with neurological conditions] Those who are more likely to be born in socio-economically disadvantaged environments, where the mother may be exposed to HIV. They may also have tuberculosis. And then you have all the barriers to access to care,” Wilmshurst said. Neurological problems often begin before birth, where complications or infections during birth can cause permanent neurological damage. A shortage of neonatologists means the damage is often not diagnosed or treated in time to prevent permanent neurological damage.
“Then there’s maternal health. In the Western Cape, we have epidemic levels of exposure to toxins from fetal alcohol syndrome, which causes neurological conditions in children,” Wilmshurst told DW. Fixing Africa’s medical ‘brain drain’
Currently, there are not enough specialist doctors and other medical staff in Africa to deal with the scale of the burden of neurological disease. Wilmshurst said, “The main problem is that specialist medical training has not taken strong hold in Africa. You can actually find the highest prevalence of neurological conditions in areas where there is a shortage of neurologists.” There is a huge disparity in the number of neurologists between African countries and European countries – Africa has 0.03 neurologists per 100,000 people, while Europe has 8.45 neurologists per 100,000 people.
Wilmshurst said the situation is improving. She is working from the ground up to build neurological medical services across Africa, and part of that is training specialist doctors. “We take a doctor [from around Africa] undergo intensive training for two years [in South Africa], The first trainee to go back to Tanzania was the first child neurologist in the entire country,” she said.
While the program has trained only about 200 specialist doctors over the past 16 years, their impact has been huge. “We had an intern who went back to Kenya, where they advocated and lobbied for the rotavirus vaccine. We know that [after] Implementing rotavirus vaccination…Decreased mortality from rotavirus complications. He saved millions of lives there,” Wilmshurst said.
Community support for neurological conditions
Wangari-Jones said that to tackle the burden of neurological diseases, it is important that support programs are integrated into local people’s communities. He said, “There is a lot of fear and anxiety around medicine or modern medicine, often due to past trauma from the colonial period. One of the challenges is not to over-medicalize neurological conditions, so they are not traditionally treated by local communities.” “Isolating the delivery of care.”
Wangari-Jones often works with Hidden Voices to reduce stigma and fear around neurological and mental health conditions by speaking to local church groups and schools in Kenya. “People often come forward to these talks with their issues and incidents that have happened to family members. It is a way of reaching out to people in the local community and helping them access sources of health and social care,” he said. “
Community health is also a major goal for Wilmshurst, which conducts “critical mass” training programs. Community health and care workers are trained to recognize and manage neurological diseases. Often this training is based on existing programs to treat diseases such as HIV or tuberculosis.
Wilmshurst said, “People in Africa are busy. The workload is huge and people have a lot of commitments. The only way to change the situation is to create solutions that are viable and adaptable to the setting where they are working. ” The hope is to reduce the burden of neurological diseases in Africa by working from the top down with public health programs and from the bottom up with local communities.
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