Africa's burden with neurological diseases - article published in Deutsche Welle

25 Mar 2024
healthcare gap in africa
25 Mar 2024

By Fred Schwaller

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, with around 3.4 billion people living with neurological conditions. However, neurological diseases disproportionately affect sub-Saharan Africa compared to other parts of the world.

Around 50% 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. The 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 is 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 paediatric neurology at Red Cross War Memorial Children's Hospital in 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 also have 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. The 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 that lack neurologists," said Wilmshurst.

There is a 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, and 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, their impact is huge.

"We had one trainee who went back to Kenya, where they advocated and lobbied to get a 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 that 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.

Edited by: Carla Bleiker

Source: Nervous System Disorders Collaborators (2024). Global, regional, and national burden of disorders affecting the nervous system, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurology. DOI: 10.1016/S1474-4422(24)00038-3