Child Neurology Services in Africa

Abstract

The first African Child Neurology Association meeting identified key challenges that the continent faces to improve the health of children with neurology disorders. The capacity to diagnose common neurologic conditions and rare disorders is lacking. The burden of neurologic disease on the continent is not known, and this lack of knowledge limits the ability to lobby for better health care provision. Inability to practice in resource-limited settings has led to the migration of skilled professionals away from Africa. Referral systems from primary to tertiary are often unpredictable and chaotic. There is a lack of access to reliable supplies of basic neurology treatments such as antiepileptic drugs. Few countries have nationally accepted guidelines either for the management of epilepsy or status epilepticus. There is a great need to develop better training capacity across Africa in the recognition and management of neurologic conditions in children, from primary health care to the subspecialist level. Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Europe PMC Funders Group Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts challenges in children across the continent. The presentations highlighted key common themes, namely, the need to promote education, training, and research. Building on these areas will have a ripple effect of improving child health care, improving facilities, and retaining skilled specialists in Africa.The following text collates the data delivered at this meeting, specifically from Ghana, Nigeria, Malawi, and Uganda, and provides a broader summary of the overall services across the continent. Summary of Services Across Africa, Focusing on EpilepsyA survey of 23 countries across Africa (Algeria, Cameroun, Cote d'Ivoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Malawi, Mali, Mauritius, Mozambique, Namibia, Nigeria, Rwanda, Sénégal, South Africa, Sudan, Togo, Tanzania, Uganda, Zambia, Zimbabwe; Figure 1) focused broadly on child neurology capacity and needs (2008)(2009)(2010)(2011). Questionnaires were sent to key pediatric physicians known to be practicing in the country to provide information on the services.

Prevalence, Aetiology and Outcome of Status Epilepticus in Children with Convulsions at the Wesley Guild Hospital, Ilesa

“…The majority of the children studied, 94.9% were under-5years while 17.9% were infants and there were more males. This is similar to the findings from earlier works [29,30]. The prevalence of status epilepticus among the 880 children ward admission in this study is 4.4%.…”

“…The mortality rates reported from the developed countries ranging from 0-3% is much lower than that obtained in this study [21]. The outcome of status epilepticus is still poor in Nigeria and in sub-Saharan Africa due to several factors [17,29,31,35,36]. The higher mortality rates in these resource poor countries may be attributed to delays in accessing treatment and lack of skills and facilities such as intensive care units, infusion pumps and ventilators, unorthodox cultural practices before presentation in the hospitals and poor infrastructure, prevalence of parasitic diseases, non-availability of appropriate and effective drugs [10,16,19,23,29,30,37].…”

“…The outcome of status epilepticus is still poor in Nigeria and in sub-Saharan Africa due to several factors [17,29,31,35,36]. The higher mortality rates in these resource poor countries may be attributed to delays in accessing treatment and lack of skills and facilities such as intensive care units, infusion pumps and ventilators, unorthodox cultural practices before presentation in the hospitals and poor infrastructure, prevalence of parasitic diseases, non-availability of appropriate and effective drugs [10,16,19,23,29,30,37]. Another contributor to the poor outcome in Africa may be the prolonged duration of anoxia from prolonged seizure activity which may be associated with status epilepticus and may lead to irreversible cerebral injury.…”

“…The mortality in Sub-Saharan Africa is higher than in the resource-rich countries. This may be due to the delay in presenting to hospital, poor management of SE in hospital and the underlying aetiology, lack of infrastructure or transport may further delay presentation to the hospital [16,23,29]. There are limited facilities and staff to manage patients in many hospitals in Africa.…”

“…There are limited facilities and staff to manage patients in many hospitals in Africa. Status epilepticus was found to be independently associated with neurological deficit at discharge as well as with mortality in children with acute seizures [8] The morbidity and mortality associated with status epilepticus is much higher developing in developing and resource-poor countries than it is in developed countries [10,12,16,17,21,29].…”