Out-patient neurological disorders in Tanzania: Experience from a private institution in Dar es Salaam

Abstract

Background and introduction Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa. Objective To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD). Materials and methods The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively reviewed and analyzed. Neurological disorders are categorized according to the international classification of diseases version-11(ICD-11). Results Of the 1186 patients seen in a period of 2 years, there were 597 (50.4%) females and 588(49.6%) males, with median age (IQR) of 38 (30.0–52.0) and 42 (33.0–54.5) years respectively ( p = 0.001). Headache disorders (27.0%); disorders of the nerve root, plexus or peripheral nerves (23.4%); epilepsy (9.3%), cerebrovascular disorders (8.9%); movement disorders (3.6%) and disorders of cognition (3.5%) were the primary neurological conditions encountered. Musculoskeletal disorders (7.5%) and mental/behavioral disorders (5.4%) were other conditions seen in the clinic. Conclusion The pattern of neurological disorders in this cohort mirrors that of high-income countries. However, the manpower to tackle these conditions pales in comparison. Increasing the neurology workforce and paying extra attention to non-communicable disorders in SSA is advocated.

Neurological disorders encountered at an out-patient clinic in Ghana's largest medical center: A 16-year review

“…The top 5 neurological disorders were epilepsy (23.0%), peripheral neuropathies (19.6%), movement disorders (14.7%), cerebrovascular diseases (11.1%) and headache disorders (7.7%), these contributed to 76.1% of the entire cohort. Broadly, the spectrum of cases in our cohort is comparable to other studies done in Africa and high -income countries [ [6] , [7] , [8] , [9] , [10] ]. There are however differences in frequency ranking of specific neurological disorders in these studies compared with ours.…”

“…There are however differences in frequency ranking of specific neurological disorders in these studies compared with ours. For instance, while epilepsy was the leading disorder in our series, Sarfo et al [ 10 ] found cerebrovascular diseases as the topmost neurological disorder in Kumasi, Ghana while Adebayo et al [ 6 ] found headache disorders in Tanzania. This trend may reflect differences in referral patterns across countries and in-hospital referral policies for neurological case management.…”

“…Due to the broad collecting team, and the number of years included in the retrospective review, we deployed the WHO ICD11 classification of neurological disorders. This is easier to use than earlier revisions for both low and high resource settings, leading to better data capture, and offering the tools to monitor and improve individual country's health with reduced costs [ 5 , 6 ]. The top 5 neurological disorders were epilepsy (23.0%), peripheral neuropathies (19.6%), movement disorders (14.7%), cerebrovascular diseases (11.1%) and headache disorders (7.7%), these contributed to 76.1% of the entire cohort.…”

Dementia Risk and Prevention in Low and Middle-income Country Settings – Focus on Tanzania Mainland

“…While there are no recent research studies conducted to determine the changes in prevalence, the most recent survey in Tanzania looked at the out-patients neurological conditions in a private institution and found that 3.5% of the observed cases (41/1186) had Alzheimer's disease (31.7%) and vascular dementia (43.9%) (Adebayo et al, 2020). Also, in another study to diagnose the presence of delirium in 506 patients admitted in a hospital in Tanzania, 18.7% (95/506) had dementia (Paddick et al, 2018).…”

“…The first risk factor observed in the Tanzanian context is age. As age progresses, the risk of Alzheimer's disease, vascular dementia and many other dementias rises drastically (Adebayo et al, 2020;Paddick et al, 2018;Paddick, Mkenda, et al, 2015).…”