Validity of a screening instrument for neurologic disability in resource-poor African communities

Abstract

Background There have been no recent population-based studies on all-cause adult neurological morbidity in Sub Saharan Africa. We have developed a screening survey to improve the feasibility in performing these studies. Methods Our screening instrument contains both history questions and examination items. We pilot tested this instrument in the Hai District, Tanzania, and Butajira, Ethiopia using trained individuals from the local communities. To measure sensitivity, we applied the instrument blindly to 25 previously-identified subjects with Parkinson’s disease, stroke or epilepsy. To measure specificity, we examined 42 randomly selected previously screened subjects. We also compared the validity of the entire instrument to the history-only section. Results There were 669 adult subjects screened in both communities (150 screen-positives, and 519 screen-negatives). The sensitivity of the instrument was 100% (95% CI 84.2–100%) and the specificity was 82.4 % (95% CI 66.1–92.0%). However, when restricting the instrument to the history-only section, the sensitivity remained unchanged, but the specificity became 91.2% (95% CI 76.3–97.7%; p=0.48). Conclusions We have created a valid tool to screen adults for neurologic morbidity in resource-poor communities. The use of the history-only section of the tool is adequate as a screen and will improve feasibility.

Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study

“…A pilot study is the first step in many types of epidemiological studies such as cross-sectional and longitudinal surveys [2-5,9], case-control studies [40], and research investigations [41]. It is unwise to establish a complex survey without an adequate pilot study, as was demonstrated by this study.…”

Construction of standardized Arabic questionnaires for screening neurological disorders (dementia, stroke, epilepsy, movement disorders, muscle and neuromuscular junction disorders)

“…Construction of separate questionnaires (original questionnaires) designed for screening the five major neurological disorders: cerebrovascular stroke, dementias, epilepsy, movement disorders, and muscle and neuromuscular disorders, based on the meticulous reading of different international standardized questionnaires, the World Health Organization (WHO) diagnostic criteria of the disease under the study, 15 , 16 the previously standardized questionnaires from former studies, 6 , 10 , 11 as well as on the clinical experience of the staff members of this work. The suggested questionnaires were refereed by 17 expert staff members from different universities, and questions that were agreed upon by >80% of the judges were included in the provisional form of the questionnaires.…”

Nervous system disorders across the life course in resource-limited settings

“…One of the chief barriers to research in LMICs is the availability of such instruments. In the past decade LMIC-based researchers have undertaken instrument development for neuropsychiatric disorders and dementia in China; neurodisabilities in Africa 37 ; HIV-associated dementia and neuropathies in Kenya 38 and Zambia 39 ; and stroke in Vietnam 40 , Argentina 41 , Portugal 42 and Nigeria 43 . Methodology and software have been developed to facilitate the use of neuroimaging to characterize and quantitatively describe novel conditions 44 that could prove important in this era of emerging infectious diseases.…”