Why does Africa have the lowest number of Neurologists and how to cover the Gap?

Kissani, Najib; Liqali, Laila; Hakimi, Khaoula; Mugumbate, Jacob; Daniel, Gams Massi; Ibrahim, Eetedal Ahmed A.; Yewnetu, Enat; Belo, Mofou; Wilmshurst, Jo M.; M’Belesso, Pascal; Ragab, Amany; Millogo, Athanase; Leone, Massimo; Naji, Yahya

doi:10.1016/j.jns.2021.120119

Cited by 29 publications

(11 citation statements)

References 9 publications

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“…Africa has many unique challenges related to the prevention and management of epilepsy, ranging from low availability of skilled health workers, the smallest global proportion of neurologists, poor availability of efficacious antiseizure medications with fewer side effects, low public awareness of epilepsy and resultant stigma, and significant barriers to research 65–68 …”

Section: Discussionmentioning

confidence: 99%

“…65,66 Africa has many unique challenges related to the prevention and management of epilepsy, ranging from low availability of skilled health workers, the smallest global proportion of neurologists, poor availability of efficacious antiseizure medications with fewer side effects, low public awareness of epilepsy and resultant stigma, and significant barriers to research. [65][66][67][68] It is reassuring to see the steady increase in publications, especially over the past decade, and that two thirds of the reports are included in peer-review international journals. In addition, African researchers appear to be taking the lead in the majority of reports, although the ratio of African lead versus non-African lead has shown little variance over the past 30 years.…”

Section: Discussionmentioning

confidence: 99%

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Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force

et al. 2022

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Objective Despite the high prevalence of epilepsy in Africa, evaluation of epilepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted. Methods A scoping review of the peer‐reviewed literature on epilepsy from Africa (1989–2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics. Results A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author leadership was evident in most reports. Nine countries had >50 publications identified; the remaining 45 countries had <50 or no publications. Research studies were typically of lower quality (case series and observational studies). Research themes were more focused on clinical epilepsy (descriptive observational studies) and social aspects (qualitative surveys). However, there were a number of unique and strong themes, specifically for neurocysticercosis and nodding syndrome, where strong research collaborations were evident, basic science understandings were explored, and interventional models were established. Significance Despite Africa being the continent with the most countries, it is lacking in the quantity, quality, and for some areas, relevance of research on epilepsy. Targeted approaches are needed to upskill the strength of research undertaken with more basic science, interventional, and randomized controlled studies. Themes of research need to promote those with unique African content but also to align with current international research areas that have impact on care delivery, such as epilepsy surgery and epilepsy genetics. For this to be possible, it is important to strengthen research hubs with collaborations that empower Africa to own its epilepsy research journey.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force

et al. 2022

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“…This may at least in part be due to missed diagnoses, given limited access to neurologists in these regions. 22…”

Section: Parkinson's Diseasementioning

confidence: 99%

Global Epidemiology of Movement Disorders: Rare or Underdiagnosed?

O’Shea

Shih

2023

Semin Neurol

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In this manuscript, we review the epidemiology of movement disorders including Parkinson's disease (PD), atypical parkinsonism, essential tremor, dystonia, functional movement disorders, tic disorders, chorea, and ataxias. We emphasize age-, sex-, and geography-based incidence and prevalence, as well as notable trends including the rising incidence and prevalence of PD. Given the growing global interest in refining clinical diagnostic skills in recognizing movement disorders, we highlight some key epidemiological findings that may be of interest to clinicians and health systems tasked with diagnosing and managing the health of patients with movement disorders.

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“…1,2 A survey of representatives from 50 African nations found that 36 reported only 1 to 30 neurologists in their country, and 10 reported none at all. 3 Implementation of locally based neurology training is a foundational step to increasing the number of neurologists and improving access to high-quality neurological care in resource-limited settings. In a survey by the World Federation of Neurology (WFN) in 2006, the majority (67%) of neurology training programs were reported to be in highincome countries (HIC), with only few in Africa (South Africa, Egypt, Morocco, and Tunisia).…”

mentioning

confidence: 99%

“…1 2 A survey of representatives from 50 African nations found that 36 reported only 1 to 30 neurologists in their country, and 10 reported none at all. 3…”

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confidence: 99%

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa

Belay,

Gebrewold,

Ayele

et al. 2024

Semin Neurol

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The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

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Why does Africa have the lowest number of Neurologists and how to cover the Gap?

Cited by 29 publications

References 9 publications

Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force

Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force

Global Epidemiology of Movement Disorders: Rare or Underdiagnosed?

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa

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