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Onohuean H, Akiyode AO, Akiyode O, Igbinoba SI, Alagbonsi AI. Epidemiology of neurodegenerative diseases in the East African region: A meta-analysis. Front Neurol 2022; 13:1024004. [PMID: 36468051 PMCID: PMC9718573 DOI: 10.3389/fneur.2022.1024004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION There is a scarcity of epidemiological data on neurodegenerative diseases (NDs) in East Africa. This meta-analysis provides the regional prevalence of NDs, their contributing factors, and evidence of change over time concerning gender per age or year. METHODS Articles were retrieved from electronic databases following the PRISMA standard. RESULTS Forty-two studies were reviewed, and 25 were meta-analyzed with a random-effects model. The pool estimate proportion of 15.27%, 95% CI (0.09-0.23) (I2 = 98.25%), (Q = 1,369.15, p < 0.0001) among a population of 15,813 male/female and 1,257 with NDs. Epidemiological characteristics associated with NDs include Dyskinesias prevalence 55.4%, 95% CI (13.5; 90.9), I2 (96%) and subsistence farming prevalence 11.3%, 95% CI (5.8; 20.9), I2 (99%). Publication bias by Egger test was (z = 4.1913, p < 0.0001), while rank correlation test using Kendall's model was (tau = 0.1237, p = 0.3873). Heterogeneity (R2 design = 5.23%, p design < 0.0001; R2 size = 52.163%, p size < 0.001; and R2 period = 48.13, p period < 0.0001. Covariates (R2 design + size + period = 48.41%, p < 0.001). CONCLUSION There is a high prevalence of NDs in the East African region, which could impact life expectancy, morbidity, and quality of life. Thus, early screening and regular surveillance could assist in management strategies.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
| | - Abraham Olutumininu Akiyode
- Department of Biology, College of Arts and Sciences, University of Texas of the Permian Odessa, TX, United States
| | - Oluwole Akiyode
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Biological and Environmental Sciences Department, Kampala International University, Kampala, Uganda
| | - Sharon Iyobor Igbinoba
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abdullateef Isiaka Alagbonsi
- Department of Clinical Biology (Physiology Unit), School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
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Mushroom Nutrition as Preventative Healthcare in Sub-Saharan Africa. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11094221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The defining characteristics of the traditional Sub-Saharan Africa (SSA) cuisine have been the richness in indigenous foods and ingredients, herbs and spices, fermented foods and beverages, and healthy and whole ingredients used. It is crucial to safeguard the recognized benefits of mainstream traditional foods and ingredients, which gradually eroded in the last decades. Notwithstanding poverty, chronic hunger, malnutrition, and undernourishment in the region, traditional eating habits have been related to positive health outcomes and sustainability. The research prevailed dealing with food availability and access rather than the health, nutrition, and diet quality dimensions of food security based on what people consume per country and on the missing data related to nutrient composition of indigenous foods. As countries become more economically developed, they shift to “modern” occidental foods rich in saturated fats, salt, sugar, fizzy beverages, and sweeteners. As a result, there are increased incidences of previously unreported ailments due to an unbalanced diet. Protein-rich foods in dietary guidelines enhance only those of animal or plant sources, while rich protein sources such as mushrooms have been absent in these charts, even in developed countries. This article considers the valorization of traditional African foodstuffs and ingredients, enhancing the importance of establishing food-based dietary guidelines per country. The crux of this review highlights the potential of mushrooms, namely some underutilized in the SSA, which is the continent’s little exploited gold mine as one of the greatest untapped resources for feeding and providing income for Africa’s growing population, which could play a role in shielding Sub-Saharan Africans against the side effects of an unhealthy stylish diet.
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Adebayo PB, Aziz OM, Mwakabatika RE, Makakala MC, Mazoko MC, Adamjee SM, Mushi N, Jusabani AM, Aris E. Out-patient neurological disorders in Tanzania: Experience from a private institution in Dar es Salaam. eNeurologicalSci 2020; 20:100262. [PMID: 32802973 PMCID: PMC7417890 DOI: 10.1016/j.ensci.2020.100262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 12/18/2022] Open
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. Available profile of neurological disorders in our environment is biased towards neurological admissions. We Profile neurological out-patient consultations in Aga Khan Hospital, Dar es Salaam. Headache, peripheral nerve disorders, epilepsy and stroke were leading neurological disorders encountered. Non-communicable neurological conditions are becoming prevalent in sub-Sahara Africa and they deserve attention.
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Affiliation(s)
- Philip B Adebayo
- Neurology Section, Aga Khan Hospital, Dar es Salaam, Tanzania.,Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Omar M Aziz
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | | | - Mandela C Makakala
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Mugisha C Mazoko
- Neurosurgery Section, Department of Surgery, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Shabbir M Adamjee
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Noureen Mushi
- Department of Internal Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Ahmed M Jusabani
- Department of Radiology, Aga Khan Hospital, Dar es Salaam, Tanzania
| | - Eric Aris
- Neurology Section, Aga Khan Hospital, Dar es Salaam, Tanzania
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Adoukonou T, Adogblé L, Agbétou M, Gnonlonfoun DD, Houinato D, Ouendo EM. Prevalence of the major neurological disorders in a semi-urban community in northern Benin. eNeurologicalSci 2020; 19:100242. [PMID: 32490220 PMCID: PMC7262545 DOI: 10.1016/j.ensci.2020.100242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/06/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Neurological disorders are some of the most disabling diseases. Epidemiological data on their incidence in Benin are scarce. OBJECTIVE The prevalence of major neurological diseases among people older than 15 years was investigated in Titirou. METHODS It was a cross-sectional study and door-to-door survey which took place from June 10 to August 30, 2014, in the district of Titirou and included 1094 persons. The diagnosis of migraine, tension-type headaches, epilepsy, peripheral neuropathies, stroke, parkinsonism, Parkinson's disease and dementia were conducted using a validated screening questionnaire, neurological examination and standard diagnostics criteria. RESULTS They were aged from 16 to 85 with a mean age of 29.8 +/- 12.9 years. Forty five percent (492/1094) were males. Among the 1094 respondents, 497 (45.4% 95%CI 42.5-48.4) had at least one neurological disorder. The raw prevalences of the conditions were: tension-type headaches (26.9%), migraine (14.3%); peripheral neuropathies (5.6%); epilepsy (1.9%); stroke (1.3%), parkinsonism (0.1%). No case of dementia or Parkinson's disease was found. Socio-demographic factors associated with these conditions were as follows: tension-type headaches: age (p = .020); peripheral neuropathies: age (p = 0. 000); sex (p = .006); profession (p = .004); marital status (p = .032); and level of education (p = .003); stroke: age (p = .000) and marital status (p = .000). CONCLUSION These results point to a high prevalence of neurological disorders in Titirou.
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Affiliation(s)
- Thierry Adoukonou
- Department of Neurology, University of Parakou, Benin
- Clinic of Neurology, University Teaching Hospital of Parakou, Benin
| | - Laurine Adogblé
- Clinic of Neurology, University Teaching Hospital of Parakou, Benin
| | - Mendinatou Agbétou
- Department of Neurology, University of Parakou, Benin
- Clinic of Neurology, University Teaching Hospital of Parakou, Benin
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Diaz MM, Hu X, Fenton BT, Kimuli I, Lee A, Lindsey H, Bigelow JK, Maiser S, Altalib HH, Sico JJ. Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward. BMC Neurol 2020; 20:42. [PMID: 32005185 PMCID: PMC6995141 DOI: 10.1186/s12883-020-1627-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc. Methods Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival. Results Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42–20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16–12.58], p = <.001), stroke (HR = 2.69 [1.20–6.04], p = .017), or head trauma (HR = 3.39, [1.27–9.07], p = 0.15) had worse survival. Conclusions In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.
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Affiliation(s)
- Monica M Diaz
- Department of Neurosciences, University of California San Diego, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. .,University of California San Diego Health, 220 Dickinson Street, Mail Code 8231, San Diego, CA, 92103, USA. .,Johnson and Johnson Global Scholars Program, Yale School of Medicine, 20 York Street, New Haven, CT, 06510, USA.
| | - Xin Hu
- Yale Center for Analytical Science, Yale School of Public Health, New Haven, CT, USA
| | - Brenda T Fenton
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ivan Kimuli
- Mulago Hospital and Makerere University, Kampala, Uganda
| | - Allison Lee
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Hayley Lindsey
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Samuel Maiser
- Departments of Neurology and Internal Medicine, University of Minnesota, Minneapolis, MN, USA.,Hennepin Healthcare, Minneapolis, MN, USA
| | - Hamada H Altalib
- Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.,Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jason J Sico
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.,Pain Research, Informatics, and Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Center for NeuroEpidemiological and Clinical Neurological Research, Yale School of Medicine, New Haven, CT, USA.,Neurology Service, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven, CT, USA
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Nyame S, Agyeman N, Danso S, Ae-Ngibise KA, Asante KP. Dementia research needs in Ghana: a perspective. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Berk T, Ashina S, Martin V, Newman L, Vij B. Diagnosis and Treatment of Primary Headache Disorders in Older Adults. J Am Geriatr Soc 2018; 66:2408-2416. [PMID: 30251385 DOI: 10.1111/jgs.15586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To provide a unique perspective on geriatric headache and a number of novel treatment options that are not well known outside of the headache literature. DESIGN Review of the most current and relevant headache literature for practitioners specializing in geriatric care. RESULTS Evaluation and management of headache disorders in older adults requires an understanding of the underlying pathophysiology and how it relates to age-related physiological changes. To treat headache disorders in general, the appropriate diagnosis must first be established, and treatment of headaches in elderly adults poses unique challenges, including potential polypharmacy, medical comorbidities, and physiological changes associated with aging. CONCLUSION The purpose of this review is to provide a guide to and perspective on the challenges inherent in treating headaches in older adults. J Am Geriatr Soc 66:2408-2416, 2018.
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Affiliation(s)
- Thomas Berk
- Division of Headache, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Sait Ashina
- Division of Headache, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Vincent Martin
- Headache and Facial Pain Center, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Lawrence Newman
- Division of Headache, Department of Neurology, School of Medicine, New York University, New York, New York
| | - Brinder Vij
- Headache and Facial Pain Center, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
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Nkusi AE, Muneza S, Nshuti S, Hakizimana D, Munyemana P, Nkeshimana M, Rudakemwa E, Amendezo E. Stroke Burden in Rwanda: A Multicenter Study of Stroke Management and Outcome. World Neurosurg 2017; 106:462-469. [PMID: 28698086 DOI: 10.1016/j.wneu.2017.06.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cerebrovascular accidents or stroke constitute the second leading cause of mortality worldwide. Low- and middle-income countries bear most of the stroke burden worldwide. The main objective of this study is to determine the burden of stroke in Rwanda. METHODS This was a prospective observational study in 2 parts: 6 months baseline data collection and outcome assessment sessions at 1 year. RESULTS A total of 96 patients were enrolled in our series. Stroke constituted 2100 per 100,000 population. Of all patients, 55.2% were male and most (60%) were 55 years and older. Of all patients and/or caretakers, 22% were not aware of their previous health status and 53.5% of hypertensive patients were not on treatment by the time of the event. Median presentation delay was 72 hours for patients with ischemic stroke and 24 hours for patients with hemorrhagic stroke. Most patients had hemorrhagic stroke (65% vs. 35%), and more patients with hemorrhagic stroke presented with loss of consciousness (80% vs. 51%). Many patients (62% ischemic group and 44% hemorrhagic group) presented with severe stroke scores, and this was associated with worst outcome (P = 0.004). At 1 year follow-up, 24.7% had no or mild disability, 14.3% were significantly disabled, and 61% had died. CONCLUSIONS Our results show that stroke is a significant public health concern in Rwanda. Risk factor awareness and control are still low and case fatality of stroke is significantly high. The significant delay in presentation to care and presentation with severe stroke are major contributors for the high mortality and severe disability rates.
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Affiliation(s)
- Agabe Emmy Nkusi
- Department of Surgery, Neurosurgery Service, King Faisal Hospital, Kigali, Rwanda
| | - Severien Muneza
- Department of Surgery, Neurosurgery Service, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
| | - Steven Nshuti
- Department of Surgery, Neurosurgery Service, King Faisal Hospital, Kigali, Rwanda; Department of Surgery, Neurosurgery Training Program, University of Rwanda, Kigali, Rwanda.
| | - David Hakizimana
- Department of Surgery, Neurosurgery Training Program, University of Rwanda, Kigali, Rwanda
| | - Paulin Munyemana
- Department of Surgery, Neurosurgery Training Program, University of Rwanda, Kigali, Rwanda
| | | | - Emmanuel Rudakemwa
- Directorate of Medical Imaging Services, King Faisal Hospital, Kigali, Rwanda
| | - Etienne Amendezo
- Department of Internal Medicine, University of Rwanda, Kigali, Rwanda
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Abstract
Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
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Cubo E, Doumbe J, Mapoure Njankouo Y, Nyinyikua T, Kuate C, Ouyang B, Shah H, Calvo S, Fernandez-Sierra A, Kompoliti K, Njiengwe E, Louis ED. The Burden of Movement Disorders in Cameroon: A Rural and Urban-Based Inpatient/Outpatient Study. Mov Disord Clin Pract 2017; 4:568-573. [PMID: 30363499 DOI: 10.1002/mdc3.12474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/28/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Because of rapid demographic changes, the prevalence of movement disorders (MDs) is expected to increase in Africa. The objective of this study was to estimate the prevalence of MDs in an inpatient/outpatient-based study of rural and urban health care centers in Cameroon. Methods In this retrospective medical chart review, the inpatient/outpatients settings covered an urban population (3,000,000) and a rural population (380,276). Neurological diseases were classified according to the International Statistical Classification of Diseases-Related Health Problems, 10th revision (ICD-10). Crude prevalence was calculated per 100 with 95% confidence intervals (CIs). Results Of 20,131 medical charts reviewed (13% from the rural area), 4187 patients (20.8%) with neurological complaints were identified. MDs were diagnosed exclusively from urban centers in 134 patients (3.2%): the mean patient age was 48.6 ± 18.6 years, and 54.7% were women. The most prevalent MDs were hyperkinetic movements (tremor, myoclonus, and drug-induced MDs [ICD-10 code G25]; prevalence, 1.19%; 95% CI, 1.192-1.194%), Parkinson's disease (ICD-10 code G20; prevalence, 0.78%; 95% CI, 0.785-0.787%), dystonia (ICD-10 code G24; prevalence, 0.61%; 95% CI, 0.612-0.613%), secondary parkinsonism (ICD-10 code G21; prevalence, 0.56%; 95% CI, 0.564-0.565%), Huntington's disease (ICD-10 code G10; prevalence, 0.09%; 95% CI, 0.091-0.092%), and ataxia (ICD-10 code R29; prevalence, 0.04%; 95% CI, 0.0451-0.0456). Conclusion Although the burden of MDs is expected to increase, MDs are likely underdiagnosed in rural areas. High-quality movement disorder training is essential to tackle this need.
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Affiliation(s)
- Esther Cubo
- Neurology Department Hospital Universitario Burgos Burgos Spain
| | - Jacques Doumbe
- Neurology Department Hospital Laquintinie University of Douala Douala Cameroon
| | | | - Theophile Nyinyikua
- Neurology Department Hospital Laquintinie University of Douala Douala Cameroon
| | - Callixte Kuate
- Neurology Department Hospital Laquintinie University of Douala Douala Cameroon
| | - Bichun Ouyang
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Hiral Shah
- Department of Neurological Sciences Columbia University New York New York USA
| | - Sara Calvo
- Research Unit Hospital Universitario Burgos Burgos Spain
| | | | - Katie Kompoliti
- Department of Neurological Sciences Rush University Chicago Illinois USA
| | - Erero Njiengwe
- Laboratory of Behavioral Sciences and Applied Psychology University of Douala Douala Cameroon
| | - Elan D Louis
- Neurology Department Yale School of Medicine Yale University New Haven Connecticut USA.,Department of Chronic Disease Epidemiology Yale School of Public Health Yale University New Haven Connecticut USA.,Center for Neuroepidemiology and Clinical Neurological Research Yale School of Medicine Yale University New Haven Connecticut USA
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Trevisan C, Devleesschauwer B, Schmidt V, Winkler AS, Harrison W, Johansen MV. The societal cost of Taenia solium cysticercosis in Tanzania. Acta Trop 2017; 165:141-154. [PMID: 26756713 DOI: 10.1016/j.actatropica.2015.12.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 12/11/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
Taenia solium is a zoonotic parasite prevalent in many low income countries throughout Latin America, Asia and sub-Saharan Africa, including Tanzania. The parasite is recognized as a public health threat; however the burden it poses on populations of Tanzania is unknown. The aim of this study was to estimate the societal cost of T. solium cysticercosis in Tanzania, by assessing both the health and economic burden. The societal cost of T. solium cysticercosis was assessed in humans and pigs based on data obtained by a systematic review. Experts' opinion was sought in cases where data were not retrievable. The health burden was assessed in terms of annual number of neurocysticercosis (NCC) associated epilepsy incident cases, deaths and disability-adjusted life years (DALYs), while the economic burden was assessed in terms of direct and indirect costs imposed by NCC-associated epilepsy and potential losses due to porcine cysticercosis. Based on data retrieved from the systematic review and burden assessments, T. solium cysticercosis contributed to a significant societal cost for the population. The annual number of NCC-associated epilepsy incident cases and deaths were 17,853 (95% Uncertainty Interval (UI), 5666-36,227) and 212 (95% UI, 37-612), respectively. More than 11% (95% UI, 6.3-17) of the pig population was infected with the parasite when using tongue examination as diagnostic method. For the year 2012 the number of DALYs per thousand person-years for NCC-associated epilepsy was 0.7 (95% UI, 0.2-1.6). Around 5 million USD (95% UI, 797,535-16,933,477) were spent due to NCC-associated epilepsy and nearly 3 million USD (95% UI, 1,095,960-5,366,038) were potentially lost due to porcine cysticercosis. Our results show that T. solium imposes a serious public health, agricultural and economic threat for Tanzania. We urge that a One Health approach, which involves the joint collaboration and effort of veterinarians, medical doctors, agricultural extension officers, researchers and relevant governmental agencies, is taken to find sustainable solutions for prevention, control and elimination of T. solium.
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Assane YA, Trevisan C, Schutte CM, Noormahomed EV, Johansen MV, Magnussen P. Neurocysticercosis in a rural population with extensive pig production in Angónia district, Tete Province, Mozambique. Acta Trop 2017; 165:155-160. [PMID: 26519884 PMCID: PMC6333921 DOI: 10.1016/j.actatropica.2015.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 09/16/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
Abstract
Neurocysticercosis (NCC) is an important neurological disease in countries with high prevalence of Taenia solium infection and is emerging as a serious public health and economic problem. The aim of this study was to estimate the prevalence of NCC in Angónia district, Tete province, Mozambique based on: prevalence of human T. solium cysticercosis assessed by antigen Enzyme-linked Immunosorbent Assay (Ag-ELISA) seropositivity, history of epilepsy, and brain computed tomography (CT) scan results. A cross sectional study was conducted between September and November 2007 in Angónia district. Questionnaires and blood samples were collected from 1,723 study subjects. Brain CT-scans were carried out on 151 study subjects with confirmed history of epilepsy. A total of 77 (51.0% (95% CI, 42.7–59.2)) and 38 (25.2% (95% CI, 18.5–32.9)) subjects met the criteria for definitive and probable diagnosis of NCC, respectively. T. solium Ag-ELISA seropositivity was found in 15.5% (95% CI, 12.8–16.2) of the study subjects. The estimated life time prevalence of epilepsy was 8.8% (95% CI, 7.5–10.2). Highly suggestive lesions of NCC were found on CT-scanning in 77 (71.9%, (95% CI, 62.4–80.2)) of the seropositive and 8 (18.1%, (95% CI, 8.2–32.7)) of the seronegative study subjects, respectively. The present findings revealed a high prevalence of NCC among people with epilepsy in Angónia district. Determination of effective strategies for prevention and control of T. solium cysticercosis are necessary to reduce the burden of NCC among the affected populations.
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Kaddumukasa M, Mugenyi L, Kaddumukasa MN, Ddumba E, Devereaux M, Furlan A, Sajatovic M, Katabira E. Prevalence and incidence of neurological disorders among adult Ugandans in rural and urban Mukono district; a cross-sectional study. BMC Neurol 2016; 16:227. [PMID: 27855635 PMCID: PMC5114749 DOI: 10.1186/s12883-016-0732-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/25/2016] [Indexed: 11/11/2022] Open
Abstract
Background The burden of neurological diseases is increasing in developing countries. However, there is a prominent scarcity of literature on the incidence of neurological diseases in sub-Saharan Africa. This study was therefore undertaken to determine the prevalence and incidence of neurological diseases in this setting to serve as a baseline for planning and care for neurological disorders in Uganda. Methods The study was conducted within rural and urban Mukono district, east of Kampala city of Uganda, central region. Over a period of six months, a cross sectional survey was conducted and screening was performed using a standardized questionnaire. All subjects with neurological symptoms and signs were reviewed by a team of neurologists and neurological diagnoses made. Results Of the 3000 study subjects, 50.3% (1510/3000) were from the rural setting. Out of the participants screened, 67.4% were female, with a median age of 33 years. Among the 98 subjects with confirmed neurological disorders, the frequency of diseases was as follows; peripheral neuropathy (46.2%), chronic headaches (26.4%), and epilepsy (8.5%), followed by pain syndromes (7.5%), stroke (6.6%) and tremors/Parkinson disease (3.8%). The crude prevalence rates of these disorders (95% CI) were 14.3% (8.5–24.1); 13.3% (7.7–22.8); 33.7% (23.9–47.4) for stroke, epilepsy and peripheral neuropathy respectively. Peripheral neuropathy followed by chronic headaches had the highest estimated incidence/1000 years. Stroke had an estimated incidence of 3.6 new cases with 95% CI of (2.1–6.1)/1000 years. Conclusion Peripheral neuropathy, chronic headaches and epilepsy disorders are major causes of morbidity in Sub-Saharan settings. There is an urgent need of more robust and powered studies to determine the incidence of these diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0732-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Leviticus Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hill Road, MUJHU3 Building, P.O. Box 7475, Kampala, Uganda.,Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, P.O. Box 7146, Kampala, Uganda
| | - Michael Devereaux
- University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
| | - Anthony Furlan
- University Hospitals Case Medical Center, Neurological Institute Case Western Reserve University, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, 44106, Cleveland, OH, USA
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Who is healthy? Aspects to consider when including healthy volunteers in QST--based studies-a consensus statement by the EUROPAIN and NEUROPAIN consortia. Pain 2016; 156:2203-2211. [PMID: 26075963 DOI: 10.1097/j.pain.0000000000000227] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Clinical and human experimental pain studies often include so-called "healthy" controls in investigations of sensory abnormalities, using quantitative sensory testing (QST) as an outcome measure. However, the criteria for what is considered "healthy" vary among the different studies and between study centers and investigators, partly explaining the high variability of the results. Therefore, several aspects should be considered during inclusion of healthy volunteers in QST-based trials to have homogenous groups of healthy controls with less variability between human experimental studies, so that results are less likely to be false negative or false positive because of subject-related factors. The EUROPAIN and NEUROPAIN consortia aimed to define factors influencing the variability in selection of healthy subjects in QST-based studies before the start of both projects and to give recommendations how to minimize it based on the current literature and expertise of the participants. The present suggestions for inclusion criteria of healthy volunteers into QST-based trials describe a 2-level approach including standardized questionnaires enabling the collection of relevant information on sociodemographic data, medical history, current health status, coping strategies in dealing with pain, and the motivation of the volunteer to participate in the study. These suggestions are believed to help researchers interpret their results in comparison with others and improve the quality of clinical studies including healthy volunteers as controls or in human experimental pain studies. They aim to reduce any confounding factors. Furthermore, the acquired information will allow post hoc analyses of variance for different potential influencing factors.
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Sarfo FS, Akassi J, Badu E, Okorozo A, Ovbiagele B, Akpalu A. Profile of neurological disorders in an adult neurology clinic in Kumasi, Ghana. eNeurologicalSci 2016; 3:69-74. [PMID: 27110596 PMCID: PMC4839267 DOI: 10.1016/j.ensci.2016.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Although the burden of neurological disorders is highest among populations in developing countries there is a dearth of data on the clinical spectrum of these disorders. OBJECTIVE To profile the frequency of neurologic disorders and basic demographic data in an adult neurology out-patient service commissioned in 2011 in Kumasi, Ghana. METHODS The study was conducted at the neurology clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Over a three year period, all medical records of patients enrolled at the out-patient neurology clinic was reviewed by a neurologist and neurological diagnoses classified according to ICD-10. RESULTS 1812 adults enrolled for care in the neurology out-patient service between 2011 and 2013. This comprised of 882 males and 930 females (male: female ratio of 1.0: 1.1) with an overall median age of 54 (IQR, 39-69) years. The commonest primary neurological disorders seen were strokes, epilepsy and seizure disorders, and movement disorders at frequencies of 57.1%, 19.8%, and 8.2% respectively. CONCLUSIONS Cerebrovascular diseases, epilepsy and movement disorders were among the commonest neurological disorders and the major contributors to neurologic morbidity among Ghanaians in an urban neurology clinic.
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Affiliation(s)
- Fred Stephen Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - John Akassi
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Owolabi MO, Akarolo-Anthony S, Akinyemi R, Arnett D, Gebregziabher M, Jenkins C, Tiwari H, Arulogun O, Akpalu A, Sarfo FS, Obiako R, Owolabi L, Sagoe K, Melikam S, Adeoye AM, Lackland D, Ovbiagele B. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr 2016; 26:S27-38. [PMID: 25962945 PMCID: PMC4557491 DOI: 10.5830/cvja-2015-038] [Citation(s) in RCA: 248] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective Information on the current burden of stroke in Africa is limited. The aim of this review was to comprehensively examine the current and projected burden of stroke in Africa. Methods We systematically reviewed the available literature (PubMed and AJOL) from January 1960 and June 2014 on stroke in Africa. Percentage change in age-adjusted stroke incidence, mortality and disability-adjusted life years (DALYs) for African countries between 1990 and 2010 were calculated from the Global Burden of Diseases (GBD) model-derived figures. Results Community-based studies revealed an age-standardised annual stroke incidence rate of up to 316 per 100 000 population, and age-standardised prevalence rates of up to 981 per 100 000. Model-based estimates showed significant mean increases in age-standardised stroke incidence. The peculiar factors responsible for the substantial disparities in incidence velocity, ischaemic stroke proportion, mean age and case fatality compared to high-income countries remain unknown. Conclusions While the available study data and evidence are limited, the burden of stroke in Africa appears to be increasing.
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Affiliation(s)
- Mayowa O Owolabi
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | | | - Oyedunni Arulogun
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | | | | | | | | | - Sylvia Melikam
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Abiodun M Adeoye
- College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Mokaya J, Dotchin CL, Gray WK, Hooker J, Walker RW. The Accessibility of Parkinson's Disease Medication in Kenya: Results of a National Survey. Mov Disord Clin Pract 2016; 3:376-381. [PMID: 30363517 DOI: 10.1002/mdc3.12294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/28/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background There is a dearth of knowledge about the availability and affordability of the different drug treatments for Parkinson's disease (PD) across sub-Saharan Africa (SSA). We aimed to determine the availability and affordability of drugs for treating PD in Kenya. Methods A facility-based survey was conducted in selected medicine outlets (pharmacies) in what were formerly the headquarter towns of the eight provinces of Kenya. We used the World Health Organization/Health Action International methodology to obtain data for drugs used to treat PD. Unit price for each drug was obtained. Results Forty-eight outlets were visited in total, six in each of Kenya's eight provinces. Levodopa (L-dopa) was available in only 24 (50.0%) outlets. Only one public pharmacy sold l-dopa (14 were private and nine were other types of outlet). Ergot-derived dopamine agonists (DAs) and anticholinergics were available in 37 and 35 outlets, respectively. Monoamine-oxidase inhibitors, non-ergot-derived DAs, and catechol-O-methyl transferase inhibitors were available in four, two and zero outlets, respectively. Mean cost of 100 l-dopa tablets was $48.2, though costs varied widely (range, $28.2-$82.4). Only five outlets considered l-dopa affordable, all of which sold 100 tablets for less than $31. Conclusion There is a lack of availability of PD drugs in Kenya, particularly in public pharmacies, where costs are generally lower. Few pharmacists consider the drugs available to be affordable. If PD is to be effectively managed in Kenya, then strategies are needed to increase the availability and affordability of medication.
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Affiliation(s)
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute for Ageing Newcastle University Newcastle upon Tyne United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute of Health and Society Newcastle University Newcastle upon Tyne United Kingdom
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Abstract
Polyneuropathy is a disabling condition of the peripheral nerves, characterized by symmetrical distal numbness and paresthesia, often accompanied with pain and weakness. Although the disease is often encountered in neurological clinics and is well known by physicians, incidence and prevalence rates are not well known. We searched EMBASE, Medline, Web-of-science, Cochrane, PubMed Publisher, and Google Scholar, for population-based studies investigating the prevalence of polyneuropathy and its risk factors. Out of 5119 papers, we identified 29 eligible studies, consisting of 11 door-to-door survey studies, 7 case-control studies and 11 cohort/database studies. Prevalence of polyneuropathy across these studies varies substantially. This can partly be explained by differences in assessment protocols and study populations. The overall prevalence of polyneuropathy in the general population seems around 1% and rises to up to 7% in the elderly. Polyneuropathy seemed more common in Western countries than in developing countries and there are indications that females are more often affected than males. Risk factor profiles differ across countries. In developing countries communicable diseases, like leprosy, are more common causes of neuropathy, whereas in Western countries especially diabetes, alcohol overconsumption, cytostatic drugs and cardiovascular disease are more commonly associated with polyneuropathy. In all studies a substantial proportion of polyneuropathy cases (20-30%) remains idiopathic. Most of these studies have been performed over 15 years ago. More recent evidence suggests that the prevalence of polyneuropathy in the general population has increased over the years. Future research is necessary to confirm this increase in prevalence and to identify new and potentially modifiable risk factors.
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20
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Rates and predictors of three-year mortality in older people in rural Tanzania. Arch Gerontol Geriatr 2015; 62:36-42. [PMID: 26549489 DOI: 10.1016/j.archger.2015.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 10/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND There are few data on mortality rates in the general elderly living in sub-Saharan Africa. We aimed to detail three-year mortality rates in a population of rural community-dwelling older adults in northern Tanzania. METHODS We performed a community-based study of 2232 people aged 70 years and over living in Hai district, Tanzania. At baseline, participants underwent clinical assessment for disability, neurological disorders, hypertension, atrial fibrillation and memory problems. At three-year follow-up mortality data were collected. Mortality rates were compared to UK estimates. RESULTS At follow-up, data were available for 1873 subjects (83.9%). Of those, 208 (11.1%, 95% CI 9.7-12.5) had died. The age-standardised mortality rate was 10.2% (95% CI 8.8-11.6). Age-standardised mortality rates were lower than estimated for the UK (13.9%). In Cox regression analysis, greater age, higher levels of functional disability, use of a walking aid, subjective report of memory problems, being severely underweight and being normotensive were significant predictors of mortality. CONCLUSIONS Those who survive to old age in Tanzania appear to have relatively low mortality rates. Physical and cognitive disabilities were strongly associated with mortality risk in this elderly community-dwelling population. The association between blood pressure and mortality merits further study.
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Paddick SM, Kisoli A, Samuel M, Higginson J, Gray WK, Dotchin CL, Longdon AR, Teodorczuk A, Chaote P, Walker RW. Mild Cognitive Impairment in Rural Tanzania: Prevalence, Profile, and Outcomes at 4-Year Follow-up. Am J Geriatr Psychiatry 2015; 23:950-9. [PMID: 25579049 DOI: 10.1016/j.jagp.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is recognized as a high-risk condition for conversion to dementia, although data on outcomes of MCI in sub-Saharan Africa are scarce. We investigated outcomes of MCI over a 4-year period in Tanzania and considered risk factors for conversion to dementia. METHODS In a longitudinal cohort study in the Hai district, Tanzania, patients with MCI were identified during a two-phase prevalence study carried out in 2010. Of 1,198 people aged 70 years and over screened in phase I, a stratified sample of 296 were fully assessed in phase II. MCI was defined according to international consensus criteria. DSM-IV criteria were used for dementia diagnosis. Background demographic and risk factor data were collected, and neuropsychiatric symptoms were assessed using the neuropsychiatric inventory. Patients were followed-up in 2011, 2012 and 2014. RESULTS Forty-six MCI patients were identified. After adjusting for stratification, the crude prevalence of MCI was 7.0% (95% CI: 3.6-10.4). Over a 4-year period, 15 patients (32.6%) progressed to dementia, 2 patients (4.3%) returned to normal cognition, 1 developed late-onset schizophrenia, 8 patients (17.4%) had stable MCI, 19 patients (41.3%) died, and 1 refused assessment. Age, sex, education levels, body mass index, hypertension, and comorbidity were not associated with progression to dementia. CONCLUSION In this rural Tanzanian population, rates of conversion from MCI to DSM-IV dementia were similar to those reported in high-income countries. Over a third of all patients had died at the 4-year follow-up.
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Affiliation(s)
- Stella-Maria Paddick
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Aloyce Kisoli
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Maria Samuel
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Janice Higginson
- Health Education North East, Newcastle upon Tyne, United Kingdom
| | - William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anna R Longdon
- South Devon National Health Service Foundation Trust, Department of Medicine, Torbay Hospital, Torquay, United Kingdom
| | - Andrew Teodorczuk
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumberland, Tyne and Wear National Health Service Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, United Kingdom
| | - Paul Chaote
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson's disease. Acta Neuropsychiatr 2015; 27:206-12. [PMID: 25777617 DOI: 10.1017/neu.2015.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability amongst the elderly in low-income countries. The aim of this study was to compare disability levels for three of the most common neurological, non-communicable diseases: dementia, stroke and Parkinson's disease (PD). METHODS We performed a community-based study of people aged 70 years and over in 12 randomly selected villages in the rural Hai district of Tanzania. Participants underwent disability assessment using the Barthel Index, and clinical assessment for dementia, stroke and PD. RESULTS In a representative cohort of 2232 people aged 70 years and over, there were 54 cases of stroke, 12 cases of PD and estimated (by extrapolation from a sub-sample of 1198 people) to be 112 cases of dementia. People with stroke were the most disabled, with 62.9% having moderate or severe disability. Levels of moderate or severe disability were 41.2% in people with dementia and 50.0% in people with PD. However, the higher prevalence of dementia meant that, at a population level, it was associated with similar levels of disability as stroke, with 18.5% of 249 people identified as having moderate or severe disability having dementia, compared to 13.7% for stroke and 2.4% for PD. CONCLUSIONS Levels of disability from these conditions is high and is likely to increase with demographic ageing. Innovative, community-based strategies to reduce disability levels should be investigated.
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Dotchin CL, Gray WK, Dewhurst F, Massawe J, Chaote P, Walker RW. Parkinson's disease related dyskinesia in a Tanzanian population. Parkinsonism Relat Disord 2015; 21:1109-10. [PMID: 26173703 DOI: 10.1016/j.parkreldis.2015.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/05/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK.
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Felicity Dewhurst
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - John Massawe
- District Medical Office, PO Box 27, Hai District Hospital, Boman'gombe, Hai, United Republic of Tanzania
| | - Paul Chaote
- District Medical Office, PO Box 27, Hai District Hospital, Boman'gombe, Hai, United Republic of Tanzania
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Callixte KT, Clet TB, Jacques D, Faustin Y, François DJ, Maturin TT. The pattern of neurological diseases in elderly people in outpatient consultations in Sub-Saharan Africa. BMC Res Notes 2015; 8:159. [PMID: 25880073 PMCID: PMC4405818 DOI: 10.1186/s13104-015-1116-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 03/31/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological diseases are frequent in older adults, affecting between 5% and 55% of people age 55 and older. They are associated with a high risk for adverse health outcomes, including mortality, disability, institutionalization and hospitalization. Little is known about the epidemiology and clinical pattern of neurological disorders of the elderly in developing countries. Although many studies have demonstrated the areas where the burden of neurological diseases lies, elderly patients in Sub-Saharan Africa have received little attention. We performed this descriptive study to understand the burden of disease faced by Cameroonian neurologists and geriatricians. METHODS The records of all out-patient neurological consultations from May 2005 to December 2011 were collected at the Clinique Bastos, the sole clinic with adult neurological consultations during the study period in Yaoundé, the political capital of Cameroon. All medical records were reviewed by a neurologist and neurological diagnoses were classified according to ICD-10. RESULTS Among a total of 912 patients, 187 (20.5%) were aged 60 and older. According to the ICD-10 classification, episodic and paroxysmal disorders were present in 18.7% of patients, extrapyramidal and movement disorders in 14.6%, and nerve, nerve root and plexus disorders in 13.3%. The most common neurological diseases of the elderly in this study were lumbar arthrosis (14%), dementia (Alzheimer's type, vascular) (12.4%), Parkinson's disease (10.2%), and polyneuropathy (9.1%). CONCLUSION Degenerative diseases like dementia and Parkinson's disease as well as strokes and headaches are frequently encountered neurological diseases in elderly patients in Sub-Saharan Africa. It is important that standard treatment regimes, often Ministry of Public Health based, are adhered to these diseases.
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Affiliation(s)
- Kuate-Tegueu Callixte
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | | | - Doumbe Jacques
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.
| | - Yepnjio Faustin
- Neurology Department, Yaoundé Central Hospital, Yaoundé, Cameroon.
| | - Dartigues Jean François
- French Institute of Public Health and Medical Research, Bordeaux, F-33076, France.
- University Victor Segalen Bordeaux 2, Bordeaux, F-33076, France.
| | - Tabue-Teguo Maturin
- French Institute of Public Health and Medical Research, Bordeaux, F-33076, France.
- University Victor Segalen Bordeaux 2, Bordeaux, F-33076, France.
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Akinyemi RO, Izzeldin IMH, Dotchin C, Gray WK, Adeniji O, Seidi OA, Mwakisambwe JJ, Mhina CJ, Mutesi F, Msechu HZ, Mteta KA, Ahmed MAM, Hamid SHM, Abuelgasim NAA, Mohamed SAA, Mohamed AYO, Adesina F, Hamzat M, Olunuga T, Maro VP, Walker R. Contribution of noncommunicable diseases to medical admissions of elderly adults in Africa: a prospective, cross-sectional study in Nigeria, Sudan, and Tanzania. J Am Geriatr Soc 2014; 62:1460-6. [PMID: 25041242 DOI: 10.1111/jgs.12940] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the nature of geriatric medical admissions to teaching hospitals in three countries in Africa (Nigeria, Sudan, Tanzania) and compare them with data from the United Kingdom. DESIGN Cross-sectional cohort study. SETTING Federal Medical Centre, Idi-Aba, Abeokuta, Nigeria; Soba University Hospital, Khartoum, Sudan; Kilimanjaro Christian Medical Centre, Moshi, Tanzania; and North Tyneside General Hospital, North Shields, United Kingdom. PARTICIPANTS All people aged 60 and older urgently medically admitted from March 1 to August 31, 2012. MEASUREMENTS Data were collected regarding age, sex, date of admission, length of stay, diagnoses, medication, date of discharge or death, and discharge destination. RESULTS In Africa, noncommunicable diseases (NCDs) accounted for 81.0% (n=708) of admissions (n=874), and tuberculosis, malaria, and the human immunodeficiency virus and acquired immunodeficiency syndrome accounted for 4.6% (n=40). Cerebrovascular accident (n=224, 25.6%) was the most common reason for admission, followed by cardiac or circulatory dysfunction (n=150, 17.2%). Rates of hypertension were remarkably similar in the United Kingdom (45.8%) and Africa (40.2%). CONCLUSIONS In the elderly population, the predicted increased burden of NCDs on health services in Africa appears to have occurred. Greater awareness and some reallocation of resources toward NCDs may be required if the burden of such diseases is to be reduced.
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Affiliation(s)
- Rufus O Akinyemi
- Federal Medical Centre, Idi-Aba, Abeokuta, Nigeria; Newcastle University, Newcastle upon Tyne, UK
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Adeloye D. An estimate of the incidence and prevalence of stroke in Africa: a systematic review and meta-analysis. PLoS One 2014; 9:e100724. [PMID: 24967899 PMCID: PMC4072632 DOI: 10.1371/journal.pone.0100724] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/27/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Stroke is increasingly becoming a challenging public health issue in Africa, and the non-availability of data has limited research output and consequently the response to this burden. This study aimed to estimate the incidence and prevalence of stroke in Africa in 2009 towards improved policy response and management of the disease in the region. METHODS A systematic search of Medline, EMBASE and Global Health for original population-based or hospital-based studies on stroke was conducted. A random effect meta-analysis was conducted on crude stroke incidence and prevalence rates, and a meta-regression-like epidemiological model was applied on all data points. The fitted curve generated from the model was used to estimate incident cases of stroke and number of stroke survivors in Africa at midpoints of the United Nation population 5-year age groups for the year 2009. RESULTS The literature search yielded a total of 1227 studies. 19 studies from 10 African countries were selected. 483 thousand new stroke cases among people aged 15 years or more were estimated in Africa in 2009, equivalent to 81.2 (13.2-94.9)/100,000 person years. A total of 1.89 million stroke survivors among people aged 15 years or more were estimated in Africa in 2009, with a prevalence of 317.3 (314.0-748.2)/100,000 population. Comparable figures for the year 2013 based on the same rates would amount to 535 thousand (87.0-625.3) new stroke cases and 2.09 million (2.06-4.93) stroke survivors, suggesting an increase of 10.8% and 9.6% of incident stroke cases and stroke survivors respectively, attributable to population growth and ageing between 2009 and 2013. CONCLUSION The findings of this review suggest the burden of stroke in Africa is high and still increasing. There is need for more research on stroke and other vascular risk factors towards instituting appropriate policy, and effective preventive and management measures.
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Affiliation(s)
- Davies Adeloye
- Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, Midlothian, United Kingdom
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A comparison of caregiver burden in older persons and persons with Parkinson's disease or dementia in sub-Saharan Africa. Int Psychogeriatr 2014; 26:687-92. [PMID: 24507385 DOI: 10.1017/s104161021300255x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Caregiver burden includes the many physical, mental and socio-economic problems arising from caring for individuals with chronic and disabling diseases. Being a carer in sub-Saharan Africa (SSA), where little is known about chronic neurological conditions, may be extremely demanding. Conversely, multigenerational living may allow sharing of care among many caregivers. We wished to determine the relative burden of caring for two chronic neurodegenerative conditions (Parkinson's disease (PD) and dementia) in rural Tanzania. METHODS All surviving patients from a PD prevalence study, newly identified people with PD from a neurological disorders study and all people with dementia from a dementia prevalence study in Hai, rural Tanzania, were invited to participate. The Zarit Burden Interview (ZBI) was used to determine level of caregiver strain (higher score reflects more strain). RESULTS Of 25 PD patients ZBI was recorded in 20 (14 male). Five had no identifiable carer as they were largely independent. Three had PD dementia (PDD). Of 75 people with dementia (excluding 3 PDD), 43 (32 female) completed the ZBI. For the other 32, the caregivers felt the care they provided was a normal intergenerational expectation. Median ages were 78.5 and 85 years for PD and dementia, respectively. Median ZBI was 30.5 for PD and 14 for dementia (U = 166.0, z = -3.913, p < 0.001). Disease duration and disease type (PD or dementia) were univariate predictor of ZBI score, although only disease type was predictive by multivariable linear regression. CONCLUSIONS Caring for an individual with PD may be more burdensome than caring for an individual with dementia in SSA. People with more advanced PD had higher caregiver burden.
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Dewhurst F, Dewhurst MJ, Gray WK, Chaote P, Howlett W, Orega G, Walker RW. Rates of diagnosis and treatment of neurological disorders within a prevalent population of community-dwelling elderly people in sub-Saharan Africa. J Epidemiol Glob Health 2013; 2:207-14. [PMID: 23856502 PMCID: PMC7320320 DOI: 10.1016/j.jegh.2012.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/18/2012] [Accepted: 11/14/2012] [Indexed: 11/16/2022] Open
Abstract
Background: The prevalence of neurological disorders in those aged 70 years and over in the Hai district of Tanzania has been previously reported. The following research reports rates of patient’s: treatment seeking, diagnosis and treatment within this prevalent population. Methods: All people identified as having at least one neurological disorder in the prevalence study were questioned regarding whether they had sought treatment for their disorder, whether they had had a previous correct diagnosis and whether they were being currently treated. Results: From a background population of 2232 people, 349 people had neurological disorders, of whom 225 (64.5%) had sought treatment for their symptoms. Of the 384 disorders identified in these 349 people, only 14.6% had been diagnosed and only 9.9% were receiving appropriate treatment. Males were significantly more likely to have been diagnosed and were more likely to have been treated appropriately. Conclusions: Levels of diagnosis and treatment were low, with some gender inequality. Reasons for this may include a lack of recognition of the condition within the local population and lack of access to appropriate services. In the absence of effective primary and secondary preventative measures, and effective treatment, the burden of neurological disorders is likely to increase with further demographic ageing.
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Affiliation(s)
- Felicity Dewhurst
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
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