Paediatric neurology in Africa: filling the gap

Field: Medicine (Health Sciences)

In 2010 the African Child Neurology Association (ACNA) was inaugurated at the 11th International Child Neurology Congress in Egypt. Doctors interested in the care of African children with neurological disorders joined the association, establishing a network of African practitioners and beyond, to advocate for these children. Strategic workshops followed on diseases of high burden (epilepsy, cerebral palsy, and autism), with the development of recommendations.1-3 The ACNA falls under the auspices of the International Child Neurology Association. This working relationship has strengthened links with other groups including the International League Against Epilepsy, the Child Neurology Society, the British Paediatric Neurology Association, and the African Paediatric Fellowship Program, who supported further educational initiatives in Sudan, Kenya, Tunisia, Zimbabwe, Tanzania, and Ghana to name a few. Most countries in Africa are under-resourced for the burden of neurological disorders. Beyond the failure of prevention there is a lack of recognition of disorders, access to facilities, screening tools, ineffective equipment, and limited or no medications. A recurring theme is the need for trained personnel across all levels of health care, including medical, nursing, ancillary workers, and technologists. Using epilepsy as an example, the burden of this disease is significant in Africa, with the prevalence in sub-Saharan Africa twice that in Europe, Asia, and North America and related to perinatal insults for a third of the affected children.4 The treatment gap for epilepsy is close to 50% in Africa, with limited manpower, cost of health care, cultural beliefs, and poor access to antiepileptic drugs idenified as key barriers. Many challenges are specific to the low and middle income settings which are evident in Africa. Solutions to these issues are often better addressed within the country or region, where insight into local systems enables more strategic processes to be implemented and sustained. Adult neurologists and psychiatrists provide most of the specialist health care for children with epilepsy in Africa. They often have limited training in paediatric diseases as well as in the interpretation of paediatric neurological investigations. There are few child neurology associations in African countries. Some countries have no paediatric neurologists; others only one or two such specialists. A survey in 2010 identified 148 doctors either formally trained or with a special interest in child neurology, for a population of 927 million.5 Specialized training is available in few African centres, inevitably leading to the migration to acquire these skills. As such there a strong case to support training in child neurology disciplines in Africa, ideally by Africans. This leads to more relevant training, which equips and empowers the health practitioner to implement change and deliver appropriate health care in the setting in which he or she is based. Training undertaken overseas can leave doctors disempowered and frustrated when they return to work in environments which may lack even the most basic of resources. Policy and change should be led from within by specialized African doctors who can envision how to implement and sustain effective care plans. The members of the ACNA represent a working body that has actively supported and pushed forward this policy. This association consists not only of African doctors, but also specialists from across the world. These specialists are aware of the clinical challenges in Africa and spend time in African centers ensuring that their teaching and support is applicable to the local setting. Within the African continent the current basic levels of health care must evolve through innovative mechanisms to ensure that an appropriate standard of health care is reached. This standard should be equivalent to that which any child with a neurodisability is entitled to, regardless of where in the world they reside.