Download PDF
Semin Neurol 2018; 38(02): 200-207
DOI: 10.1055/s-0038-1649336
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Global Health: Pediatric Neurology

David R. Bearden
1   Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York
,
Ornella Ciccone
2   Department of Pediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
,
Archana A. Patel
3   Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding Source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

Publication Date:
23 May 2018 (online)

    Permissions and Reprints

Abstract

Neurologic disorders contribute significantly to both morbidity and mortality among children in resource-limited settings, but there are a few succinct studies summarizing the epidemiology of neurologic disorders in these settings. A review of available literature was performed to identify data on the prevalence, etiology, outcomes, and treatment of neurologic disorders in children in resource-limited settings. The burden of neurologic disorders in children is high in resource-limited settings. Barriers to optimal care include lack of trained personnel, limited access to diagnostic technology, and limited availability of drugs used to treat common conditions. Several solutions have been suggested to deal with these challenges including increased collaborations to train neurologists willing to practice in resource-limited settings and increased training of physician extenders or community health workers. Further studies are necessary to improve our understanding of the epidemiology of neurologic disorders in resource-limited settings. Future epidemiologic studies should incorporate multiple countries in resource-limited settings and utilize standardized definitions and methodologies to enable comparison across regions.

Keywords

nervous system disorders - neurologic impairment - low- and middle-income countries - children

Financial Disclosure

All authors have no financial relationships relevant to this article to disclose.


 

  • References

  • 1 GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol 2017; 16 (11) 877-897
    CrossrefPubMedGoogle Scholar
  • 2 Kassebaum N, Kyu HH, Zoeckler L. , et al; Global Burden of Disease Child and Adolescent Health Collaboration. Child and adolescent health from 1990 to 2015: findings from the global burden of diseases, injuries, and risk factors 2015 study. JAMA Pediatr 2017; 171 (06) 573-592
    CrossrefPubMedGoogle Scholar
  • 3 Abubakar A, Ssewanyana D, Newton CR. A systematic review of research on autism spectrum disorders in Sub-Saharan Africa. Behav Neurol 2016; 2016: 3501910
    PubMedGoogle Scholar
  • 4 Donald KA, Samia P, Kakooza-Mwesige A, Bearden D. Pediatric cerebral palsy in Africa: a systematic review. Semin Pediatr Neurol 2014; 21 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 5 Tan CT. Neurology in Asia. Neurology 2015; 84 (06) 623-625
    CrossrefPubMedGoogle Scholar
  • 6 Wilmshurst JM. Child neurology in Africa. Semin Pediatr Neurol 2014; 21 (01) 1-2
    CrossrefPubMedGoogle Scholar
  • 7 Wilmshurst JM, Kakooza-Mwesige A, Newton CR. The challenges of managing children with epilepsy in Africa. Semin Pediatr Neurol 2014; 21 (01) 36-41
    CrossrefPubMedGoogle Scholar
  • 8 Birbeck GL. Barriers to care for patients with neurologic disease in rural Zambia. Arch Neurol 2000; 57 (03) 414-417
    CrossrefPubMedGoogle Scholar
  • 9 Chugani HT, Wilmshurst J, Newton CR. The role of ICNA in Africa. Dev Med Child Neurol 2011; 53 (05) 387-388
    CrossrefPubMedGoogle Scholar
  • 10 Fink EL, Kochanek PM, Tasker RC. , et al; Prevalence of Acute critical Neurological disease in children: A Global Epidemiological Assessment (PANGEA) Investigators. International survey of critically ill children with acute neurologic insults: the prevalence of acute critical neurological disease in children: a global epidemiological assessment study. Pediatr Crit Care Med 2017; 18 (04) 330-342
    CrossrefPubMedGoogle Scholar
  • 11 Phillips N, Amos T, Kuo C. , et al. HIV-associated cognitive impairment in perinatally infected children: a meta-analysis. Pediatrics 2016; 138 (05) 5
    PubMedGoogle Scholar
  • 12 Christensen SS, Eslick GD. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Trans R Soc Trop Med Hyg 2015; 109 (04) 233-238
    CrossrefPubMedGoogle Scholar
  • 13 Postels DG, Taylor TE, Molyneux M. , et al. Neurologic outcomes in retinopathy-negative cerebral malaria survivors. Neurology 2012; 79 (12) 1268-1272
    CrossrefPubMedGoogle Scholar
  • 14 Postels DG, Birbeck GL. Cerebral malaria. Handb Clin Neurol 2013; 114: 91-102
    PubMedGoogle Scholar
  • 15 Bearden DR, Monokwane B, Khurana E. , et al. Pediatric cerebral palsy in Botswana: etiology, outcomes, and comorbidities. Pediatr Neurol 2016; 59: 23-29
    CrossrefPubMedGoogle Scholar
  • 16 Donald KA, Kakooza AM, Wammanda RD. , et al. Pediatric cerebral palsy in Africa: where are we?. J Child Neurol 2015; 30 (08) 963-971
    CrossrefPubMedGoogle Scholar
  • 17 Prins A, Chengo E, Mung'ala Odera V. , et al. Long-term survival and outcome in children admitted to Kilifi District Hospital with convulsive status epilepticus. Epilepsy Res Treat 2014; 2014: 643747
    PubMedGoogle Scholar
  • 18 Sadarangani M, Seaton C, Scott JA. , et al. Incidence and outcome of convulsive status epilepticus in Kenyan children: a cohort study. Lancet Neurol 2008; 7 (02) 145-150
    CrossrefPubMedGoogle Scholar
  • 19 Bearden D, Steenhoff AP, Dlugos DJ. , et al. Early antiretroviral therapy is protective against epilepsy in children with human immunodeficiency virus infection in Botswana. J Acquir Immune Defic Syndr 2015; 69 (02) 193-199
    CrossrefPubMedGoogle Scholar
  • 20 Kerac M, Postels DG, Mallewa M. , et al. The interaction of malnutrition and neurologic disability in Africa. Semin Pediatr Neurol 2014; 21 (01) 42-49
    CrossrefPubMedGoogle Scholar
  • 21 Sudfeld CR, McCoy DC, Fink G. , et al. Malnutrition and its determinants are associated with suboptimal cognitive, communication, and motor development in Tanzanian children. J Nutr 2015; 145 (12) 2705-2714
    CrossrefPubMedGoogle Scholar
  • 22 Berkowitz AL. Neurology education in resource-limited settings. Neurology 2014; 82 (16) 1463-1464
    CrossrefPubMedGoogle Scholar
  • 23 Birbeck GL, Munsat T. Neurologic services in sub-Saharan Africa: a case study among Zambian primary healthcare workers. J Neurol Sci 2002; 200 (1-2): 75-78
    CrossrefPubMedGoogle Scholar
  • 24 Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology 2005; 64 (03) 412-415
    CrossrefPubMedGoogle Scholar
  • 25 Mateen FJ, Clark SJ, Borzello M, Kabore J, Seidi O. Neurology training in sub-Saharan Africa: a survey of people in training from 19 countries. Ann Neurol 2016; 79 (06) 871-881
    CrossrefPubMedGoogle Scholar
  • 26 Wilmshurst JM, Badoe E, Wammanda RD. , et al. Child neurology services in Africa. J Child Neurol 2011; 26 (12) 1555-1563
    CrossrefPubMedGoogle Scholar
  • 27 Meyer AC, Dua T, Boscardin WJ, Escarce JJ, Saxena S, Birbeck GL. Critical determinants of the epilepsy treatment gap: a cross-national analysis in resource-limited settings. Epilepsia 2012; 53 (12) 2178-2185
    CrossrefPubMedGoogle Scholar
  • 28 Singhal BS, Khadilkar SV. Neurology in the developing world. Handb Clin Neurol 2014; 121: 1773-1782
    PubMedGoogle Scholar
  • 29 World Health Organization. WHO Atlas: Country Resources for Neurological Disorders. Geneva, Switzerland: 2017
    Google Scholar
  • 30 Watila MM, Keezer MR, Angwafor SA, Winkler AS, Sander JW. Health service provision for people with epilepsy in sub-Saharan Africa: a situational review. Epilepsy Behav 2017; 70 (Pt A): 24-32
    CrossrefPubMedGoogle Scholar
  • 31 Nwani PO, Nwosu MC, Enwereji KO, Asomugha AL, Arinzechi EO, Ogunniyi AO. Epilepsy treatment gap: prevalence and associated factors in Southeast Nigeria. Acta Neurol Scand 2013; 128 (02) 83-90
    CrossrefPubMedGoogle Scholar
  • 32 Singh A, Trevick S. The epidemiology of global epilepsy. Neurol Clin 2016; 34 (04) 837-847
    CrossrefPubMedGoogle Scholar
  • 33 Singh MB. Epilepsy in developing countries: perspectives from India. Neurology 2015; 84 (15) 1592-1594
    CrossrefPubMedGoogle Scholar
  • 34 Rimmer K, Shah H, Thakur K. Expanding medicines for neurologic disorders on the WHO Model List. Neurology 2017; 88 (10) e87-e91
    CrossrefPubMedGoogle Scholar
  • 35 Wilmshurst JM, Berg AT, Lagae L, Newton CR, Cross JH. The challenges and innovations for therapy in children with epilepsy. Nat Rev Neurol 2014; 10 (05) 249-260
    CrossrefPubMedGoogle Scholar
  • 36 Gladstone M. A review of the incidence and prevalence, types and aetiology of childhood cerebral palsy in resource-poor settings. Ann Trop Paediatr 2010; 30 (03) 181-196
    CrossrefPubMedGoogle Scholar
  • 37 McLane HC, Berkowitz AL, Patenaude BN. , et al. Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries. Neurology 2015; 85 (18) 1614-1622
    CrossrefPubMedGoogle Scholar
  • 38 Wilmshurst JM, Birbeck GL, Newton CR. Epilepsy is ubiquitous, but more devastating in the poorer regions of the world... or is it?. Epilepsia 2014; 55 (09) 1322-1325
    CrossrefPubMedGoogle Scholar
  • 39 Dua T, de Boer HM, Prilipko LL, Saxena S. Epilepsy care in the world: results of an ILAE/IBE/WHO global campaign against epilepsy survey. Epilepsia 2006; 47 (07) 1225-1231
    CrossrefPubMedGoogle Scholar
  • 40 de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav 2008; 12 (04) 540-546
    CrossrefPubMedGoogle Scholar
  • 41 Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux PM. Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet Neurol 2014; 13 (10) 1029-1044
    CrossrefPubMedGoogle Scholar
  • 42 Birbeck G, Hesdorffer D. The geography of epilepsy: a fatal disease in resource-poor settings. Neurology 2011; 77 (02) 96-97
    CrossrefPubMedGoogle Scholar
  • 43 Caraballo R, Fejerman N. Management of epilepsy in resource-limited settings. Epileptic Disord 2015; 17 (01) 13-18 , quiz 18
    PubMedGoogle Scholar
  • 44 Jette N, Trevathan E. Saving lives by treating epilepsy in developing countries. Neurology 2014; 82 (07) 552-553
    CrossrefPubMedGoogle Scholar
  • 45 Jost J, Millogo A, Preux PM. Antiepileptic treatments in developing countries. Curr Pharm Des 2017; 23 (37) 5740-5748
    PubMedGoogle Scholar
  • 46 Kvalsund MP, Birbeck GL. Epilepsy care challenges in developing countries. Curr Opin Neurol 2012; 25 (02) 179-186
    CrossrefPubMedGoogle Scholar
  • 47 Levira F, Thurman DJ, Sander JW. , et al; Epidemiology Commission of the International League Against Epilepsy. Premature mortality of epilepsy in low- and middle-income countries: a systematic review from the mortality task force of the International League Against Epilepsy. Epilepsia 2017; 58 (01) 6-16
    CrossrefPubMedGoogle Scholar
  • 48 Wilmshurst JM, Cross JH, Newton C. , et al. Children with epilepsy in Africa: recommendations from the International Child Neurology Association/African Child Neurology Association Workshop. J Child Neurol 2013; 28 (05) 633-644
    CrossrefPubMedGoogle Scholar
  • 49 Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia 2011; 52 (08) 1376-1381
    CrossrefPubMedGoogle Scholar
  • 50 Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord 2015; 17 (02) 117-123
    CrossrefPubMedGoogle Scholar
  • 51 Carter JA, Molyneux CS, Mbuba CK, Jenkins J, Newton CR, Hartley SD. The reasons for the epilepsy treatment gap in Kilifi, Kenya: using formative research to identify interventions to improve adherence to antiepileptic drugs. Epilepsy Behav 2012; 25 (04) 614-621
    CrossrefPubMedGoogle Scholar
  • 52 Katchanov J, Birbeck GL. Epilepsy care guidelines for low- and middle- income countries: from WHO mental health GAP to national programs. BMC Med 2012; 10: 107
    CrossrefPubMedGoogle Scholar
  • 53 Mbuba CK, Ngugi AK, Newton CR, Carter JA. The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies. Epilepsia 2008; 49 (09) 1491-1503
    CrossrefPubMedGoogle Scholar
  • 54 Meinardi H, Scott RA, Reis R, Sander JW. ; ILAE Commission on the Developing World. The treatment gap in epilepsy: the current situation and ways forward. Epilepsia 2001; 42 (01) 136-149
    CrossrefPubMedGoogle Scholar
  • 55 Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet 2012; 380 (9848): 1193-1201
    CrossrefPubMedGoogle Scholar
  • 56 Baskind R, Birbeck G. Epilepsy care in Zambia: a study of traditional healers. Epilepsia 2005; 46 (07) 1121-1126
    CrossrefPubMedGoogle Scholar
  • 57 de Boer HM. Epilepsy stigma: moving from a global problem to global solutions. Seizure 2010; 19 (10) 630-636
    CrossrefPubMedGoogle Scholar
  • 58 Chin JH. Epilepsy treatment in sub-Saharan Africa: closing the gap. Afr Health Sci 2012; 12 (02) 186-192
    PubMedGoogle Scholar
  • 59 Prevett M. Epilepsy in sub-Saharan Africa. Pract Neurol 2013; 13 (01) 14-20
    CrossrefPubMedGoogle Scholar
  • 60 Dean D, Berger JR. Neuro-AIDS in the developing world. Neurology 2012; 78 (07) 499-500
    CrossrefPubMedGoogle Scholar
  • 61 Chomba EN, Haworth A, Mbewe E. , et al. The current availability of antiepileptic drugs in Zambia: implications for the ILAE/WHO “out of the shadows” campaign. Am J Trop Med Hyg 2010; 83 (03) 571-574
    CrossrefPubMedGoogle Scholar
  • 62 Bhalla D, Aziz H, Bergen D. , et al. Undue regulatory control on phenobarbital--an important yet overlooked reason for the epilepsy treatment gap. Epilepsia 2015; 56 (04) 659-662
    CrossrefPubMedGoogle Scholar
  • 63 Cao D, Badoe E, Zhu Y, Zhao X, Hu Y, Liao J. First application of ketogenic diet on a child with intractable epilepsy in Ghana. Child Neurol Open 2015; 2 (03) 2329048 × 15604593
    PubMedGoogle Scholar
  • 64 Kossoff EH, Al-Macki N, Cervenka MC. , et al. What are the minimum requirements for ketogenic diet services in resource-limited regions? Recommendations from the International League Against Epilepsy Task Force for Dietary Therapy. Epilepsia 2015; 56 (09) 1337-1342
    CrossrefPubMedGoogle Scholar
  • 65 Megaw K, Wilmshurst JM. The Keilah Foundation: making the ketogenic diet viable for children in Africa. Epilepsia 2015; 56 (04) 514-516
    CrossrefPubMedGoogle Scholar
  • 66 Wilmshurst JM, Burman R, Gaillard WD, Cross JH. Treatment of infants with epilepsy: common practices around the world. Epilepsia 2015; 56 (07) 1033-1046
    CrossrefPubMedGoogle Scholar
  • 67 Monokwane B, Johnson A, Gambrah-Sampaney C. , et al. Risk factors for cerebral palsy in children in Botswana. Pediatr Neurol 2017; 77: 73-77
    CrossrefPubMedGoogle Scholar
  • 68 Patel P, Baier J, Baranov E. , et al. Health beliefs regarding pediatric cerebral palsy among caregivers in Botswana: a qualitative study. Child Care Health Dev 2017; 43 (06) 861-868
    CrossrefPubMedGoogle Scholar
  • 69 Johnson A, Gambrah-Sampaney C, Khurana E. , et al. Risk factors for malnutrition among children with cerebral palsy in Botswana. Pediatr Neurol 2017; 70: 50-55
    CrossrefPubMedGoogle Scholar
  • 70 Gladstone M, Mallewa M, Alusine Jalloh A. , et al. Assessment of neurodisability and malnutrition in children in Africa. Semin Pediatr Neurol 2014; 21 (01) 50-57
    CrossrefPubMedGoogle Scholar
  • 71 Suchdev PS, Boivin MJ, Forsyth BW, Georgieff MK, Guerrant RL, Nelson III CA. Assessment of neurodevelopment, nutrition, and inflammation from fetal life to adolescence in low-resource settings. Pediatrics 2017; 139 (Suppl. 01) S23-S37
    CrossrefPubMedGoogle Scholar
  • 72 World HO. . World Malaria Report 2015. 2016
    PubMed
  • 73 Idro R, Kakooza-Mwesige A, Asea B. , et al. Cerebral malaria is associated with long-term mental health disorders: a cross sectional survey of a long-term cohort. Malar J 2016; 15: 184
    CrossrefPubMedGoogle Scholar
  • 74 Kampondeni SD, Potchen MJ, Beare NA. , et al. MRI findings in a cohort of brain injured survivors of pediatric cerebral malaria. Am J Trop Med Hyg 2013; 88 (03) 542-546
    CrossrefPubMedGoogle Scholar
  • 75 Seydel KB, Kampondeni SD, Valim C. , et al. Brain swelling and death in children with cerebral malaria. N Engl J Med 2015; 372 (12) 1126-1137
    CrossrefPubMedGoogle Scholar
  • 76 Yusuf FH, Hafiz MY, Shoaib M, Ahmed SA. Cerebral malaria: insight into pathogenesis, complications and molecular biomarkers. Infect Drug Resist 2017; 10: 57-59
    CrossrefPubMedGoogle Scholar
  • 77 Dunst J, Kamena F, Matuschewski K. Cytokines and chemokines in cerebral malaria pathogenesis. Front Cell Infect Microbiol 2017; 7: 324
    CrossrefPubMedGoogle Scholar
  • 78 Buch S, Chivero ET, Hoare J. , et al. Proceedings from the NIMH symposium on “NeuroAIDS in Africa: neurological and neuropsychiatric complications of HIV”. J Neurovirol 2016; 22 (05) 699-702
    CrossrefPubMedGoogle Scholar
  • 79 Birbeck GL. HIV neurology in the developing world. Handb Clin Neurol 2007; 85: 33-43
    PubMedGoogle Scholar
  • 80 Bearden DR, Meyer AC. Should the Frascati criteria for HIV-associated neurocognitive disorders be used in children?. Neurology 2016; 87 (01) 17-18
    CrossrefPubMedGoogle Scholar
  • 81 Lindl KA, Marks DR, Kolson DL, Jordan-Sciutto KL. HIV-associated neurocognitive disorder: pathogenesis and therapeutic opportunities. J Neuroimmune Pharmacol 2010; 5 (03) 294-309
    CrossrefPubMedGoogle Scholar
  • 82 Carroll A, Brew B. HIV-associated neurocognitive disorders: recent advances in pathogenesis, biomarkers, and treatment. F1000 Res 2017; 6: 312
    CrossrefPubMedGoogle Scholar
  • 83 Cassol E, Misra V, Morgello S, Gabuzda D. Applications and limitations of inflammatory biomarkers for studies on neurocognitive impairment in HIV infection. J Neuroimmune Pharmacol 2013; 8 (05) 1087-1097
    CrossrefPubMedGoogle Scholar
  • 84 Zayyad Z, Spudich S. Neuropathogenesis of HIV: from initial neuroinvasion to HIV-associated neurocognitive disorder (HAND). Curr HIV/AIDS Rep 2015; 12 (01) 16-24
    CrossrefPubMedGoogle Scholar
  • 85 Mateen FJ, Martins N. A health systems constraints analysis for neurologic diseases: the example of Timor-Leste. Neurology 2014; 82 (14) 1274-1276
    CrossrefPubMedGoogle Scholar
  • 86 Brady O, Nordin M, Hondras M. , et al. Global forum: spine research and training in underserved, low and middle-income, culturally unique communities: The World Spine Care Charity Research Program's challenges and facilitators. J Bone Joint Surg Am 2016; 98 (24) e110
    CrossrefPubMedGoogle Scholar
  • 87 Chan MH, Boop F, Qaddoumi I. Challenges and opportunities to advance pediatric neuro-oncology care in the developing world. Childs Nerv Syst 2015; 31 (08) 1227-1237
    CrossrefPubMedGoogle Scholar
  • 88 Mateen FJ. Neurology and international organizations. Neurology 2013; 81 (04) 392-394
    CrossrefPubMedGoogle Scholar
  • 89 Bifftu BB, Dachew BA, Tiruneh BT, Alemu WG. First choice of treatment place in the pathways to epileptic care at the outpatient department of University of Gondar Hospital, Northwest Ethiopia: cross-sectional institutional based study. PLoS One 2017; 12 (08) e0181310
    CrossrefPubMedGoogle Scholar
  • 90 Ciapponi A, Lewin S, Herrera CA. , et al. Delivery arrangements for health systems in low-income countries: an overview of systematic reviews. Cochrane Database Syst Rev 2017; 9: CD011083
    PubMedGoogle Scholar
  • 91 Mateen FJ. Neurocritical care in developing countries. Neurocrit Care 2011; 15 (03) 593-598
    CrossrefPubMedGoogle Scholar