Epilepsy and stigma in Africa: Viewpoint of healthcare professionals and combat strategies.

Epilepsy is a major public health problem in developing countries where eighty percent (80%) of people with epilepsy (PWE) live. Stigma has psychological consequences as well as serious repercussions on patients' quality of life. This study assesses the perception of health professionals in Africa regarding the stigmatization of PWE. METHODOLOGY: This is a multicenter descriptive, cross-sectional study, from 1st August 2020 to 1st September 2021. Medical practitioners from African countries involved in the management of epilepsy and who agreed to fill out forms were included in the study. Sampling was nonrandom and based on respondent choice. The data were analyzed using the EPI INFO 7 software. RESULTS: A total of two hundred and twenty-nine (229) health workers from twenty-six (26) African countries participated in this survey. 24.89% of the respondents were specialists and 46.72% were neurologists. Ninety-one percent (91%) of practitioners felt that PWE were stigmatised. The main forms of stigma were isolation (68.56%), celibacy (60.70%), unemployment (53.28%), divorce (44.54%) and exclusion (37.99%)%). Community, school and family were recognized as the main places of stigmatization. The fight against this stigma was carried out mainly in hospitals and in isolation in 58.4% and 55.8% of cases, respectively. Only 0.4% of practitioners opted for mass awareness. CONCLUSION: PWE are victims of various forms of stigmatization, particularly in community settings. Measures aimed at raising awareness of the public are essential to reduce this stigma and improve patients' quality of life.

Clinical management and disease-modifying treatment for amyotrophic lateral sclerosis in African hospital centers: the TROPALS study.

Objective: To assess the availability of health workers and medications for clinical management of amyotrophic lateral sclerosis (ALS) in African hospital centers. Availability and affordability analyses of disease-modifying treatments were performed. Methods: A multicenter observational study involving African hospitals was conducted. A standard questionnaire was developed based on the European Federation of the Neurological Societies (EFNS) guidelines. We collected data on multidisciplinary care and availability of medicines. The availability and affordability were evaluated according to the WHO guidelines. Results: Nine hospital centers from eight African countries participated. We observed a low degree of implementation of multidisciplinary care in ALS management. Riluzole was only available in centers from South Africa, Senegal, Tunisia, and Togo. This treatment was unaffordable and the adjusted price was highly variable among countries. The cost of riluzole was partly or fully covered by patients, which implies a substantial economic burden. Conclusion: Our findings strengthen the need to promote multidisciplinary care in the clinical management of ALS in Africa. Disease-modifying medication should be both available and affordable. Local and international collaboration is needed to improve ALS health care access in Africa.

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study.

OBJECTIVE: We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa. METHODOLOGY: We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model. RESULTS: Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5-64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival. CONCLUSION: More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.

[Intracranial tuberculomas in Nouakchott, Mauritania]. / Les tubérculomes intracrâniens à Nouakchott, Mauritanie.

Tuberculosis is a major public health problem in developing countries. Cerebral tuberculomas is a tuberculous granulation tissue mass restrained and limited by immune defenses of the host. This study aims to describe the characteristics and the evolutionary profile of intracranial tuberculomas in Mauritania. Data of 34 patients with intracranial tuberculoma were collected retrospectively in several hospitals in the city of Nouakchott between January 2005 and June 2017. Evolutionary features of patients under treatment were analyzed. Our retrospective study involved 20 men and 14 women (sex ratio 1.4). The average age of our patients was 28.7 years. Twelve patients were less than or equal to 16 years. Symptomatology was dominated by increased intracranial pressure and seizures in 27 cases (79.41%) and 20 cases (58.82%) respectively. Intradermo tuberculin reaction was positive in 14 (41.17%) cases. Supratentorial lesion was found in 24 patients (70.58%). In all patients, therapeutic approach was based on multidrug chemotherapy for a period greater than or equal to 12 months. Surgical procedure was performed in 12 patients (35.29%). Outcome was favorable with complete healing without sequelae in 23 cases, reflecting a rate of 67.64%. Given the non-specific role of imaging exams in the diagnosis of intracranial tuberculoma and the lack of the stereotactic biopsy in our Country where the disease is endemic, we recommend to perform a two-month therapeutic test in patients with suspicious lesions.

Juvenile and adult-onset ALS/MND among Africans: incidence, phenotype, survival: a review.

AIM: We reviewed the epidemiology of ALS among subjects of African origin, considering incidence, phenotype and prognosis. METHODS: We searched Medline, Scopus, Science direct, Bibliothèque Virtuelle de Neurologie Africaine (BVNA), ( http://www-ient.unilim.fr/ ) and African journal OnLine databases using the following search terms "amyotrophic lateral sclerosis (ALS)", "motor neuron disease (MND)" or "Charcot disease", in combination with "Africa", "ethnic groups", "blacks" or "epidemiology". Of 1264 references examined, 35 were included in this review. RESULTS AND DISCUSSION: Among the 35 references, 19 studies were performed in the African continent and dealt with MND/ALS; four other studies focused on ALS-like syndromes; finally, 12 studies were not performed in Africa but focused on either incidence and mortality or survival of ALS in subjects of African origin. Several characteristics of ALS among Africans or subjects of African origin were identified: (i) lower incidence rates among people of African origin living in western countries, (ii) higher incidence of classic ALS among men, (iii) presence of juvenile form, (iv) younger age at onset of classic ALS. We cannot draw firm conclusions about (i) the prognosis in African ALS patients, (ii) prognostic factors, (iii) genetic or behavioral factors affecting incidence or clinical phenotype. CONCLUSION: Further multicenter prospective studies with homogeneous methodological approaches need to be performed in Africa to clarify the situation.

Investigating epilepsy in Africa: 10 years of data collection using a standardized questionnaire in 2,269 peoples with epilepsy.

PURPOSE: The need for comparable epidemiologic data on epilepsy from various locations in tropical areas has led in 1994 to the creation of a questionnaire able to standardize information. The Limoges' questionnaire was created to collect information independently of the objectives of each survey performed, and since it has been employed in various continents under tropics latitude. In Africa between 1994 and 2004, 13 epidemiologic surveys in 12 countries were performed by this means. Authors of these works were solicited to communicate their raw data on people with epilepsy (PWE). METHODS: Information collected was aggregated in a database upon which operations of data management were processed. Undernutrition status was determined using an anthropologic method, according World Health Organization (WHO) recommendations. Factors associated with undernutrition and absence of treatment by phenobarbitone were searched for by using multivariate logistic regression. KEY FINDINGS: Information about 2,269 PWE was collected. Mean treatment gap and undernutrition were determined, respectively, to be 30.6% [95% confidence interval (95% CI) 28.7-32.6] and 25.4% (95% CI 22.7-28.2). Factors significantly associated with undernutrition and not being treated with phenobarbitone were determined. SIGNIFICANCE: Despite the different purposes of each study, we were able to pool information in order to characterize and study particular traits of PWE in Africa. Some items of particular importance should be collected systematically and will be highlighted in a newer version of this questionnaire. Because many surveys were undertaken using this tool in tropical areas, a backward compatibility should be ensured.

Japanese encephalitis revisited.

Japanese encephalitis (JE) is a major public health problem in Southeast Asia with around 50,000 cases and 10,000 deaths per year affecting essentially children below 10 years of age. The JE virus has shown a tendency to extend to other geographic regions. JE may cause severe encephalitis and survivors are frequently left with serious neurological lesions. In the absence of an effective antiviral treatment, prevention constitutes the best defense against this disease. Besides the implementation of vector control, immunization by vaccination is available. Vector control is expensive and difficult to implement on a large scale, leaving vaccination as the best means for mass campaigns. Recent progress in the development of live attenuated vaccines has given hope of an effective vaccine, which is both easy to use and inexpensive for large scale programs.