Global Health: Pediatric Neurology

David R. Bearden; Ornella Ciccone; Archana A. Patel

doi:10.1055/s-0038-1649336

Seminars in Neurology, Table of Contents

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

¹Division of Child Neurology, Department of Neurology, University of Rochester School of Medicine, Rochester, New York

,

Ornella Ciccone

²Department of Pediatrics, Arthur Davison Children's Hospital, Ndola, Zambia

,

Archana A. Patel

³Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

› Author Affiliations

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

Full Text

References

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
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
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
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
5 Tan CT. Neurology in Asia. Neurology 2015; 84 (06) 623-625
6 Wilmshurst JM. Child neurology in Africa. Semin Pediatr Neurol 2014; 21 (01) 1-2
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
8 Birbeck GL. Barriers to care for patients with neurologic disease in rural Zambia. Arch Neurol 2000; 57 (03) 414-417
9 Chugani HT, Wilmshurst J, Newton CR. The role of ICNA in Africa. Dev Med Child Neurol 2011; 53 (05) 387-388
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
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
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
13 Postels DG, Taylor TE, Molyneux M. , et al. Neurologic outcomes in retinopathy-negative cerebral malaria survivors. Neurology 2012; 79 (12) 1268-1272
14 Postels DG, Birbeck GL. Cerebral malaria. Handb Clin Neurol 2013; 114: 91-102
15 Bearden DR, Monokwane B, Khurana E. , et al. Pediatric cerebral palsy in Botswana: etiology, outcomes, and comorbidities. Pediatr Neurol 2016; 59: 23-29
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
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
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
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
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
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
22 Berkowitz AL. Neurology education in resource-limited settings. Neurology 2014; 82 (16) 1463-1464
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
24 Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology 2005; 64 (03) 412-415
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
26 Wilmshurst JM, Badoe E, Wammanda RD. , et al. Child neurology services in Africa. J Child Neurol 2011; 26 (12) 1555-1563
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
28 Singhal BS, Khadilkar SV. Neurology in the developing world. Handb Clin Neurol 2014; 121: 1773-1782
29 World Health Organization. WHO Atlas: Country Resources for Neurological Disorders. Geneva, Switzerland: 2017
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
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
32 Singh A, Trevick S. The epidemiology of global epilepsy. Neurol Clin 2016; 34 (04) 837-847
33 Singh MB. Epilepsy in developing countries: perspectives from India. Neurology 2015; 84 (15) 1592-1594
34 Rimmer K, Shah H, Thakur K. Expanding medicines for neurologic disorders on the WHO Model List. Neurology 2017; 88 (10) e87-e91
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
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
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
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
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
40 de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav 2008; 12 (04) 540-546
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
42 Birbeck G, Hesdorffer D. The geography of epilepsy: a fatal disease in resource-poor settings. Neurology 2011; 77 (02) 96-97
43 Caraballo R, Fejerman N. Management of epilepsy in resource-limited settings. Epileptic Disord 2015; 17 (01) 13-18 , quiz 18
44 Jette N, Trevathan E. Saving lives by treating epilepsy in developing countries. Neurology 2014; 82 (07) 552-553
45 Jost J, Millogo A, Preux PM. Antiepileptic treatments in developing countries. Curr Pharm Des 2017; 23 (37) 5740-5748
46 Kvalsund MP, Birbeck GL. Epilepsy care challenges in developing countries. Curr Opin Neurol 2012; 25 (02) 179-186
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
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
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
50 Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord 2015; 17 (02) 117-123
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
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
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
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
55 Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet 2012; 380 (9848): 1193-1201
56 Baskind R, Birbeck G. Epilepsy care in Zambia: a study of traditional healers. Epilepsia 2005; 46 (07) 1121-1126
57 de Boer HM. Epilepsy stigma: moving from a global problem to global solutions. Seizure 2010; 19 (10) 630-636
58 Chin JH. Epilepsy treatment in sub-Saharan Africa: closing the gap. Afr Health Sci 2012; 12 (02) 186-192
59 Prevett M. Epilepsy in sub-Saharan Africa. Pract Neurol 2013; 13 (01) 14-20
60 Dean D, Berger JR. Neuro-AIDS in the developing world. Neurology 2012; 78 (07) 499-500
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
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
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
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
65 Megaw K, Wilmshurst JM. The Keilah Foundation: making the ketogenic diet viable for children in Africa. Epilepsia 2015; 56 (04) 514-516
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
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
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
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
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
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
72 World HO. . World Malaria Report 2015. 2016
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
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
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
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
77 Dunst J, Kamena F, Matuschewski K. Cytokines and chemokines in cerebral malaria pathogenesis. Front Cell Infect Microbiol 2017; 7: 324
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
79 Birbeck GL. HIV neurology in the developing world. Handb Clin Neurol 2007; 85: 33-43
80 Bearden DR, Meyer AC. Should the Frascati criteria for HIV-associated neurocognitive disorders be used in children?. Neurology 2016; 87 (01) 17-18
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
82 Carroll A, Brew B. HIV-associated neurocognitive disorders: recent advances in pathogenesis, biomarkers, and treatment. F1000 Res 2017; 6: 312
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
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
85 Mateen FJ, Martins N. A health systems constraints analysis for neurologic diseases: the example of Timor-Leste. Neurology 2014; 82 (14) 1274-1276
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
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
88 Mateen FJ. Neurology and international organizations. Neurology 2013; 81 (04) 392-394
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
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
91 Mateen FJ. Neurocritical care in developing countries. Neurocrit Care 2011; 15 (03) 593-598