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Walker J. Patient and caregiver experiences of living with dementia in Tanzania. DEMENTIA 2023; 22:1900-1920. [PMID: 37879079 PMCID: PMC10644685 DOI: 10.1177/14713012231204784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don't receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers' experiences of living with dementia in Tanzania and the perceived needs of people with dementia.Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.Results: Three sub-themes were identified within data describing the experience of 'Living with Dementia in Tanzania': 'Deteriorations in Health', 'Challenges to living with Dementia in Tanzanian Culture', and 'Lack of Support': people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma.
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Affiliation(s)
- Jessica Walker
- Population Health Sciences Institute, Newcastle University, UK
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Mbiydzenyuy NE, Pieme CA, Brown RE, Nguemeni C. Neuroscience education and research in Cameroon: Current status and future direction. IBRO Neurosci Rep 2021; 10:216-224. [PMID: 34179870 PMCID: PMC8211920 DOI: 10.1016/j.ibneur.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/22/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Neurological disorders comprise 20% of hospital admissions in Cameroon. The burden of neurological disorders is increasing, especially in children and the elderly. However, there are very few neurologists, psychiatrists, gerontologists and neuropsychologists trained in the treatment of neurological disorders in Cameroon and there are very few facilities for training in basic and clinical neuroscience. Although non-governmental organizations such as the International Brain Research Organization (IBRO), International Society of Neurochemistry (ISN), and Teaching and Research in Natural Sciences for Development (TReND) in Africa have stepped in to provide short training courses and workshops in neuroscience, these are neither sufficient to train African neuroscientists nor to build the capacity to train neuroscience researchers and clinicians. There has also been little support from universities and the government for such training. While some participants of these schools have managed to form collaborations with foreign researchers and have been invited to study abroad, this does not facilitate the training of neuroscientists in Cameroon. Moreover, the research infrastructure for training in neuroscience remains limited. This is reflected in the low research output from Cameroonian universities in the field. In this review, we describe the burden of neurological disorders in Cameroon and outline the outstanding efforts of local scientists to develop the discipline of neuroscience, which is still an emerging field in Cameroon. We identify key actionable steps towards the improvement of the scientific capacity in neuroscience in Cameroon: (1) develop targeted neuroscience training programs in all major universities in Cameroon; (2) implement a thriving scientific environment supported by international collaborations; (3) focus on the leadership and the mentorship of both local and senior neuroscientists; (4) develop public awareness and information of policy makers to increase governmental funding for neuroscience research. Improving scientific capacity to tackle the neurological diseases burden in Cameroon is urgent. Neuroscience schools and advocated researchers shape the future of neuroscience in Cameroon. Public-private partnerships are required for sustainable country impact of neuroscience schools.
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Affiliation(s)
- Ngala Elvis Mbiydzenyuy
- Department of Basic Medical Science, School of Medicine, Copperbelt University, Ndola, Zambia
| | | | - Richard E Brown
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carine Nguemeni
- Department of Neurology, University Hospital of Würzburg, Germany
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Lewis EG, Whitton LA, Collin H, Urasa S, Howorth K, Walker RW, Dotchin C, Mulligan L, Shah B, Mohamed A, Mdegella D, Mkodo J, Zerd F, Gray WK. A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen. Aging Clin Exp Res 2020; 32:1959-1967. [PMID: 31811571 DOI: 10.1007/s40520-019-01406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. AIM To validate and further refine a frailty screening tool for SSA. METHODS Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our 'gold standard' diagnosis. RESULTS Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. DISCUSSION The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. CONCLUSIONS The B-FIT 2 should be externally validated.
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Affiliation(s)
- Emma Grace Lewis
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise A Whitton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Collin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kate Howorth
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - 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
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Louise Mulligan
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bhavini Shah
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Ali Mohamed
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Joyce Mkodo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Zerd
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
- Department of Research and Development, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
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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: 41] [Impact Index Per Article: 5.1] [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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Paddick SM, Kisoli A, Dotchin CL, Gray WK, Chaote P, Longdon A, Walker RW. Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study. Age Ageing 2015; 44:636-41. [PMID: 25918185 DOI: 10.1093/ageing/afv048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/31/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND we have previously conducted a community-based prevalence study of dementia in older adults living in the rural Hai district of Tanzania. The aim of this study was to record mortality rates at 4 years post-diagnosis, of those with dementia, mild cognitive impairment (MCI) and no cognitive impairment. METHODS during Phase I of the prevalence study, 1,198 people aged 70 years and over were screened, and a stratified sample of 296 was assessed for the presence of dementia or MCI in Phase II. Seventy-eight people had dementia and 46 had MCI. Four years after diagnosis, we attempted to follow-up all those seen in Phase II and record all deaths. RESULTS of the 296, follow-up data were available for 287 (97.0%), including 77 with dementia and 45 with MCI. Of the 172 with no cognitive impairment, 165 (95.9%) were followed up and a sample of 89 people selected as representative of the background population. Forty-eight people with dementia (62.3%), 19 with MCI (42.2%) and 11 with no cognitive impairment (12.4%) had died at 4-year follow-up. After adjusting for the effects of age, gender and education, the hazard ratio was 6.33 (95% CI 3.19-12.58) for dementia and 3.57 (95% CI 1.64-7.79) for MCI relative to people with no cognitive impairment. Mortality rates were highest in those with vascular dementia. CONCLUSION dementia and MCI were associated with excess mortality relative to those with no cognitive impairment.
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Affiliation(s)
- Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Aloyce Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute for Ageing, Newcastle University, Newcastle-upon-Tyne, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK
| | - Paul Chaote
- District Medical Office, Hai District Hospital, Boman'gombe, Hai, Tanzania
| | - Anna Longdon
- South Devon Healthcare NHS Foundation Trust, Torquay, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, 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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Evans MRB, Manji H. Neurology in Africa: Howlett. Journal of Neurology, Neurosurgery and Psychiatry 2015. [DOI: 10.1136/jnnp-2014-308919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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