Neurology conditions and management in periods of political instability Patrice BARASUKANA NEUROLOGIST,MD, MMed UNIVERSITY TEACHING HOSPITAL OF KAMENGE UNIVERSITY OF BURUNDI,

Introduction The absence of death records or functional monitoring networks in the vast majority of Sub-Saharan African countries: the database as incidence rate, prevalence or exact mortality related to neurological conditions are not known. The derisory technical platform : neurological explorations, nonexistent or irregular imaging and improperly functional services

Introduction According to WHO data (2006), the five neurological pathologies causing the largest burden of diseases encountered in low-income countries are: traumatic pathologies, Neuro- infectious diseases Cerebrovascular disease the pathology of deficiency and peripheral neuropathies

Recent studies Epilepsy (Estimating incidence of epilepsy in Sub– Saharan Africa): Active epilepsy was estimated to affect 4.4 million people in Sub–Saharan Africa, The prevalence of active epilepsy peaks in the 20–29 age group at 11.5/1000 and again in the 40–49 age group at 8.2/1000. The lowest prevalence value of 3.1/1000 is seen in the 60+ age group Neurodegenerative diseases: The body of literature on neurodegenerative disorders in Sub Saharan Africa is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders Adeloye D, et al: journal of global health, 2012 Vol. 2 No. 2 Lekoubou et al. BMC Public Health 2014, 14:653

Recent studies Stroke: The burden of stroke in Africa is high and still increasing(10.8% and 9.6% for incident stroke cases and stroke survivors respectively 2013 compared to 2009 World Malaria report 2015: Malaria remains a major public health problem in many countries of the world In 2015, it is estimated that 15 countries accounted for 78% of deaths(D.R.C and Nigeria more than 35%) Adeloye D:An Estimate of the Incidence and Prevalence of Stroke in Africa: A Systematic Review and Meta-Analysis, Plos June 2014,9,6

Problem of management There is a big gap between developed and developing countries in terms of neurological disease prevention, diagnosis, treatment.

Problem of management No referral facilities (medical transportation) Lack of functional stroke units, trained neurologists, and other human resources, Equipments: Lack of machine(computed tomography (CT) scans, magnetic resonance imaging (MRI),echo-doppler machines, EEG,EMG machines, Lack of general drugs No health insurance Resources are insufficient and inequitably distributed

Consequences of Political instability The 3 traditionnal levels of service (primary, secondary, tertiary) provided to people are disorganized Delay of consultation and management( disease worsening followed sometimes with death and occurrence of complications with severe sequelae) Health infrastructures destroyed or looted Brain drain ( doctors)

Consequences of Political instability Many neurological disorders run a chronic, relapsing or remitting course The supply and treatment compliance are no longer met:  Reappearance of neurological manifestations related to HIV  Epilepsy which was stable becomes pharmaco- resistant  Recurrent Stroke

Consequences of Political instability Traumatic brain injury remains the cause of death and disability, Rehabilitation takes a long time(spasticty, severe sequelae Malnutrition and related neurological disorders increase in period of conflict.

conclusion Neurological disorders and their sequelae are found among all age categories and in all geographical regions Many neurological disorders can be prevented and treated Improvement of neurological care requires a good health policy accompanied by public and professionnal awareness War is never a solution in any conflict whatsoever

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