Clinical Spectrum, Etiology, and Outcome of Neurological Disorders in the Rural Hospital of Mosango, the Democratic Republic of Congo

Abstract

Abstract.There is little published information on the epidemiology of neurological disorders in rural Central Africa, although the burden is considered to be substantial. This study aimed to investigate the pattern, etiology, and outcome of neurological disorders in children > 5 years and adults admitted to the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo, with a focus on severe and treatable infections of the central nervous system (CNS). From September 2012 to January 2015, 351 consecutive patients hospitalized for recent and/or ongoing neurological disorder were prospectively evaluated by a neurologist, subjected to a set of reference diagnostic tests in blood or cerebrospinal fluid, and followed-up for 3–6 months after discharge. No neuroimaging was available. Severe headache (199, 56.7%), gait/walking disorders (97, 27.6%), epileptic seizure (87, 24.8%), and focal neurological deficit (86, 24.5%) were the predominant presentations, often in combination. Infections of the CNS were documented in 63 (17.9%) patients and mainly included bacterial meningitis and unspecified meningoencephalitis (33, 9.4%), second-stage human African trypanosomiasis (10, 2.8%), and human immunodeficiency virus (HIV)-related neurological disorders (10, 2.8%). Other focal/systemic infections with neurological manifestations were diagnosed in an additional 60 (17.1%) cases. The leading noncommunicable conditions were epilepsy (61, 17.3%), psychiatric disorders (56, 16.0%), and cerebrovascular accident (23, 6.6%). Overall fatality rate was 8.2% (29/351), but up to 23.8% for CNS infections. Sequelae were observed in 76 (21.6%) patients. Clinical presentations and etiologies of neurological disorders were very diverse in this rural Central African setting and caused considerable mortality and morbidity.

Prevalence of and Characteristics Associated with In-Hospital Mortality in a Ugandan Neurology Ward

“…Combined, these studies demonstrate that neurological illness is routinely encountered in community and inpatient settings throughout sub-Saharan Africa. Overall inpatient mortality in our study was comparable to other prevalence studies throughout sub-Saharan Africa from Ethiopia (22%) and Cameroon (19%) [4,21], was lower than that reported by two studies from Nigeria (34%) and Central Ghana (31%) [30,34], and was higher than one study from Congo (8.2%) [24] . Inaptient mortality due to neurological illness is variable, likely attributable to factors that differ between countries, including socioeconomic factors, healthcare systems, or data collection methods.…”

“…One retrospective study from Cameroon found a similar mortality rate (19%) to that in our study with greatest mortality among those with stroke diagnoses (53%) [21]. Only one prospective study was identified in the literature reporting prevalence of neurological diagnoses in hospitalized patients in Congo, with a lower prevalence of stroke than that in our study (6.6% stroke) which may have been underestimated as there was no access to imaging [24]. Combined, these studies demonstrate that neurological illness is routinely encountered in community and inpatient settings throughout sub-Saharan Africa.…”

“…While there is a pronounced need to describe the prevalence of neurological illness and identify predictors of mortality associated with these diagnoses in healthcare settings throughout Uganda and other sub-Saharan countries, electronic health record (EHR) systems, and hence, administrative data, are not widely available to aid in such endeavors. Several studies have analyzed in-hospital mortality rates and associated factors in various sub-Saharan African countries, with no prior work analyzing inhospital mortality among patients admitted to a neurology ward particularly within Uganda [4,21,24,25,30,34]. Understanding the prevalence and identifying high-risk causes of mortality is critical for healthcare providers and policy makers to prioritize public health, clinical, and quality improvement interventions.…”

High frequency of Taenia solium antigen positivity in patients admitted for neurological disorders in the Rural Hospital of Mosango, Democratic Republic of Congo.

“…However, the etiological spectrum has been hardly studied so far because of lack of diagnostic facilities [13]. To ll this knowledge gap, we investigated the infectious etiologies of neurological disorders in the rural hospital of Mosango, province of Kwilu, Democratic Republic of Congo (DRC) [14], as part of the NIDIAG project ("Neglected Infectious diseases DIAGnosis", https://nidiag.eu/). In this setting where neuroimaging is not available, the contribution of neurocysticercosis in the neurological case load is unknown.…”

Neurological Disease Surveillance in Cameroon, a Rural and Urban-Based Inout Patient Population Study

“…[4,5] Much recent neuro-epidemiological work in Africa has been carried out in urban areas, [6] but data regarding disability and death associated with neurological diseases is still scarce, especially for non-communicable diseases in the rural areas. [7,8] Epidemiology plays an important role in elucidating patterns in the occurrence of disease and determining risk factors and etiology. [9,10] While obtaining information on the burden of neurological diseases by region or district is important so that interventions can be specifically targeted, there is also a need to establish a reliable database system to record the prevalence of neurological diseases in larger geographical areas like the Sub-Saharan African countries.…”