Abstract
BackgroundNeurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo.MethodsWe used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti.ResultsCare providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a “diviner” do not enhance any use of laboratory or other diagnostic methods.ConclusionInnovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.
Highlights
The frequency of neurological disorders and their etiology is poorly documented in low-resource settings, in subSaharan Africa
Knowledge of the neurological syndrome The care providers at the health centers and hospitals in these rural areas are quite familiar with the neurological syndrome as a clinical presentation
"Coma, convulsions, motor or sensory deficits,..., this list is not exhaustive, there are several clinical expressions that point to the concept of a neurological syndrome." (FGD1)
Summary
The frequency of neurological disorders and their etiology is poorly documented in low-resource settings, in subSaharan Africa. In Central Africa for example, neurological disorders may be due to infections such as Human African trypanosomiasis (HAT), cerebral malaria, bacterial meningitis, tuberculous meningitis, neurosyphilis, cryptococcal meningitis or encephalitis due to Toxoplasma [5] If such conditions are not timely treated, death or serious sequelae occur frequently [6], while early specific treatment may substantially improve the outcome. Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences These syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo
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