Harnessing momentum to advance brain health in north Africa

Abstract

On Nov 12–17, 2011, the neurological community will gather in Marrakesh, Morocco, for the 20th World Congress of Neurology. As its first congress in Africa, the event is a historic occasion for the World Federation of Neurology (WFN), whose mission is “to foster quality neurology and brain health worldwide”. North Africa is in the midst of a momentous transformation, and the WFN must use this opportunity as a first move towards permanent engagement with society and neurologists in the region.A wave of civil resistance, known as the Arab spring, has led to the collapse of long-held dictatorial regimes, such as those ousted in Tunisia and Egypt. The world has watched with admiration as a popular revolution has ushered in radical political changes that should eventually lead to more open societies, in which citizens can express themselves freely and have improved access to basic requirements such as health care. The Congress is therefore timely. The WFN has put an emphasis on sub-Saharan Africa, and it must not waste this opportunity to also help neurologists in north Africa in fulfilling their aspirations to advance clinical practice and research.The transition from rural to urban populations in north Africa has accelerated over the past decade. Urbanisation has improved health-care access, but many health status indicators, such as maternal and infant mortality, still lag behind those in other emerging economies, and data on morbidity are inadequate. According to a recent study, neonatal mortality in the region ranges from 9·4 per 1000 births in Tunisia to 19·1 in Morocco. Under-5 mortality rates were estimated at 15·2 per 1000 children in Tunisia, 19·3 in Algeria, and 24·7 and 32·4 in Egypt and Morocco, respectively. Neonatal and perinatal morbidity rates, which are associated with long-term neurological sequelae, are also likely to be high in these populations. Morbidity data are urgently needed so that primary and secondary neuroprotective strategies can be implemented; the effects of therapeutic and neurorehabilitation strategies for these children should also be assessed. WFN member societies can contribute invaluable expertise to such initiatives.The socioeconomic transition that has brought about a wave of revolutions might also be linked to an enormous rise in non-communicable diseases (NCDs), including heart disease and stroke. According to WHO 2005 data, the top cause of mortality in Egypt was intracerebral haemorrhage, and cerebral infarction was also among the top ten causes of death. In Tunisia, heart and brain vascular diseases are the greatest cause of mortality and morbidity. By promoting the training of neurovascular specialists and the engagement of African health workers in international networks of stroke research, the WFN is well placed to make a lasting impact; it would be disappointing if it does not do so.The WFN has led an initiative to create the World Brain Alliance, an umbrella group of neurological organisations worldwide, including the World Stroke Organization, that aims to move neurological and psychiatric diseases up the agenda of global health policymakers. At a recent UN High-Level Meeting on NCDs in New York, USA, the Alliance argued that NCDs will not be tackled unless brain health becomes top of that agenda. The World Brain Alliance has planted a valuable seed in the global health ground, but unfortunately it was not enough to change UN priorities towards cerebrovascular disease. The timid, targetless commitment expressed in a UN declaration issued on Sept 19, 2011, caused general disappointment, particularly among the neurological health community. Hence, the crucial work of the World Brain Alliance must go on. A WFN task force has been created to coordinate efforts and identify common aims for the Alliance, and the Marrakesh congress is a valuable opportunity for this task force to involve the African brain health community.For half a century, the WFN held quadrennial conferences but, by 2007, the consensual view of its members was that biennial events would be preferable. The aim of this change is to encourage prompt dissemination of new knowledge in the neurosciences and to speed up the work of the research networks in the subspecialties. A shorter cycle is also expected to generate additional revenues that would allow the WFN to extend its work in parts of the world where improvements in neurological practice and research are urgently needed. The first biennial event took place in Bangkok, Thailand, in 2009; the second, in Marrakesh, has the theme “with Africa, and for Africa”. A special effort has been made to attract delegates from the continent and to dedicate the revenues generated by the congress to training and research projects in Africa. Expectations are justly high. For the neurological health community in the region, autumn 2011 should become a second, and peaceful, Arab spring. On Nov 12–17, 2011, the neurological community will gather in Marrakesh, Morocco, for the 20th World Congress of Neurology. As its first congress in Africa, the event is a historic occasion for the World Federation of Neurology (WFN), whose mission is “to foster quality neurology and brain health worldwide”. North Africa is in the midst of a momentous transformation, and the WFN must use this opportunity as a first move towards permanent engagement with society and neurologists in the region. A wave of civil resistance, known as the Arab spring, has led to the collapse of long-held dictatorial regimes, such as those ousted in Tunisia and Egypt. The world has watched with admiration as a popular revolution has ushered in radical political changes that should eventually lead to more open societies, in which citizens can express themselves freely and have improved access to basic requirements such as health care. The Congress is therefore timely. The WFN has put an emphasis on sub-Saharan Africa, and it must not waste this opportunity to also help neurologists in north Africa in fulfilling their aspirations to advance clinical practice and research. The transition from rural to urban populations in north Africa has accelerated over the past decade. Urbanisation has improved health-care access, but many health status indicators, such as maternal and infant mortality, still lag behind those in other emerging economies, and data on morbidity are inadequate. According to a recent study, neonatal mortality in the region ranges from 9·4 per 1000 births in Tunisia to 19·1 in Morocco. Under-5 mortality rates were estimated at 15·2 per 1000 children in Tunisia, 19·3 in Algeria, and 24·7 and 32·4 in Egypt and Morocco, respectively. Neonatal and perinatal morbidity rates, which are associated with long-term neurological sequelae, are also likely to be high in these populations. Morbidity data are urgently needed so that primary and secondary neuroprotective strategies can be implemented; the effects of therapeutic and neurorehabilitation strategies for these children should also be assessed. WFN member societies can contribute invaluable expertise to such initiatives. The socioeconomic transition that has brought about a wave of revolutions might also be linked to an enormous rise in non-communicable diseases (NCDs), including heart disease and stroke. According to WHO 2005 data, the top cause of mortality in Egypt was intracerebral haemorrhage, and cerebral infarction was also among the top ten causes of death. In Tunisia, heart and brain vascular diseases are the greatest cause of mortality and morbidity. By promoting the training of neurovascular specialists and the engagement of African health workers in international networks of stroke research, the WFN is well placed to make a lasting impact; it would be disappointing if it does not do so. The WFN has led an initiative to create the World Brain Alliance, an umbrella group of neurological organisations worldwide, including the World Stroke Organization, that aims to move neurological and psychiatric diseases up the agenda of global health policymakers. At a recent UN High-Level Meeting on NCDs in New York, USA, the Alliance argued that NCDs will not be tackled unless brain health becomes top of that agenda. The World Brain Alliance has planted a valuable seed in the global health ground, but unfortunately it was not enough to change UN priorities towards cerebrovascular disease. The timid, targetless commitment expressed in a UN declaration issued on Sept 19, 2011, caused general disappointment, particularly among the neurological health community. Hence, the crucial work of the World Brain Alliance must go on. A WFN task force has been created to coordinate efforts and identify common aims for the Alliance, and the Marrakesh congress is a valuable opportunity for this task force to involve the African brain health community. For half a century, the WFN held quadrennial conferences but, by 2007, the consensual view of its members was that biennial events would be preferable. The aim of this change is to encourage prompt dissemination of new knowledge in the neurosciences and to speed up the work of the research networks in the subspecialties. A shorter cycle is also expected to generate additional revenues that would allow the WFN to extend its work in parts of the world where improvements in neurological practice and research are urgently needed. The first biennial event took place in Bangkok, Thailand, in 2009; the second, in Marrakesh, has the theme “with Africa, and for Africa”. A special effort has been made to attract delegates from the continent and to dedicate the revenues generated by the congress to training and research projects in Africa. Expectations are justly high. For the neurological health community in the region, autumn 2011 should become a second, and peaceful, Arab spring.