Abstract
The characteristics of neurological, psychiatric, developmental and substance-use disorders in low- and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low- and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.
Highlights
The characteristics of neurological, psychiatric, developmental and substance-use disorders in low- and middle-income countries are unique and the burden that they have will be different from country to country
disability adjusted life years (DALYs) for a disease or health condition are calculated as the sum of the years of life lost (YLL) due to premature mortality in the population and the years lost due to disability (YLD) for people living with the health condition or its consequences
There is some commonality in the prevalence of certain brain disorders (Fig. 1), significant diversity exists with respect to the origin, manifestation and treatment strategies or options adopted across these regions. In this Review, we focus on sub-Saharan Africa, the Middle East and North Africa, Asia, South and Southeast Asia and Latin America[4,5]
Summary
Vijayalakshmi Ravindranath[1], Hoang-Minh Dang[2], Rodolfo G. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. There is some commonality in the prevalence of certain brain disorders (Fig. 1), significant diversity exists with respect to the origin, manifestation and treatment strategies or options adopted across these regions In this Review, we focus on sub-Saharan Africa, the Middle East and North Africa, Asia, South and Southeast Asia and Latin America[4,5]. Subtle changes in white-matter integrity have been used for early diagnosis and monitoring progression of neurological disease in individuals with HIV26
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