article · American Journal of Tropical Medicine and Hygiene
A prospective study of 351 children over five years old and adults admitted to a rural hospital in the Democratic Republic of Congo mapped the clinical patterns, causes, and outcomes of neurological disorders without access to neuroimaging. Severe headache, walking disorders, seizures, and focal neurological deficits formed the primary clinical presentations. Central nervous system infections accounted for nearly eighteen percent of cases, dominated by bacterial meningitis, meningoencephalitis, human African trypanosomiasis, and HIV-related conditions, alongside a similar proportion of systemic infections with neurological symptoms. Non-communicable conditions were also frequent, led by epilepsy, psychiatric conditions, and cerebrovascular accidents. Hospitalised neurological disorders resulted in an overall fatality rate of over eight percent, rising to nearly twenty-four percent for central nervous system infections, with over a fifth of all surviving patients experiencing lasting sequelae.
Neurological conditions cause significant illness and death in rural Central Africa, yet epidemiological data remain scarce. Identifying the most common causes, ranging from treatable central nervous system infections to chronic non-communicable conditions like epilepsy, provides vital baseline clinical evidence. This helps health systems and medical practitioners allocate appropriate clinical resources, prioritise diagnostic tools, and address severe health burdens in rural hospital settings without neuroimaging facilities.
The abstract does not indicate an immediate application pathway, as it reports an observational clinical study. However, the documented burden of acute infections and non-communicable neurological disorders indicates a clear requirement for affordable, field-adapted diagnostic assays and point-of-care testing platforms for rural healthcare providers lacking neuroimaging facilities. Any commercial development responding to these clinical findings remains at an early discovery or concept stage.
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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.
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DOI: 10.4269/ajtmh.17-0375
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