Victor Tamba Tolno (Malawi)
Comunity of S. Egidio DREAM ProgramAuthor Of 2 Presentations
LINKING EUROPE AND SUB-SAHARAN AFRICA IN THE COVID-19 ERA. PARTNERSHIP AND TELENEUROLOGY
- Massimo Leone (Italy)
Abstract
Background and Aims:
Low patients’ retention summarizes difficulties of chronic care programs in sub-Saharan Africa (SSA): about 50% of the patients are lost to follow up few years after initiating treatments hampering epilepsy and stroke management. COVID-19 care disruption can increase epilepsy and stroke mortality particularly among HIV+ patients - as HIV increases epilepsy and stroke risks. Teleneurology can contribute to limit care disruption in SSA.
Methods:
Since 2008 Global Health Telemedicine (GHT) offers advices from European neurologists and education from remote to thousands of African health workers particularly of the Disease Relief through Excellent and Advanced Means (DREAM) health program. In 2019 the Italian Society of Neurology, the C.Besta Neurologic Institute and the Mariani Foundation joined the DREAM-GHT education program in basic neurology in Malawi and Central African Republic (CAR). The impact of the partnership can be measured by comparing 1. the one year-total number of teleconsultations and 2. patients’ retention before (2019) and during COVID (2020).
Results:
In Malawi the DREAM program follows 17280 patients (88% HIV+): the lost-to-follow up before and during COVID-19 were 1,3% and 1,04% respectively. The total number of GHT-teleconsultations with Africa dropped from 3095 in 2019 to 2047 in 2020, -33,9%. On the opposite teleneurology consultations in Malawi and CAR increased from 91 in 2019 to 141 in 2020, +54,9%; 72% were for epilepsy.
Conclusions:
Partnerships supporting teleneurology break COVID-19-provoked-isolation to improve local health providers work; this favours patients’ trust and retention. The combined effect can limit COVID-19 care disruption.
FACING EPILEPSY TREATMENT GAP IN SUB-SAHARAN AFRICA. EUROPEAN NEUROLOGISTS INCREASE EDUCATION AND TRAINING PROGRAMS
- Massimo Leone (Italy)
Abstract
Background and Aims:
About 10 millions epileptic patients live in sub-Saharan Africa (SSA), the treatment gap is more than 70%. HIV, highly prevalent in SSA is a risk factor for epilepsy and WHO indicated to unify epilepsy and HIV/AIDS treatment at HIV centres. The dramatic lack of neurologists in SSA imposes that many epileptic patients are seen by non-medical health-care providers (NMHCP), hence task-shifting is needed. To show the need of education in epilepsy and the short-term effects of local teaching courses to NMHCP in SSA-Malawi.
Methods:
The Disease Relief through Excellent and Advanced Means (DREAM) health program operates in Malawi since 2005 to prevent and treat HIV/AIDS and related conditions; there it follows 17,280 patients (88% HIV+). In 2021 two 2-full-days teaching courses on epilepsy have been offered by DREAM-volunteer neurologists to 40 NMHCP from both DREAM and governmental HIV/primary care from distinct areas. NMHCP were asked to answer some questions.
Results:
All NMHCP see epileptic patients in their daily practice. No one received education from neurologists; 90% were unsatisfied with their education on epilepsy. All NMHCP used phenobarbitone, out of stock was frequent; other antiepileptic drugs are difficult to get. 43.6% (pre-course) considered epilepsy a brain treatable disorder (100% post-course); 14.7% considered epilepsy more frequent in HIV+ and in children (94.6% post-course).
Conclusions:
Basic knowledge in epilepsy among NMHCP in SSA can be easily improved. Neurologists should increase education and training programs to NMHCP at primary care and HIV centres level to reduce epilepsy treatment gap in SSA.