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Partnering across countries to improve care for neurologic patients in Ethiopia

Disseminate knowledge to Ethiopian neurologists to create a sustainable research and health care infrastructure for the future.

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In 2011, the General Assembly of the United Nations acknowledged that “the global burden and threat of non-communicable diseases constitutes one of the major challenges for development in the 21st century.” Non-communicable diseases, also referred to as chronic disease, are long lasting, require medical management and typically cannot be entirely cured. According to the World Health Organization, these conditions are responsible for 31 million deaths in low- and middle-income countries.

 

The research project of James H. Bower, M.D., professor of Neurology at Mayo Clinic and director of Mayo Clinic Abroad, focuses on the burden of neurological disease in sub-Saharan Africa, where little is known about prevalence of these non-communicable diseases or their risk factors. The long-term goal of this research is to develop a sustainable research infrastructure on neurologic disease in Ethiopia so that Ethiopian physicians and scientists can identify the evolving burden of neurologic disorders, and reduce this burden through risk factor reduction and cost-effective treatment.

 

To reach this long-term objective, Dr. Bower and his Ethiopian colleagues will begin by studying the prevalence of neurologic disorders in Addis Ababa, Ethiopia. We believe urban sites in Ethiopia have unique risk factors increasing prevalence of diseases, including stroke, which is one of the most common types of non-communicable diseases.

 

The contribution from this project will be significant because it acts as a critical first step in allowing Ethiopian scientists to address the unique neurologic public health issues across their country, and predict evolving neurologic burden as their country develops.

Explain your idea

Non-communicable diseases, including mental and neurological disorders, are the No. 1 cause of death and disability worldwide. Africa is experiencing an emerging epidemic of non-communicable diseases that may be due to urbanization. However, the data on the actual prevalence of neurologic disease in sub-Saharan Africa is weak – very little is actually known. Although the Global Burden of Disease Study 2010 documented that neurological disorders make up only three percent of the burden of disease in eastern sub-Saharan Africa (Murray, 2012), hospital reports from the region estimate that 18 to 25 percent of medical admissions are patients with neurologic conditions. Unfortunately, the reason for this discrepancy is unclear. To bridge this dangerously growing gap in knowledge, there is an urgent need to understand the true prevalence of neurologic disability and its major risk factors in sub-Saharan Africa. Our long-term goal is to develop a sustainable research infrastructure in Ethiopia that can identify the evolving burden of neurologic disorders, and reduce this burden through risk factor reduction and cost-effective treatment. We will begin by partnering with Ethiopian physicians and scientists to determine the prevalence of all neurological diseases in Addis Ababa, the capital of Ethiopia, and documenting the pervasiveness of recognized risk factors associated with the two most common neurologic disorders, epilepsy and stroke. Since urbanization is believed to be one cause for the expected increase in non-communicable diseases, we are interested in studying Ethiopia’s capital. The estimated annual growth of Addis Ababa is about four percent, one of the highest rates in the world. We will test this concept through the following aims: 1. Determine the prevalence of neurologic disability in adults in Addis Ababa. Based on our preliminary work and the work of others, we believe there will be a higher prevalence of stroke than epilepsy. 2. Measure the prevalence of recognized risk factors for stroke in Addis Ababa. We expect that smoking, obesity and hyperglycemia will be the most common factors. 3. Quantify the prevalence of recognized risk factors for epilepsy in Addis Ababa. We predict that common risk factors for epilepsy in sub-Saharan Africa, such as cerebral malaria, perinatal injury and pig exposure, will be low in the urban setting. These would suggest a decreasing incidence of epilepsy in the future. This work will propel us one step closer to understanding the burden of disease placed on this population. We will finally identify the prevalence of risk factors for debilitating conditions like stroke and epilepsy, which will lead to better interventions and treatment options. Finally, through a unique collaboration with Addis Ababa University School of Medicine, we will establish the infrastructure necessary for Ethiopian scientists to perform future analytic epidemiologic studies.

Who Benefits?

Ultimately, the people of Ethiopia will benefit. Studies have shown that the care available for people suffering from neurologic disease in sub-Saharan Africa is dismal. In the U.S., there is approximately one neurologist for every 24,000 people. In 23 nations of Africa, there is one neurologist for every 5,099,908 people. For 12 nations in Africa, there are not any neurologists at all (Bower and Zebene, 2005). Clearly, the care in Africa must improve. However, the model of Westerners traveling to Africa to provide care is inadequate and unsustainable. This study will document the actual prevalence of neurologic burden in Addis Ababa. More importantly, its design will train Ethiopian scientists to perform ongoing work independently. The purpose of the program is to train local Ethiopian physicians to measure ongoing changes in disease distribution as their country develops and urbanization increases.

How is your idea unique?

This will be the first prevalence study of neurological disease in sub-Saharan Africa conducted in a quarter century and will help to: • Supply data for a model predicting future disease burden with ongoing urbanization. • Provide evidence that the oncoming “non-communicable disease epidemic” hypothesis is supported. Dr. Bower and his colleagues in Ethiopia are uniquely qualified to perform this study. Since 2001, Dr. Bower has made annual visits to Ethiopia to teach neurology. When he first went to Ethiopia, there were only two neurologists in the entire country of 70 million people. In 2006, he helped these two neurologists begin a neurology residency program in Addis Ababa. Because of this program there are now 21 neurologists in the country. This program has also trained neurologists from Rwanda and Somalia. Dr. Bower, his team and collaborators are building bridges between countries, teaching independence and creating an infrastructure that supports autonomy.

Idea Proposal Stage

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

Tell us more about you

Mayo Clinic developed gradually from the medical practice of a pioneer doctor, Dr. William Worrall Mayo, who settled in Rochester, Minnesota, in 1863. His dedication to medicine became a family tradition when his sons, Drs. William James Mayo and Charles Horace Mayo, joined his practice in 1883 and 1888, respectively. As the demand for their services increased, they asked other doctors and basic science researchers to join them in the world's first private integrated group practice. Patients discovered the advantages to a pooled resource of knowledge and skills among doctors. In fact, the group practice concept that the Mayo family originated has influenced the structure of medical practice throughout the world. “The Mayos' Clinic" also developed a reputation for excellence in individual patient care. Doctors and students came from around the world to learn new techniques from the Mayo doctors, and patients came from around the world for diagnosis and treatment. What attracted them was not only technologically advanced medicine, but the caring attitude of the doctors. That teamwork in medicine is carried out today by more than 60,000 doctors, nurses, scientists, students and allied health staff at Mayo Clinic locations in the Midwest, Arizona and Florida. Mayo Clinic's reputation for excellence in integrated patient care, research and education is substantiated by the numerous external grants we are honored to receive. Even so, the need for additional financial resources to support the Mayo mission is great. As a private, not-for-profit organization, philanthropic gifts are a vital resource for enabling Mayo to advance its daily work. This research project will be led by James H. Bower, M.D., in collaboration with Seid Gugssa, M.D. Dr. Bower holds academic rank as professor of neurology, Mayo Clinic College of Medicine and Science. He serves as medical director for Mayo Clinic Abroad and chair of the Division of Movement Disorders, Department of Neurology at Mayo Clinic in Rochester, Minnesota. Dr. Seid earned his M.D. from Jimma University School of Medicine in Ethiopia, and was one of the six original graduates of the Ethiopian neurology residency program. He now chairs the growing Department of Neurology at Addis Ababa University School of Medicine. Drs. Bower and Seid have been colleagues for over 10 years. Initially, Dr. Bower acted as Dr. Seid's teacher when he was a medical and neurology resident, and later became colleagues when they pilot tested the epidemiologic survey methodology in Butajira, Ethiopia. Now, they coordinate the annual visits to Ethiopia of Mayo neurologists. Together, they will bridge the gap between nations to find the solution to this global problem. Inspired by the proverb “Give a man a fish and you feed him for a day. Teach a man to fish, and you feed him for a lifetime,” the duo will disseminate existing knowledge to other neurologists to create a sustainable infrastructure for the future.

Expertise in sector

  • 7+ years

Organization Filing Status

  • Yes, we are a registered non-profit.

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