Neurologic services in sub-Saharan Africa: a case study among Zambian primary healthcare workers.
BACKGROUND
In many parts of the developing world, access to physician consultation and neurologic expertise is limited or nonexistent. We conducted a survey among non-physician, primary healthcare workers (PHCWs) to determine the neurological needs and services in rural Zambia.


METHODS
Semi-structured written questionnaire utilizing fill-in-the-blank, multiple-choice likert-scaled questions, and open-ended questions.


RESULTS
Seizures were reported as the most common neurologic disorder by 66% of the PHCWs. Only 1/3 of PHCWs reported feeling adequately trained to care for seizures and seizure disorders. PHCWs reported even less expertise for other neurologic conditions. Over 40% of PHCWs surveyed work in primary care clinics without a physician available for consultation. Their patients must travel a median of 50 km to access a physician and geographic barriers are a frequent problem. In addition to difficulty physically accessing care, PHCWs reported that financial barriers to physician referral are substantial. Expenses cited include additional user fees for physician-level care, transportation costs, and the cost of maintaining the patient and/or family at a site distant from the home village. Traditional beliefs, social stigma, and discriminatory healthcare policies associated with neurologic conditions were also noted to deter and defer care and care seeking.


CONCLUSIONS
PHCWs lack sufficient training and experience to care for the neurologic disorders in their patient populations, although such disorders are relatively common. Geographic, financial and cultural barriers substantially limit physician referrals. To assure at least a minimal quality of care for people with nervous system disorders in Zambia, PHCWs' neurologic education must be increased and barriers to physician referral decreased.
Department of Neurology, African Studies Center Faculty, Michigan State University, #138 Service Road, A217, East Lansing, MI 48824-1313, USA. gretche.birbeck@ht.msu.edu
Gretchen L
GL
Birbeck
Theodore
T
Munsat
D017954:Africa South of the Sahara / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D011320:Primary Health Care / Q000706:statistics & numerical data; D015024:Zambia / Q000453:epidemiology