title: Diagnostic work-up of neurological syndromes in a rural African setting: knowledge, attitudes and practices of health care providers.
abstract: BACKGROUND
  Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo.
  
  
  METHODS
  We used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti.
  
  
  RESULTS
  Care providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a "diviner" do not enhance any use of laboratory or other diagnostic methods.
  
  
  CONCLUSIONS
  Innovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.
authors.affiliation: Division de la Recherche, Programme National de Lutte contre la Trypanosomiase Humaine Africain, Kinshasa, DR Congo; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Alain
authors.initials: A
authors.lastname: Mpanya
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.affiliation: Sciences de la Santé, Université Pédagogique Nationale, Kinshasa, DR Congo.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Baloji
authors.affiliation: Département de Médecine Tropical, Université de Kinshasa, Kinshasa, DR Congo.
authors.forename: Junior
authors.initials: J
authors.lastname: Matangila
authors.affiliation: Département d'Anthropologie, Université de Kinshasa, Kinshasa, DR Congo.
authors.forename: Symphorien
authors.initials: S
authors.lastname: Lubanza
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bottieau
authors.affiliation: Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Chappuis
authors.affiliation: Département de Médecine Tropical, Université de Kinshasa, Kinshasa, DR Congo; Departement d'Epidémiologie, Institut Nationale de Recherche Biomédicale, Kinshasa, DR Congo.
authors.forename: Pascal
authors.initials: P
authors.lastname: Lutumba
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Hendrickx
mesh_terms: D001291:Attitude of Health Personnel; D003223:Congo; D017144:Focus Groups; D005843:Geography; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D012424:Rural Population; D013577:Syndrome