title: Lumbar puncture refusal in sub-Saharan Africa: A call for further understanding and intervention.
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA. kthakur1@jhmi.edu.
authors.forename: Kiran T
authors.initials: KT
authors.lastname: Thakur
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Kondwelani
authors.initials: K
authors.lastname: Mateyo
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Lottie
authors.initials: L
authors.lastname: Hachaambwa
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Violet
authors.initials: V
authors.lastname: Kayamba
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Macpherson
authors.initials: M
authors.lastname: Mallewa
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Jane
authors.initials: J
authors.lastname: Mallewa
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Ernest O
authors.initials: EO
authors.lastname: Nwazor
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Tope
authors.initials: T
authors.lastname: Lawal
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Chindo B
authors.initials: CB
authors.lastname: Mallum
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Masharip
authors.initials: M
authors.lastname: Atadzhanov
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
authors.affiliation: From the Division of Neuroinfectious Diseases and Neuroimmunology, Department of Neurology (K.T.T.), Johns Hopkins Hospital, Baltimore, MD; the Department of Internal Medicine (K.M., L.H., V.K., M.A., O.K.S.), University of Zambia School of Medicine, Lusaka, Zambia; the Department of Internal Medicine (L.H.), University of Maryland School of Medicine, Baltimore, MD; the Department of Pediatrics and Child Health, College of Medicine (M.M.), and the Department of Internal Medicine (J.M.), Queen Elizabeth Central Hospital, Blantyre, Malawi; the Neurology Unit, Department of Internal Medicine (E.O.N.), Federal Medical Center Owerri, Imo State, Nigeria; the Neurology Unit (T.L.), Department of Internal Medicine, Lagos University Teaching Hospital, Lagos State, Nigeria; the Neurology Unit, Department of Internal Medicine (C.B.M.), Jos University Teaching Hospital, Jos, Plateau State, Nigeria; the Division of Infectious Diseases & International Medicine, Department of Medicine (D.R.B.), University of Minnesota, Minneapolis; Epilepsy Division, Department of Neurology (G.L.B.), University of Rochester, NY; the Chikankata Epilepsy Care Team (G.L.B.), Mazabuka, Zambia; and the Global Neurology Program, Division of Neuroimmunology, Center for Virology and Vaccine Research, Department of Neurology (O.K.S.), Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Omar K
authors.initials: OK
authors.lastname: Siddiqi
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D001294:Attitude to Health; D019538:Health Care Surveys; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D013129:Spinal Puncture / Q000523:psychology* / Q000706:statistics & numerical data*; D016312:Treatment Refusal / Q000523:psychology* / Q000706:statistics & numerical data*