title: The spectrum of neurological presentations in an outpatient clinic of rural Zimbabwe.
abstract: BACKGROUND
  Previous studies to estimate burden of neurological disorders in Africa are limited to inpatients in urban hospitals. The spectrum of neurological conditions in rural Africa remains unclear.
  
  
  OBJECTIVE
  To determine the spectrum of neurological presentations in an outpatient setting in rural Zimbabwe.
  
  
  METHODS
  Clinical data was collected from outpatient records at Karanda Mission Hospital, a rural community hospital in Northern Zimbabwe from February 2013 to February 2014. Each patient visit was entered in an outpatient record book by a registered nurse or a nurse trainee. Demographic details such as age, sex, weight and address of the patient, and clinical details such as diagnosis on discharge and medications prescribed were recorded in the record book following assessment by a physician or nurse practitioner. Each visit corresponded to a separate entry in the study.
  
  
  RESULTS
  We recorded a total of 19,206 visits in the outpatient registry. The average age was 46.41 years (standard deviation=21.46), and there were more visits from women (57.81%). 11.63% (2233) of all visits had a neurological diagnosis at discharge. The most common neurological diagnoses were epilepsy/seizures (24.38%), followed by neuropathies (13.63%), headaches (11.4%) and strokes (4.6%).
  
  
  CONCLUSIONS
  One in ten cases in an outpatient setting in rural Zimbabwe were neurologically related. Further studies are required to determine the public health burden of neurological disorders in rural Africa. The development and funding of educational initiatives in resource-limited areas is needed to improve neurological diagnosis and care.
authors.affiliation: Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Manav V
authors.initials: MV
authors.lastname: Vyas
authors.affiliation: Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Canada.
authors.forename: Jinghao Mary
authors.initials: JM
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; College of Health Sciences, The University of Zimbabwe, Harare, Zimbabwe; Karanda Mission Hospital, Mt. Darwin, Zimbabwe.
authors.forename: Paul
authors.initials: P
authors.lastname: Thistle
authors.affiliation: Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: Liesly.Lee@sunnybrook.ca.
authors.forename: Liesly
authors.initials: L
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications* / Q000453:epidemiology*; D010045:Outpatients; D012189:Retrospective Studies; D012424:Rural Population; D015030:Zimbabwe / Q000453:epidemiology
keywords: Africa; Epidemiology; General neurology; Global health; Zimbabwe