ABSTRACT
Background: The number of people with multiple sclerosis (MS) globally has increased from 2.3 million in 2013 to 2.8 million in 2020. However, MS and other demyelinating diseases are reported to be very rare in sub-Saharan Africa. Objective(s): We aimed to describe demographic and clinical characteristics of the first cohort of patients with MS and neuromyelitis optica (NMO) from Zambia and one of the first such cohorts from the sub-Saharan African region. Method(s): Adults diagnosed with either MS, NMO, NMO spectrum disorder (NMOSD), or clinically isolated syndrome (CIS) at the neurology outpatient clinic at the University Teaching Hospital in Lusaka, Zambia, the only neurology clinic in the country, were eligible to participate. Participants were enrolled from October 2019 through February 2022 with significant interruptions due to Covid- 19. An MS-trained nurse administered structured questionnaires regarding sociodemographic characteristics, and each participant also underwent a comprehensive neurological history and examination by a neurologist. Finally, plasma 25-hydroxyvitamin D levels were obtained. For analysis, the cohort was dichotimized into a MS/CIS disease group and NMO/NMOSD disease group. Descriptive statistics of the cohort are presented and compared between both groups. Result(s): Amongst the 34 participants, mean age was 36 + 9 years, 65% (n=22) were female, 90% were Black-African, 10% were of Southeast Asian decent, 50% had MS/CIS, and 50% had NMO/NMOSD. The average age was 34 + 11 years in the MS/CIS group and 37 + 7 years in the NMO/NMOSD group (p=0.28). Females constituted 65% (n=11) of both disease groups. Median time to diagnosis was 242 days (interquartile range IQR: 91-974) and did not differ significantly between the groups. The majority (82%) of the NMO/NMOSD group presented with bilateral optic neuritis. Among the MS/CIS group, median EDSS was 4 (IQR: 2.25-4.25), median Disease Steps were 2 (IQR: 1-2), and 59% (n=10) had an abnormal gait at enrollment. Median 25-hydroxyvitamin D level was 29 (IQR: 24-46) ng/mL in the overall cohort but did not differ by disease group or supplementation status. Conclusion(s): In this sub-Saharan African cohort of adults with demyelinating diseases, MS and NMO were equally prevalent. Furthermore, delays in diagnosis resulted in high levels of disability in both groups. This demonstrates the need for more research and funding towards demyelinating diseases in sub-Saharan Africa.
ABSTRACT
Objective: Evaluate the feasibility of teleneurology visits in lieu of in-person visits for adults attending the University Teaching Hospital (UTH) Neurology Clinic in Lusaka, Zambia. Background: Telemedicine increased during the COVID19 pandemic as a safe and feasible alternative to in-person care, but this expansion was primarily limited to high-income countries. Suspension of outpatient clinics at UTH during COVID19 resulted in the urgent need for alternative methods of continuing neurology outpatient care. Design/Methods: Patients scheduled for neurology outpatient appointments in June and July 2020 and those with missed appointments between March and May were called and offered a televisit. If agreeable, neurologists conducted teleneurology visits over the phone, WhatsApp video or Zoom calls, based on patient accessibility. Neurologists then completed post-visit forms documenting visit outcomes. Descriptive statistics based on neurologists' evaluations are presented. Results: Of 300 patients, 186 (62%) were reachable by phone, with 38% unreachable due to incorrect or missing contact number or death. Among reachable patients, 81% agreed to a televisit. There was no significant difference in demographics or diagnoses between those who accepted or refused televisits. Most televisits (81%) were completed by telephone call, 12% WhatsApp video call and 7% Zoom call. Neurologists' self-rated confidence in their assessment was highest for Zoom calls, but still high for telephone and WhatsApp video calls. Televisit outcomes showed 46% of patients managed exclusively via televisit, 24% needed in-person follow-up visits With in a few weeks, and 30% were stable with no follow-up needs and were discharged from the clinic. Neurologists further recommended that 60% of patients seen could be seen by televisit at their next follow-up. Conclusions: Teleneurology visits are a feasible means of service provision for adults attending the UTH neurology clinic. They are a promising replacement to in-person visits even in a lowresourced setting when video-call support is absent.