Clinical Profile of Parkinson's Disease: Experience of Niger.

BACKGROUND: Parkinson's disease (PD) is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. AIMS: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. PATIENTS AND METHODS: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger) over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. RESULTS: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48%) had secondary parkinsonism and 25 patients (1.47%) had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42-74 years). The male sex was predominant (60%) with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1-5 years). The tremor was the most common symptom (84%). Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32%) were in Stage I of the classification of Hoehn and Yahr, 16 patients (64%) in Stage II, and 1 patient (4%) in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%). The mean time of follow-up of the patients was 2.5 years (range: 1-4.42 years). During the course of the disease, 9 patients (36%) were in Stage II of the classification of Hoehn and Yahr, 13 patients (52%) in Stage III, and 3 patients (12%) in Stage IV. CONCLUSION: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1.47%). The demographic and clinical features of our patients are similar to those of the patients of the prior studies reported in sub-Saharan Africa.

A survey of the mental healthcare systems in five Francophone countries in West Africa: Bénin, Burkina Faso, Côte d'Ivoire, Niger and Togo.

Sub-Saharan Africa has a wide mental health treatment gap, with low levels of access to mental health services. This paper presents the findings of systematic situation analyses carried out in five Francophone countries in West Africa, which are among the poorest in the world. The findings showed low levels of budgetary allocation to mental health, poor health infrastructure (especially at primary level) and unequal distribution of human and financial resources. In this challenging context, there are signs of reform of services, based on international best-practice guidelines and practical considerations such as decentralisation of services, task-sharing and strengthening stakeholder skills to advocate for change.

Mental health services in the Republic of Niger.

The Republic of Niger is a large, landlocked west African country. Around 80% of its vast land mass (1 300 000 km2) is in the Sahara Desert. Its neighbours are Mali, Algeria, Libya and Chad to the north, and Nigeria, Benin and Burkina Faso to the south. The country came under French rule in the 1890s and gained its independence in 1960, but development has been slowed by political instability, lack of natural resources and drought. In 1999, voters overwhelmingly approved a new constitution, allowing for multi-party elections, which were held later that year. An ongoing rebellion in the north makes access to much of the country difficult.