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Letter
Motor neuron disease in sub-Saharan Africa: case series from a Tanzanian referral hospital
  1. Marieke Cornelia Johanna Dekker1,2,
  2. Sarah Japhet Urasa2,
  3. Marjolein Berendina Aerts2,
  4. William P Howlett2
  1. 1 Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
  2. 2 Department of Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
  1. Correspondence to Dr Marieke Cornelia Johanna Dekker, Department of Pediatrics and Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, United Republic of Tanzania; marieke{at}zwets.com

https://doi.org/10.1136/jnnp-2017-317858

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    Introduction

    Motor neuron disease (MND) is an overarching term for progressive conditions affecting anterior horn cells and the primary motor neurons. In a multiethnic population study (estimated incidence rate 144 per 100 000 person-years), there was a relatively lower age-adjusted risk for patients of African descent.1 For the sub-Saharan African region, most epidemiological studies on MND come from Western Africa.2 From the United Republic of Tanzania, no reports are available. The original predominance of infectious disease, a lower life expectancy, scarce healthcare facilities and a threshold to neurological care with one neurologist per 8–10 million inhabitants of the country3 contribute to this gap.

    Materials and methods

    The study was conducted in Kilimanjaro Christian Medical Centre, a tertiary referral hospital in Northern Tanzania. During two periods in which neurologists were present (1984–1992 with 1628 subjects and 2007–2015 with 2040 subjects), epidemiological data on consecutive neurological patients (age, sex, primary neurological diagnosis and disease category) were collected.3 Apart from the neuromuscular disease category which comprised MND, disease categories included stroke, infection, paraplegia, confusion/coma, space-occupying lesion and neurodegenerative disease. Medical ethical clearance was obtained and all patients provided written informed consent. On neurological examination by a neurologist (WH and/or MD), patients with MND with ALS phenotype were further classified by the original El Escorial (EE) criteria4 into ‘possible’, ‘probable’ and ‘definite’ ALS with cross-validation by the other neurologist and an independent third neurologist (MA).

    Clinical …

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    Footnotes

    • Contributors WH and MD planned and drafted the study. WH, MD and SU examined patients. MD submitted the study. MA is responsible for the cross-checking of categorisation.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval Medical Ethics Review Committee, Kilimanjaro Christian Medical University College/Kilimanjaro Christian Medical Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional unpublished data mainly concern Professor Howlett’s unpublished data that he is still working on.

    • Presented at This article was in part presented as a poster in the European Academy of Neurology meeting in Amsterdam (25 July 17).