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1 Background
1 Background
Pages 5-20
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From page 5... ...
MNS also factors into sexual and reproductive health in, for example, postpartum depression or injuries from violence or traffic accidents. Furthermore, depression and substance use disorders adversely affect adherence to treatment for other diseases, often exacerbated by poverty and the presence of endemic infectious diseases.
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From page 6... ...
THE MNS DISEASE BURDEN "Disease burden" is a term used to convey how prevalent various diseases are. Donald Silberberg, professor at the Department of Neurology at the University of Pennsylvania School of Medicine, put it plainly, "The burden of disease can be viewed as the gap between current health status and an ideal situation in which everyone lives into old age free of disease and disability.
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From page 7... ...
The result is a systemic underreporting of the true disease burden created by these disorders. Vikram Patel from the University of London highlighted data from the WHO's 2006 Global Burden of Disease report, which shows that nearly 10 percent of the total disease burden in the world's lowest income countries is attributable to neurological and psychiatric disorders (Global burden of disease and risk factors, 2006)
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From page 8... ...
MNS Disorders in Sub-Saharan Africa While many MNS disorders are common throughout the world, their relative impact on each region varies. Silberberg noted that with respect to MNS disorders, "The leading problems that are more common in subSaharan Africa are birth defects affecting the brain and spinal cord; mental retardation; cerebral palsy; bacterial, viral, and parasitic infections of the nervous system; epilepsy; and head and spinal cord trauma, mostly from road traffic accidents." Although the number of comprehensive epidemiology studies is limited, it is widely accepted in the provider
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From page 9... ...
Not only are there common mental health disorders that are due to, or associated, with these diseases, such as depression and substance use, but there are also many neurological disorders that can arise as direct complications from opportunistic infections (UNAIDS, 2007)
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From page 10... ...
Although most experts agree that mental disorders represent a substantial portion of the world's disease burden, these disorders remain highly neglected and stigmatized, making prevalence data difficult to obtain and interpret (Horton, 2007)
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From page 11... ...
SOURCE: WHO, 2006c. The Disease Burden of Epilepsy Throughout the workshop, participants stressed that although substantial prevalence data are not available, epilepsy is one of the most common MNS problems in SSA.
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From page 12... ...
Although a number of factors can account for the reported high rates of epilepsy in SSA, common causes of epilepsy are likely to include infectious diseases, trauma, alcohol consumption, and birth asphyxia resulting from poor maternal health care -- all of which are known to be high in parts of SSA. In addition, due to poor living conditions characterized by overcrowding, poor water supply, and bad sanitation, there is a high prevalence of communicable diseases such as malaria, meningitis, cysticercosis, and tuberculosis, which are also frequent causes of epilepsy.
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From page 13... ...
One common guideline recommends initiating therapy if a patent's CD4 white blood cell count falls below 200 (WHO, 2006a)
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From page 14... ...
Patrick Kelley, director of the Board on Global Health at the IOM, noted, "We have about 4 million people under antiretroviral therapy, yet there are approximately 30 million infected people and 2 to 3 million new infections in Africa each year." At the same time, MNS disorders will likely grow as well. "We know scientifically, at the molecular level, that HIV affects brain cells much earlier than we anticipated in the past," noted Elly Katabira, associate professor at Makerere University School of Medicine.
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From page 15... ...
Although most complications are transient and resolve within 6 months, about 10 to 24 percent of people who survive cerebral malaria go on to have neurological and cognitive sequelae -- impaired vision, impaired hearing, impaired speech, recurrent seizures, gait disturbances, and various degrees of paralysis, noted Daniel Kyabayinze, clinical epidemiologist and research officer at Malaria Consortium Africa. However, Silberberg reported data that suggest an even greater impact on children, noting that between 50 and 75 percent of children with cerebral malaria survive, but not without consequences.
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From page 16... ...
Sub-Saharan countries with endemic malaria have an added risk for MNS disorders because the disorder may stem from delayed treatment for what appears to be just malaria. However, with improved focus on malaria prevention and awareness among healthcare providers about associated MNS complications, the portion of the burden of MNS disease arising from malaria could potentially decline.
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From page 17... ...
STIGMA AND HUMAN RIGHTS The Stigma Problem: Breaking the Silence Throughout Europe and the United States, MNS disorders such as substance use, seizure disorders, and psychological conditions carry social stigmas. SSA is no different, and MNS sufferers face substantial stigma within their communities (Baskind and Birbeck, 2005; Satcher, 1999)
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From page 18... ...
"When they see a person with an epilepsy fit, their natural instincts tend to come on first, and these may actually deter the patients from actually seeking professional health services." Workshop participants discussed the need to end the silence about MNS disorders, noting the importance of education -- educating the communities and health workers in each local village that these MNS disorders are treatable medical conditions that should be devoid of shame and fear of, or for, the victim. Through the collection of data, instituting education, advocacy, and healthcare policies that include MNS disorders can be tools to end the silence and treat the suffering.
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From page 19... ...
Two models were discussed that could serve as ways the provider community could improve care and reduce stigma and mistreatment of individuals with MNS disorders. The South African Treatment Action Campaign (TAC)
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