Changing Epidemiology of Neurological Diseases in Africa

The epidemiology of neurological disorders is rapidly changing in Africa due to the important increase in life expectancy as well as population growth. This pattern is similar to what is occurring in all low- and medium-income countries (LMICs) across the globe.Population in Africa is expected to nearly double from 1.34 million in 2020 to 2.49 million in 2050. The estimated life expectancy among Africans is increasing within a wide range from the lowest in Chad with 53.7 years to the highest in Algeria with 77.3 in 2023 [1].This is due to the declining mortality. The top drivers of mortality are neonatal conditions, lower respiratory infections, and diarrheal diseases.HIV is still the fourth condition causing 5.6% of all deaths. The first chronic diseases are ischemic heart disease and stroke in the fifth and sixth position in ranking causing 5.5% of all deaths [2].In tandem with these changes, the fertility rate is declining going from 5.23 children born per woman in 2011 to 4.6 in 2021 (12% in 10 years). All these phenomena determine the epidemiological and health transition with increasing prevalence and incidence of several chronic diseases, including chronic conditions of the central nervous system (CNS) and peripheral nervous systems.There appear to be three main features of epidemiology in Africa [3] vis-a-vis demographic, epidemiological, and health transitions. These are most relevant to population health patterns in Africa [4]: (1) the emergent epidemic of chronic diseases, mental and brain disorders, and traumatic injuries; (2) the still important HIV epidemic with a sustained prevalence of tuberculosis; tuberculosis is ranked 8th cause of deaths with 4.9% of all deaths; and (3) the presence of a large number of communicable diseases with the three first positions in the mortality ranking.Stroke, epilepsy, and dementia constitute a substantial part of the increasing burden of neurological diseases in Africa. Focusing on the global epidemiological transition, the burden of chronic neurological disorders is much heavier in LMICs than in high-income countries (HICs) [5]. Eighty percent of the burden of mortality and DALys for stroke is in LMICs [6]. The incidence of stroke in Africa is particularly high with 106/1,000 person-years [7], while the 30-day mortality after stroke is 24.5%, higher in females than males. A similar report outlined regional differences in Africa of case-fatality rate [8].Epilepsy also is common in people living in LMICs, determining 80% of cases worldwide, mainly due to determinants that are clearly preventable, such as brain trauma after traffic injuries, infections like echinococcosis and peri- and post-natal injury [9]. Thus, the burden of epilepsy is particularly linked to secondary epilepsy compared to a primary cause, but the appropriate use of antiepileptic drugs significantly reduces the burden [10, 11].According to recent estimates of the global burden of diseases, the number of dementia cases in Central and sub-Saharan Africa is projected to increase from 228,000 cases in 1990 to 986,000 in 2050, a phenomenal increase to 330% [12].In Africa, dementia prevalence varies from 2 to 20% in the elderly population while incidence is about 15/1,000 person-year. Among different etiological subtypes, beyond the well-known Alzheimer’s and vascular dementia, HIV-related dementia has a specific role in the burden of dementia in African countries [13].The burden of infectious diseases affecting the CNS remains a significant public health challenge in Africa, contributing substantially to morbidity and mortality across the continent. Despite advances in healthcare and disease prevention, infectious diseases such as meningitis, cerebral malaria, and neurocysticercosis persist, exacerbating the overall burden of neurological disorders [14, 15]. These conditions not only reflect the ongoing struggle against infectious diseases in Africa but also underscore the critical need for enhanced surveillance, improved diagnostic capabilities, and more effective treatment protocols. The persistence of these infections highlights the intersection of infectious and non-communicable diseases within the epidemiological profile of neurological disorders in the region [16], necessitating a comprehensive approach to healthcare that addresses both the direct and indirect impacts of infectious diseases on the CNS.The epidemiology of neurological diseases in Africa exhibits pronounced regional differences, with variations in disease frequency and burden often evident between Francophone and Anglophone countries. The third area, the Portuguese-speaking countries (six according to WHO) is characterized by the very low number of neurologists and no evidence of research in the area of epidemiology of neurological diseases. The important disparities across different areas are attributable to a variety of factors, including differences in healthcare systems, disease surveillance and reporting practices, and public health interventions. For instance, stroke prevalence and mortality rates may differ significantly between regions, influenced by variations in risk factor profiles, such as hypertension, diabetes, lipids, and lifestyle factors [17]. Similarly, the incidence of epilepsy and dementia shows regional variability, reflecting not only genetic and environmental factors but also the availability and accessibility of healthcare services. Therefore, the contrast between Francophone and Anglophone countries in Africa, based on available and published data, also provides valuable insights into the complexities of neurological disease epidemiology in the continent, emphasizing the importance of localized research and tailored public health strategies to effectively address the unique challenges faced by each region.The authors have no conflicts of interest to declare.This study was not supported by any sponsor or funder.G.L., K.R., and P.M.P. contributed equally to the conception and writing of this editorial.