Availability of Therapies and Services for Parkinson's Disease in Africa: A Continent‐Wide Survey
Eman Hamid, Biniyam A. Ayele, Daniel Gams Massi, Samia Ben Sassi, Houyam Tibar, Emmanuel Epenge Djonga, Sarah El-Sadig, Wahiba Amer El Khedoud, Julien Razafimahefa, Ange-Éric Kouame-Assouan, Djibrilla Ben‐Adji, Yilédoma T. M. LENGANE, Abdu K Musubire, Muhyadin Hassan Mohamed, Tiwonge Elisa Phiri, Nsengiyumva Nestor, Wael Abdulgader Alwahchi, Saara Ndinelago Neshuku, Cassandra Ocampo, Foksouna Sakadi, Moulid Ali Maidal, Gift Ngwende, Juzor Hooker, Kigocha Okeng’o, Augustina Charway‐Felli, Masharip Atadzhanov, Jonathan Carr, Njideka Okubadejo, Ali Shalash
Abstract
BACKGROUND: The growing burden of Parkinson's disease (PD) in Africa necessitates the identification of available therapies and services to improve patient care. OBJECTIVE: To investigate the availability, affordability, frequency of usage, and insurance coverage of PD therapies (pharmacological, surgical, physical, and speech therapies) and services including specialized clinics, specialists, and nurses across Africa. METHODS: A comprehensive web-based survey was constructed and distributed to neurologists/physicians with a special interest in PD across Africa. The survey instrument includes components that address availability, affordability, frequency of use, and insurance coverage of different therapies and services. RESULTS: Responses were received from 28 (of 43 contacted) countries. Levodopa-based oral preparations were always available in 13 countries (46.4%) with variable affordability and "partial or no" insurance coverage in 60% of countries. Bromocriptine was the most available (50%) and affordable ergot dopamine agonists (DA), whereas non-ergot DA was always available in only six countries (21.4%). Trihexyphenidyl was the most available and affordable anticholinergic drug (46.4%). Tricyclic antidepressants and selective serotonin reuptake inhibitors were available in most countries (89.3% and 85.7% respectively), with variable affordability. Quetiapine and clozapine were less available. Specialized clinics and nurses were available in 25% and 7.1% of countries surveyed, respectively. Other services were largely unavailable in the countries surveyed. CONCLUSION: PD-specific therapies and services are largely unavailable and unaffordable in most African countries. The data provide a platform for organizing strategies to initiate or scale up existing services and drive policies aimed at improving access to care and tailoring education programs in Africa. © 2021 International Parkinson and Movement Disorder Society.