Child neurology in resource-poor countries the role of the ICNA

The International Child Neurology Association was founded in 1973 to improve the care of children with neurological disorders worldwide, promote training in child neurology, and support research and international cooperation.

It is estimated that 70% of children with disabilities live in resource-poor countries¹ and most of these children have neurological impairments. The prevalence of common neurological conditions such as epilepsy is higher in resource-poor countries than the West.² Furthermore, the burden of acute neurological conditions such as seizures in these countries is also considerably higher than in the West. For example, neurological features occur in 20% of children admitted to a Kenyan district general hospital.³ Yet despite this significant burden, there are few personnel or facilities available for the management of neurological conditions in these parts of the world.

There is a considerable lack of medical personnel in many resource-poor countries. For example, there are less than 10 doctors per 100 000 people in many African countries, compared with 230/100 000 in the UK.⁴ There are few doctors with any neurological training. Thus, in many countries in Africa, there are no child neurologists. In those countries that have child neurologists, these doctors have not been able to obtain proper training, but often rely on a 6-month period in a Western centre on which they are expected to base their clinical expertise. These periods often provide experience that is not relevant to their home countries. Furthermore, these attachments have become even more problematic in Europe with the restrictions on employment of doctors from outside this region. But many doctors and other health care personnel without specialist training are interested in child neurology, and are keen to learn more, improve their expertise, and set up services for children with neurological conditions and neurodisabilities. So what can be done?

The training opportunities in resource-poor countries are limited, but are improving. Many of these countries have national societies of child neurology and/or developmental medicine, which organise local symposia for continuing medical education. The number of regional societies is also increasing, and these societies are often able to host larger meetings and attract more international speakers and medical practitioners interested in child neurology.

One of the remits of the International Child Neurology Association is to provide educational seminars throughout the world. These seminars are organised in collaboration with local medical societies, and draw upon the expertise of its members to provide lectures, case discussions and in some instances workshops. Furthermore, International Child Neurology Association supports a website (http://www.icnapedia.org/) that provides web-based access to appropriate papers and management protocols. On the website there is access to training programmes throughout the world. These initiatives are being taken up by doctors in resource-poor countries, helping the development of child neurology in these regions.

The International Child Neurology Association's ability to meet its goals comes through expanded membership (http://www.icnapedia.org/icna/membership/membership_of_the_icna_2007040111/). It represents a tangible mechanism by which Western paediatric neurologists can support child neurology in resource-poor countries. Furthermore, members can contribute to the Help Every Region Organize fund that supports members from countries where incomes are lower. But, there are also other benefits of membership. Each member receives a copy of the International Review of Child Neurology series for each year of membership. Books on Neurodisability, Stroke and Leucodystrophies are about to be published. Finally members obtain discount congress fees for the International Child Neurology Association international conferences on child neurology. These are held every 4 years, with the next one in Cairo in 2010 (http://www.icnc2010.com/), after which the conferences will be held every second year.

Thus, there are many ways in which International Child Neurology Association supports the development of Child Neurology in under resourced countries, but more support for International Child Neurology Association is required from, paediatric neurologists from Western countries.

CHARLES RJC NEWTON
Professor of Tropical Neurosciences and Paediatrics, Kenya Medical Research Institute, Kilifi, Kenya;
Neuroscience Unit, Institute of Child Health, University College London, London, UK


References

1. Helander E. Prejudice and dignity: an introduction to community based rehabilitation. New York: United Nations Development Programme, 1993.
2. World Health Organization. The World Health Report: 2001: Mental health: new understanding, new hope. Geneva: World Health Organization, 2001.
3. Idro R, Ndiritu M, Ogutu B, et al. Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children. JAMA 2007; 297: 223240. Links
4. United Nations Development Programme. Human Development Report 2007/2008. New York: Palgrave Macmillian, 2007.
This article appears as an Editorial in Developmental Medicine & Child Neurology Volume 51, Issue 7

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