Neurological services in Darfur: a deprived rural community in a tropical zone affected by ongoing armed conflict

Abstract

This report, compiled after a short visit to Darfur sponsored by the Association of British Neurologists, describes the status of healthcare in Nyala, the capital of southern Dafur. Four hospitals and 19 consultants supervise the care of over three million people.The most common neurological diseases in Darfur are infections of the central nervous system, characterised by meningitis during the dry seasons and cerebral malaria following the short rainy autumn. Trauma-related neurological disorders are common. Epilepsy, mostly symptomatic, is largely caused by untreated or poorly treated CNS infection, head injury and neonatal/childhood diseases. Epilepsy management is greatly hindered by the fact that the disease is considered to be a social stigma. Uncontrolled hypertension is the leading vascular risk factor, and stroke is frequently seen in younger patients who are not fully investigated. During his visit, the first author saw 46 patients in whom the most common neurological problem was infection and trauma-related epilepsy. The spectrum and presentation of neurological diseases was very different from the usual disease pattern seen by neurologists in the UK. Most components of a multidisciplinary team for neurological patients are lacking; no physical, occupational or speech and language therapy. The medical and neurology services in Nyala desperately need CT scanning to complement a reasonably equipped laboratory service. In addition, there is a need for local clinical guidelines to govern the practice of more junior staff and those working in disadvantaged health units.