Kim, Curi

School of Public Health

MSPH

Zambia

Epidemiology of Neurologic Disease in Zambia

Neurologic disorders were the leading cause of disability-adjusted life-years and the second leading cause of death worldwide in 2015. While these disorders disproportionately affect low and middle income countries, detailed epidemiology of neurologic disease in these countries is relatively unknown, particularly in sub-Saharan Africa where most countries have few or no neurologists. For example, recent meta-analyses concluded that little is known about the burden of non-compressive myelopathies and neuro-syphilis in Africa, although neither of these disorders are uncommon. Furthermore, systems of care for common neurologic disorders, including stroke, have not been well studied in sub-Saharan Africa despite the growing burden of these disorders in this region.

Zambia is a low-income country in southern Africa. We recently started the first adult neurology inpatient service in Zambia at the University Teaching Hospital (UTH), which is the national referral hospital. The inpatient service is currently staffed full-time by US- and European-trained neurologists who serve as teaching faculty for post-graduate Zambian neurology trainees, and we average 40-60 patients on the service at any time. We are developing an inpatient registry of all patients on the neurology service at UTH and their inpatient, 30-day and 90-day functional outcomes and mortality rates. This information can then be used to improve inpatient and post-discharge systems of care, standardize diagnostic and treatment algorithms for common neurologic disorders, and provide preliminary data for subsequent grants in a variety of neurologic diseases.

Aims
1.) Describe the epidemiology of inpatient neurologic disease at the University Teaching Hospital in Zambia
2.) Determine inpatient, 30-day and 90-day post-discharge morbidity and mortality associated with neurologic disease in Zambia
3.) Determine demographic and clinical risk factors for mortality and poor functional outcome during inpatient hospitalization and at 30 days and 90 days post-discharge in patients with neurologic disorders in Zambia
 

PI Mentor: Deanna Saylor

Over the five months of my GHEFP, I lived in Lusaka, Zambia and conducted a study examining the prevalence of headaches among individuals living with HIV. I worked at the Adult Infectious Disease Clinic (AIDC) of the University Teaching Hospital, the main referral hospital of Zambia. Unfortunately, it took a few weeks for the IRB to be approved for the study. In the meantime, I familiarized myself with the hospital and its patient care system, talked to patients to understand their problems, and met with clinical staff members I would be interacting with over the next few months. This delay was expected since the previous students in my program had mentioned that it is important to be flexible with my schedule.

            When the study was finally approved, I worked daily, conducting surveys, interviewing patients, entering and analyzing data using the skills I have learned in biostatistics just a few months prior. Since I was in charge of my project, I had a lot of freedom to conduct the study and utilize my creativity. One of my main challenges was communicating with the patients. Despite English being the official language, most patients were more comfortable conversing in the two local languages- Nyanja and Bemba. The staff members at AIDC were wonderful and offered to translate when I needed their help despite their busy schedules. I have been incredibly grateful for that. Over the five months I lived in Zambia, many of them became close friends, showing me the local hang-out places after work, bringing me homemade food and local snacks to try, and teaching me about the history and culture of Zambia. I even picked up some Nyanja and Bemba (which led to a friendly debate over which language would be more useful/easy for me to learn). 

  While AIDC arguably provides the best medical care in Zambia, it is not without problems. Many of the patients come from surrounding towns and villages outside Lusaka. A typical patient might have to leave home in the early hours of the morning and take several buses for hours just to get to the hospital. When I asked my colleague why patients refused to go to the local clinic, she told me that many patients try to hide their HIV status from their friends and family, a challenge in small communities. Going to AIDC is an all-day event for which patients miss work, or alternatively, miss their appointments. In addition, lab testing is not routine, meaning that a lot of patients have outdated clinical results. And, patient information, all documented by hand and stored in a file, occasionally goes missing. 

            Despite the challenges, my time in Zambia was truly an amazing experience. Running my own project and using the skills I learned at Hopkins not only helped with my professional development but also taught me to adapt to a new country and way of life. At the time, Zambia was going through extreme drought. The country relies exclusively on hydropower for energy, so there was not only limited water but also electricity. In my final months, power was limited to 6-8 hours a day and would sometimes be unavailable over several days. With Zambia approaching scorching hot summer, these were challenging conditions, but I learned to cope -- storing buckets of water, taking showers at 2 am when power was back on, and eating food that did not require refrigeration. Zambia had its challenges, but I have come to love the people, and along the way found my passion for global health research. 

 

 

 

 

Me trying to eat a sugarcane. My colleagues at AIDC often brought Zambia food/snacks to work for me to try. Here’s me trying to crack open a sugarcane with my teeth as they taught me but it was harder than I thought!

 

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University Teaching Hospital. The facilities were outdated but were not as bad as I expected. The weather was always sunny like this until the rainy season came along. 

This friend is a nurse at AIDC who I’ve come to be friends with over time. She helped me translate when I was having communication problems with patients, and we also shared many lunches together. 

My main mode of transportation. I took the minibus to and from the hospital every day for only 5 kwachas (~35 cents) each. These buses are second-hand Toyota Hiaces with broken seats and no seatbelt, and drivers often ignore the traffic rules, but it got me to where I needed to be. Over time, I became close with the conductors who ran these buses, so I was able to learn more about the system.

Bottom of Victoria Falls. I took a bus down to Victoria Falls from Lusaka one weekend (~7 hours long) to meet up with some friends from Hopkins. We did an excursion which involved 

People

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...
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June 2020

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