Academic Ageing Seminar - The diagnosis and treatment of patients with Parkinson’s disease in Tanzania
Location: Seminar Room, Wolfson Research Centre, Campus for Ageing and Vitality
Time/Date: 25th March 2010, 12:30 - 13:30
You are invited to attend the Academic Ageing Seminar on Thursday 25 March 2010 in the Wolfson Seminar Room, Institute for Ageing and Health. The seminar will take place at 12.30 pm with sandwiches available from 12 noon.
The speaker is Dr Catherine Dotchin, Academic Clinical Lecturer in Ageing Medicine, IAH, and the title of her talk is 'The diagnosis and treatment of patients with Parkinson’s disease in Tanzania'.
Abstract:
The prevalence of Parkinson’s disease (PD) in sub-Saharan Africa (SSA) was always thought to be less than the rest of the world. However, initial estimates were based on anecdotal evidence and two large community based studies of all neurological disease (Nigeria and Ethiopia) which only included 6 cases of PD in total.
We carried out a door-to-door, community-based prevalence study of PD in a rural population of 161,000 in Hai, northern Tanzania. We used a six question screening tool along with a census of the population in 2005. Those answering positively to the screening tool were examined, at home, by a Tanzanian PD nurse specialist and the research doctor. Cases were also identified through family history tracing, medical, physiotherapy and occupational therapy records searches, neurology outpatient clinic records and village elder reporting.
In total 33 cases of PD were found (fulfilling the UK PD Brain Bank criteria). This gave a crude prevalence rate of 20/100,000, after age-standardisation this was 40/100,000. This is higher than previously reported from SSA, but still significantly less than the developed world. Very few of our patients had been previously diagnosed and only 3 were on treatment. Patients reported significant stigma about the condition, which was further investigated by a Tanzanian anthropologist.
We have since instituted a physiotherapy intervention, speech and swallow assessments and started medical treatment with levodopa in April 2007. Patients have had a good response to treatment, even those who had had the disease for many years prior to the study. 2 years into treatment, and there are 19 surviving patients, half of whom have developed wearing off of medication, and so far only 2 have developed dyskinesias. We continue to follow these patients up on at least an annual basis, and are collecting verbal autopsy data for those who have died.
We hope to describe our intervention as a potential model for the diagnosis, treatment and follow up of PD patients that could be used in other developing countries. With the population ageing, even in developing countries, this is likely to become a much bigger issue worldwide. Using our prevalence rate from Tanzania, we estimate that there may be 1.8 million people with PD in developing countries who do not know they have it and who are not on the good symptomatic treatment that is available.
http://www.ncl.ac.uk/iah/staff/profile/catherine.dotchin
Published: 3rd February 2010
