The spectrum of neurological disorders in a Zambian tertiary care hospital

Objectives: To define the spectrum of inpatient and outpatient neurological illness in a Zambian tertiary care facility where HIV is endemic. Methods: A retrospective period prevalence study of patients seen by the consulting neurologist between 1/2/06-12/20/06 at the University of Zambia's University Teaching Hospital (UTH). Results: 443 inpatients and 368 outpatients were seen during this period. Overall, 160 (19.7%) patients underwent HIV testing: 125 (15.4%) HIV⁺ and 35 (4.3%) HIV^-. The other 651 (80.3%) patients were untested. The most common inpatient neurological diseases among HIV⁺ patients were infectious diseases 26 (38.8%), neuropathy/radiculopathy 10 (10.4%), cerebrovascular disease 6 (9.0%), and myelopathy 5 (7.5%). The most common inpatient neurological diseases in the general population were cerebrovascular disease 62 (16.5%), infectious diseases 47 (12.5%), neuropathy/radiculopathy 37 (9.8%), and seizures/epilepsy 27 (7.2%). In the outpatient population, the most common neurological illnesses in HIV⁺ patients were neuropathy/radiculopathy 18 (31.0%), cerebrovascular disease 8 (13.8%), dementia/neurodegenerative 8 (13.8%), and encephalopathy 7 (12.1%). Outpatients in the general population most commonly had headaches/cephalgias 60 (19.4%), movement disorders 47 (15.2%), neuropathy/radiculopathy 43 (13.8%), and seizures/epilepsy 39 (12.6%). Conclusions: HIV-infected individuals are a sizeable group among neurology patients in Zambia, and they are affected by a different disease spectrum than the general population. Infectious diseases make up the largest percentage of inpatient neurological illness. Non-infectious causes are responsible for the majority of outpatient neurological cases. Emphasis should be placed on treatment of both infectious and non-infectious neurological illnesses. The most common outpatient neurological conditions are symptomatically treatable with routinely available medications.