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EDITORIAL
Year : 2018  |  Volume : 21  |  Issue : 4  |  Page : 237-238
 

Relevance of neuroepidemiology: Burden of neurological disorders and public health issues


Emeritus Professor of Neurology, Institute of Human Behaviour and Allied Sciences, Senior Consultant Neurologist and Chairperson, Department of Neurophysiology, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication2-Nov-2018

Correspondence Address:
Prof. M Gourie-Devi
Emeritus Professor of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_428_18

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How to cite this article:
Gourie-Devi M. Relevance of neuroepidemiology: Burden of neurological disorders and public health issues. Ann Indian Acad Neurol 2018;21:237-8

How to cite this URL:
Gourie-Devi M. Relevance of neuroepidemiology: Burden of neurological disorders and public health issues. Ann Indian Acad Neurol [serial online] 2018 [cited 2018 Dec 13];21:237-8. Available from: http://www.annalsofian.org/text.asp?2018/21/4/237/244869




India is going through a rapid phase of epidemiological transition with increase in noncommunicable diseases (NCDs), and neurological disorders form a significant proportion of NCDs.[1],[2] There is a striking variation of various health parameters and magnitude of epidemiological transition between different states and regions in India.[1] Determination of burden of neurological disorders is the cornerstone for planning workforce requirement, creating infrastructural facilities and health needs at the local community, regional, and national level to the people affected by a variety of neurological disorders. The emerging data will be crucial for initiating neurology-related health services and for creating a competent workforce required for comprehensive management of acute and chronic neurological disorders and also rehabilitation in motor, sensory, and cognitive spheres.

The prevalence of neurological disorders is a measure of the burden while incidence study will provide the magnitude of the number of new cases in a year and will also generate important data regarding morbidity, mortality, and trend of the diseases over the period of the study. Identification of risk factors and galvanizing program for disease prevention is an important outcome of epidemiological studies. In the developed countries, neuroepidemiological studies have been done for more than 50 years; however, in India as in other developing countries, confronted with grossly limited trained workforce in neurology and scant resources, this field did not develop till the late 1960s.[3],[4],[5],[6],[7],[8],[9],[10] To overcome these constraints, novel two-phase strategy was developed; in the first-phase training of health workers or social workers to administer a validated questionnaire developed by the World Health Organization to screen the population and in the second-phase neurologist to examine the screened positive subjects and make a clinical diagnosis.[3],[11] This approach was effectively used in Nigeria, Mexico, and China[3] In the Indian context, the WHO questionnaire was modified and effectively used for population-based neuroepidemiological study of urban and rural population in Bengaluru.[12],[13] Recognizing that case ascertainment and definition of common neurological disorders is of prime importance, a manual was developed by Gourie-Devi et al. which has been widely used by neurologists in India.[14] The questionnaire developed by these authors has also been adapted with modifications to suit the local conditions in neuroepidemiological surveys in the country.[15],[16],[17]

The average crude prevalence rate of common neurological disorders in India is 2394 and ranged from 967 to 4070/100000 population with higher prevalence rate in rural compared to urban population.[2] It is emphatically stated that there are nations within a nation in India;[1],[18] hence, it is timely that recently, a survey has been conducted in tribal region in Gujarat overcoming many unsurmountable challenges of accessibility, poor health-care facilities, inadequate awareness of the community, and the latter being an essential requisite for survey.[17] Determination of sensitivity and specificity of the questionnaire was not possible due to a large dropout of subjects at second phase which required examination by neurologists. The authors have stated that all attempts were made to ensure good attendance but the local prevailing circumstances were the deterring factors. Despite the limitations it is noteworthy that the prevalence rate of neurological disorders of 2592/100000 in the tribal population was similar to that of general population (967 to 4070 per 100000) of India, as also the prevalence rates of epilepsy (tribal population -2.5/1000; general population 2.5 to 11.9/1000) and stroke (tribal population -109/100000; general population 52 to 472/100000).[2] It is of immense relevance to health administrators and planners that adequate neurology services have to be provided with requisite workforce and infrastructure for the tribal population in remote areas of the country. In view of the constraints of limited specialist workforce and finances, with optimization of available resources, neurology care can be delivered through “rural model,” “community health center model,” “satellite clinic model,” and “district model” with integration of these various models through interactive methods.[5]



 
   References Top

1.
India State-Level Disease Burden Initiative Collaborators. Nations within a nation: Variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study. Lancet 2017;390:2437-60.  Back to cited text no. 1
    
2.
Gourie-Devi M. Epidemiology of neurological disorders in India: Review of background, prevalence and incidence of epilepsy, stroke, Parkinson's disease and tremors. Neurol India 2014;62:588-98.  Back to cited text no. 2
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3.
Schoenberg BS. Clinical neuroepidemiology in developing countries. Neurology with few neurologists. Neuroepidemiology 1982;1:137-42.  Back to cited text no. 3
    
4.
Bergen DC; World Federation of Nuerology Task Force on Neurological Services. Training and distribution of neurologists worldwide. J Neurol Sci 2002;198:3-7.  Back to cited text no. 4
    
5.
Gourie-Devi M. Organization of neurology services in India: Unmet needs and the way forward. Neurol India 2008;56:4-12.  Back to cited text no. 5
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6.
Kapoor SK, Banerjee AK. Prevalence of common neurological diseases in a rural communitay of India. Indian J Community Med 1989;14:171-6.  Back to cited text no. 6
    
7.
Razdan S, Kaul RL, Motta A, Kaul S, Bhatt RK. Prevalence and pattern of major neurological disorders in rural Kashmir (India) in 1986. Neuroepidemiology 1994;13:113-9.  Back to cited text no. 7
    
8.
Gourie-Devi M, Rao VN, Prakashi R. Neuroepidemiological study in semi-urban and rural areas in South India: Pattern of neurological disorders including motor neurone disease. In: Gourie-Devi M, editor. Motor Neurone Disease: Global Clinical Patterns and International Research. New Delhi: Oxford and IBH; 1987. p. 11-21.  Back to cited text no. 8
    
9.
Gourie-Devi M, Rao VN, Prakashi R. A protocol to detect neurological disorders in the community. Indian J Med Res 1988;88:443-9.  Back to cited text no. 9
    
10.
Bharucha NE, Bharucha EP, Dastur HD, Schoenberg BS. Pilot survey of the prevalence of neurologic disorders in the Parsi community of Bombay. Am J Prev Med 1987;3:293-9.  Back to cited text no. 10
    
11.
World Health Organization. Research Protocol for Measuring the Prevalence of Neurological Disorders in Developing Countries. Neurosciences Programme. Geneva: World Health Organization; 1981.  Back to cited text no. 11
    
12.
Gourie-Devi M, Gururaj G, Satishchandra P, Subbakrishna DK. Neuro-epidemiological pilot survey of an urban population in a developing country. A study in Bangalore, South India. Neuroepidemiology 1996;15:313-20.  Back to cited text no. 12
    
13.
Gourie-Devi M, Gururaj G, Satishchandra P, Subbakrishna DK. Prevalence of neurological disorders in Bangalore, India: A community-based study with a comparison between urban and rural areas. Neuroepidemiology 2004;23:261-8.  Back to cited text no. 13
    
14.
Gourie-Devi M, Gururaj G, Satishchandra P. Neuroepidemiology in Developing Countries: A Manual for Descriptive Studies. 2nd ed. Bangalore: Prism Books Pvt Ltd.; 1997.  Back to cited text no. 14
    
15.
Das SK, Biswas A, Roy T, Banerjee TK, Mukherjee CS, Raut DK, et al. A random sample survey for prevalence of major neurological disorders in Kolkata. Indian J Med Res 2006;124:163-72.  Back to cited text no. 15
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16.
Goel D, Dhanai JS, Agarwal A, Mehlotra V, Saxena V. Neurocysticercosis and its impact on crude prevalence rate of epilepsy in an Indian community. Neurol India 2011;59:37-40.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Mansukhani KA, Barretto MA, Donde SA, Wandrekar J, Nigudkar A, Nair R. Epidemiological Survey of Neurological Diseases in a Tribal Population Cluster in Gujarat. Ann Indian Acad Neurol 2018;21:294-9.  Back to cited text no. 17
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18.
The Lancet. India-a tale of one country, but stories of many states. Lancet 2017;390:2413.  Back to cited text no. 18
    




 

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