Prevalence of neuroinfectious diseases and outcomes in Africa : IJS Global Health

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Prevalence of neuroinfectious diseases and outcomes in Africa

Aderinto, Nicholas MBBSa,*; Alare, Kehindea; AbdulBasit, Opeyemi Muilia; Edun, Mariamb; Ogunleke, Praisea

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International Journal of Surgery: Global Health 6(2):p e104, March 2023. | DOI: 10.1097/GH9.0000000000000104
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Neuroinfectious diseases are infections affecting the central and peripheral nervous system, possibly due to bacterial, viral, fungal, or parasitic infections1. The route of infection to the nervous system could be through direct inoculation, blood circulation, retrograde spread, or others2. Central nervous system infections are often challenging to diagnose, and the burden of undiagnosed nervous system infections is currently underreported; despite the recent advances in investigative technology, about 30% of patients with suspected central nervous system infections never received an etiological diagnosis, with nearly one-third of these patients dying of the illness3,4. Neurological disorders related to neuroinfectious diseases are highly prevalent in sub-Saharan Africa, which constitute a significant cause of disabilities and economic burden for the patients and society5. There are dual burdens of neuroinfectious diseases in developing countries of Africa in which the conditions are both under-recognized and under-treated6. One of the significant challenges of neuroinfectious diseases in Africa is the lack of neurological experts, with the average number of neurologists to the general population of about 1–3.4 million in some African countries; with about 11 countries not having any neurologists, the case is worst in neurological surgery6,7.

Epidemiology of neuroinfectious diseases

There are few pieces of literature reporting the epidemiology of neuro-infectious diseases in Africa. Still, with a global incidence of about 389/100,000 estimated between 1990 and 2016, certain infections have been noted to affect the nervous system8. The infectious diseases of the nervous can be grouped according to their causative agents, such as bacterial, viral, fungal, and parasitic.

  • Common bacterial infections of the nervous system
  • Bacterial meningitis has been reported to be prevalent in some regions of Africa, especially sub-Saharan Africa, which is referred to as the meningitis belt9–12. About 393,614 cases of bacterial meningitis were reported by the World Health Organization in Nigeria between 1991 and 201113. The commonly indicated organisms causing bacterial meningitis include Streptococcus pneumonia, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenza, and Mycobacterium tuberculosis14. Another important bacterial infection of the nervous system that has been found to be epidemic in Africa is neurosyphilis which accounts for about 3% of all bacterial neuro infections reported in Africa15.
  • Common viral infections of the nervous system
  • Some of the infections of the nervous system are of viral origin, which causes severe morbidity and mortality in Africa, as many potentially lethal neurotrophic viruses were discovered in Africa9. Some emerging viral infections in Africa, such as West Nile virus, Ebola virus, Chikungunya virus, and Zika virus, were found cause some neurological sequelae such as encephalitis, hydrocephalus, and meningitis; these were found to be endemic in some regions of sub-Saharan Africa with increasing incidence16–22. other viral infections such as herpes simplex, varicella zoster, cytomegalovirus, Epstein Barr, and HIV are endemic in some areas of Africa23.
  • Common fungal infections of the nervous system
  • Cryptococcal meningitis is one of the leading causes of meningitis globally. It was reported in 2017 that about 160,000 people in Africa had been diagnosed with cryptococcal meningitis, with 98% localized to sub-Saharan Africa24. Countries like Nigeria, South Africa, and Mozambique have an average of 20,000 cases of cytomegalovirus per year, with North Africa recording the least cases24. Despite the recent decrease in the yearly incidence of cryptococcal meningitis, the mortality of cryptococcal meningitis in Africa is about 44% on short-term follow-up and about 73% on long-term follow-up25–30. Other nervous system fungal infections, such as candida and Histoplasma, have also been reported in Africa31.
  • Common parasitic infections of the nervous system
  • Cerebral malaria affects about 3 million children worldwide, accounting for about 1 million death, with 90% occurring in Africa32. There has been a recent decline in the incidence of cerebral malaria by up to 50% in some countries like Tanzania, Kenya, and Zambia33–35. Neurocysticercosis is the most common parasitic infection of the central nervous system globally, which is found to be endemic in low-income countries of Africa36,37. Neurocysticercosis accounts for a significant cause of seizures and epilepsy in Africa37–39. Human African Trypanosomiasis is found to be endemic in Africa, with a prevalence of about 50,000–70,000 and an annual incidence of about 17,000. Still, in endemic countries, it causes some significant neurological sequelae40,41. Toxoplasmosis is another parasitic infection of the nervous system that is of public health importance in Africa, with prevalence varying by geographical distribution. However, Toxoplasma gondii was widely distributed in Mali and other west African countries42,43.

Factors influencing the outcome of neuroinfectious diseases in Africa

Predisposing factors to neuroinfectious diseases

Some factors have been identified to contribute to the prevalence of neuroinfectious diseases in Africa, which include poor sanitation, nutrition, inadequate infection prevention control programs, environmental conditions favoring the endemicity of some infections, inadequate immunization programs, and others44–49. The increase prevalence of HIV infection was also found to be associated with the increased prevalence of viral meningitis in Africa, the environmental conditions, such as high temperatures, were found to contribute to the endemicity of meningococcal infections in the meningitis belt of sub-Saharan Africa50.

Challenges of management of neuroinfectious diseases

Management of neuroinfectious diseases in Africa has been faced with several challenges part of in which includes a lack of access to adequate healthcare especially neurological care, access to diagnostic facilities, and limitations in the availability, number, and geographical distribution of trained specialists51–53. Another challenge is people in Africa tend to access traditional health practices with an average of conventional health practitioners to the general population of about 5:1000, while for neurologists is 1: 1,500,000–1: 5,000,000 and neurosurgeons 1:4,000,000–1: 6,000,00054–56.


The study noted several bacterial, fungal, viral, and parasitic diseases that significantly affect the occurrence of neuroinfectious diseases. On the African continent, the prevalence of neuroinfectious illnesses has been rising over time, with a heavy burden on low and middle-income countries57. Its management in the area is faced with some difficulties, including inadequate care, poverty, research, and an unstable health care system.

The majority of neuroinfectious illnesses necessitate accurate diagnosis and care. To properly diagnose these infections and treat the sickness, it is necessary to ascertain the nature of the infection. A correct diagnosis is necessary to identify the type of parasite affecting the nervous system in cases of parasitic diseases like malaria. In addition, a solid health care system will offer the range of people and physical resources required to combat different neuroinfectious illnesses. These include human resources like medical professionals and Infrastructural resources like medical labs, hospitals, and cutting-edge health care facilities. They are necessary because they would make a significant contribution to overcoming the numerous obstacles to the detection and treatment of neuroinfectious illnesses58.

Governments and stakeholders in low and middle-income countries should offer health care delivery subsidies to solve the problems brought on by poverty; this would enable free treatment to the needy and disadvantaged while also expanding the reach of health care delivery in these areas.

Finally, there is a need for proper research on various infections affecting the nervous system. Ngarka et al5 study on neuroinfections in Africa demonstrated the need for a thorough investigation into the risk factors, triggering factors, and mechanisms underlying these infections. This would aid in the development of novel therapeutic approaches for the effective management of these infections5.


Neuroinfectious diseases are often underreported in Africa. Public health stakeholders in the continent must pay key attention to the growing prevalence of neuroinfectious diseases.


1. Johnson T, Nath A. Neurological complications of immune reconstitution in HIV-infected populations. Ann N Y Acad Sci 2010;1184:106–20.
2. Nath A, Berger JR. Complications of immunosuppressive/immunomodulatory therapy in neurological diseases. Curr Treat Options Neurol 2012;14:241–55.
3. Tan K, Patel S, Gandhi N, et al. Burden of neuroinfectious diseases on the neurology service in a tertiary care center. Neurology 2008;71:1160–6.
4. Thakur KT, Motta M, Asemota AO, et al. Predictors of outcome in acute encephalitis. Neurology 2013;81:793–800.
5. Ngarka L, Siewe Fodjo JN, Aly E, et al. The interplay between neuroinfections, the immune system and neurological disorders: a focus on Africa. Front Immunol 2022;12:803475.
6. Siddiqi OK, Atadzhanov M, Birbeck GL, et al. The spectrum of neurological disorders in a Zambian tertiary care hospital. J Neurol Sci 2010;290:1–5.
7. Kumwenda JJ, Mateyu G, Kampondeni S, et al. Differential diagnosis of stroke in a setting of high HIV prevalence in Blantyre, Malawi. Stroke 2005;36:960–4.
8. Robertson FC, Lepard JR, Mekary RA, et al. Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide. J Neurosurg 2018;1:1–20.
9. Davis LE. Acute bacterial meningitis. Continuum (Minneapolis, Minn) 2018;24:1264–83.
10. Hulten KG. Viral meningitis in the UK: time to speed up risk factors in septic revisions following total hip arthroplasty. Lancet Infect Dis 2018;18:930–1.
11. Paradowska-Stankiewicz I, Piotrowska A. Meningitis and encephalitis in Poland in 2015. Przegl Epidemiol 2017;71:493–500.
12. Chong H, Tan C. Epidemiology of central nervous system infections in Asia, recent trends. Neurol Asia 2005;10:7–11.
13. Abdussalam AF, Qaffas Y. Spatiotemporal patterns and social risk factors of meningitis in Nigeria. Open Access Libr J 2016;3:1–14.
14. Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 1997;337:970–6.
15. Marks M, Jarvis JN, Howlett W, et al. Neurosyphilis in Africa: a systematic review. PLoS Negl Trop Dis 2017;11:e0005880.
16. Kakooza-Mwesige A, Tshala-Katumbay D, Juliano SL. Viral infections of the central nervous system in Africa. Brain Res Bull 2019;145:2–17.
17. Posen HJ, Keystone JS, Gubbay JB, et al. Epidemiology of Zika virus, 1947–2007. BMJ Glob Health 2016;1:e000087.
18. Mlakar J, Korva M, Tul N, et al. Zika virus associated with microcephaly. N Engl J Med 2016;374:951–8.
19. Chimelli L, Melo A, Avvad-Portari E, et al. The spectrum of neuropathological changes associated with congenital Zika virus infection. Acta Neuropathol 2017;133:983–99.
20. Shives KD, Tyler KL, Beckham JD. Molecular mechanisms of neuroinflammation and injury during acute viral encephalitis. J Neuroimmunol 2017;308:102–11.
21. Hasbun R, Garcia MN, Kellaway J, et al. West Nile virus retinopathy and associations with long term neurological and neurocognitive sequelae. PLoS One 2016;11:e0148898.
22. Fritel X, Rollot O, Gerardin P, et al. Chikungunya virus infection during pregnancy, Reunion, France, 2006. Emerg Infect Dis 2010;16:418–25.
23. Schieffelin JS, Shaffer JG, Goba A, et al. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med 2016;371:2092–2100.
24. Badoe E, Wilmshurst JM. An overview of the effect and epidemiology of viral central nervous system infections in African children. Semin Pediatr Neurol 2014;21:26–9.
25. Rajasingham R, Smith RM, Park BJ, et al. Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis 2017;17:873–81.
26. Kalata N, Ellis J, Kanyama C, et al. Short-term mortality outcomes of HIV-associated cryptococcal meningitis in antiretroviral therapy-naïve and -experienced patients in sub-Saharan Africa. Open Forum Infect Dis 2021;8:ofab397.
27. Tenforde MW, Gertz AM, Lawrence DS, et al. Mortality from HIV-associated meningitis in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 2020;23:e25416.
28. Makadzange AT, Ndhlovu CE, Takarinda K, et al. Early versus delayed initiation of antiretroviral therapy for concurrent HIV infection and cryptococcal meningitis in sub-saharan Africa. Clin Infect Dis 2010;50:1532–8.
29. Rothe C, Sloan DJ, Goodson P, et al. A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi. PloS One 2013;8:e67311.
30. Kambugu A, Meya DB, Rhein J, et al. Outcomes of cryptococcal meningitis in Uganda before and after the availability of highly active antiretroviral therapy. Clin Infect Dis 2008;46:1694–701.
31. Mohamed SH, Nyazika TK, Ssebambulidde K, et al. Fungal CNS infections in Africa: the neuroimmunology of cryptococcal meningitis. Front Immunol 2022;13:804674.
32. White NJ, Pukrittayakamee S, Hien TT. Malaria. Lancet 2013;12:30–32.
33. Mmbando BP, Vestergaard LS, Kitua AY, et al. A progressive declining in the burden of malaria in north-eastern Tanzania. Malar J 2010;9:216.
34. O’Meara WP, Bejon P, Mwangi TW, et al. Effect of a fall in malaria transmission on morbidity and mortality in Kilifi, Kenya. Lancet (London, England) 2008;372:1555–62.
35. Chizema-Kawesha E, Miller JM, Steketee RW, et al. Scaling up malaria control in Zambia: progress and impact 2005-2008. Am J Trop Med Hygiene 2010;83:480–8.
36. Román G, Sotelo J, Del Brutto O, et al. A proposal to declare neurocysticercosis an international reportable disease. Bull World Health Organ 2000;78:399–406.
37. Grill J, Pillet P, Rakotomalala W, et al. La neurocysticercose: particularités pédiatriques [Neurocysticercosis: pediatric aspects]. Arch Pediatr 1996;3:360–8.
38. Quet F, Guerchet M, Pion SD, et al. Meta-analysis of the association between cysticercosis and epilepsy in Africa. Epilepsia 2010;51:830–7.
39. Winkler AS, Blocher J, Auer H, et al. Epilepsy and neurocysticercosis in rural Tanzania-an imaging study. Epilepsia 2009;50:987–93.
40. Simarro PP, Diarra A, Ruiz Postigo JA, et al. The human African trypanosomiasis control and surveillance programme of the World Health Organization 2000-2009: the way forward. PLoS Negl Trop Dis 2011;5:e1007.
41. Fèvre EM, Picozzi K, Fyfe J, et al. A burgeoning epidemic of sleeping sickness in Uganda. Lancet (London, England) 2005;366:745–7.
42. Feldman HA. Toxoplasmosis. N Engl J Med 1968;279:30–32.
43. Ouologuem DT, Djimdé AA, Diallo N, et al. Toxoplasma gondii seroprevalence in Mali. J Parasitol 2013;99:371–4.
44. Birbeck GL. Barriers to care for patients with neurologic disease in rural Zambia. Arch Neurol 2000;57:414–7.
45. Burton KJ, Allen S. A review of neurological disorders presenting at a paediatric neurology clinic and response to anticonvulsant therapy in Gambian children. Ann Trop Paediatr 2003;23:139–43.
46. Durkin M. The epidemiology of developmental disabilities in low-income countries. Mental Retard Dev Dis Res Rev 2002;8:206–11.
47. Gill GV, Scott B, Beeching NJ, et al. Enumeration of non-communicable disease in rural South Africa by electronic data linkage and capture-recapture techniques. Trop Med Int Health 2001;6:435–41.
48. Izuora GI, Iloeje SO. A review of neurological disorders seen at the Paediatric Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu. Ann Trop Paediatr 1989;9:185–90.
49. McArthur JC, Brew BJ, Nath A. Neurological complications of HIV infection. Lancet Neurol 2005;4:543–55.
50. Slikkerveer LJ. (1982). Rural health development in Ethiopia. Problems of utilization of traditional healers. Soc Sci Med 1982;16:1859–72.
51. Birbeck GL, Munsat T. Neurologic services in sub-Saharan Africa: a case study among Zambian primary healthcare workers. J Neurol Sci 2002;200:75–8.
52. Idro R, Newton C, Kiguli S, et al. Child neurology practice and neurological disorders in East Africa. J Child Neurol 2010;25:518–24.
53. Bower JH, Zenebe G. Neurologic services in the nations of Africa. Neurology 2005;64:412–5.
54. Krishna S, Boren SA, Balas EA. Healthcare via cell phones: a systematic review. Telemed J E-health 2009;15:231–40.
55. Abbo C, Ekblad S, Waako P, et al. Psychological distress and associated factors among the attendees of traditional healing practices in Jinja and Iganga districts, Eastern Uganda: a cross-sectional study. Int J Ment Health Syst 2008;2:16.
56. Rabiu TB, Komolafe EO. Neurosurgery in rural Nigeria: a prospective study. J Neurosci Rural Pract 2016;7:485–8.
57. World Health Organization. Neurological Disorders: Public Health Challenges: World Health Organization. World Health Organization; 2006.
58. Institute for Health Metrics and Evaluation. Annual % Change 1990 to 2019 DALYs/100000, Global, Both Sexes, All Ages, Neurological Disorders, SubSaharan Africa GBD Compare. Seattle, WA: IHME, University of Washington; 2015. Accessed October 26, 2022.
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