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Letters to the Editor
Addressing the Burden of Disease: A View from Ethiopia

The article, “Neurologic diseases found to be the largest cause of disability worldwide” (November 16, 2017; provides a timely review of the Global Burden of Disease analysis, which documented a significant increase in the neurological disease burden. The findings were partially attributable to the World Health Organization (WHO) reclassification of stroke as a neurological disorder, but the absolute increase due to population growth and aging illustrates the devastating impact of neurological disorders and should serve as a guide for more appropriate resource allocation.

The most serious concern is in sub-Saharan Africa (SSA) which harbours the highest burden of disease, the least resources, and a population exceeding one billion that is expected to double over the next generation. Improving access to neurological care in this region is crucial, but as Dr. Jerome Chin points out the barriers are “numerous and complex.” In fact, outsiders may be deterred by the dearth of healthcare workers, limited diagnostic facilities, lack of medications, adherence to traditional beliefs, and seemingly insurmountable infrastructural challenges, all superimposed on abject poverty with food and water insecurity and frank undernutrition.

But it is precisely because of these diverse barriers that the international neurological community must unite to address these overwhelming healthcare disparities and “reach the furthest behind first.” This mandates collaborative partnerships with a goal of developing local programs to increase the recruitment, training and retention of medical staff, avoiding the self-serving short term medical missions that cause more harm than good.

Global NeuroCare, a non-profit organization working in consultation with the United Nations and other international organizations, focusing on the Addis Ababa University (AAU) Neurology Residency Training Program, strongly endorses this approach. In fact, this form of capacity building is aligned with the Sustainable Development Goals (SDGs), supported by the WHO, and crucial for the continuing development of neurology in SSA, where there remains an abysmal ratio of 1 neurologist for every 3-5,000,000 people.

The AAU Program is a testament to the success of this approach, with 30 graduates over the past decade and more physicians entering the program every year. These outstanding neurologists are now training physicians from other African nations and participating in triangular cooperation with South-South ties that will more effectively combat the burden of disease.

Partnerships like these engaging all stakeholders will ensure cooperative alliances to provide an integrated and sustainable approach for advancing neurological services. The end result will be a cross-cutting impact on the interrelated SDGs that not only improves neurological care but serves to promote poverty reduction, stimulate economic growth, eliminate harmful practices, encourage scientific research, and advance overall health security.

We applaud the AAN for supporting global neurology, and encourage the Academy to promulgate guidelines for healthcare partnerships to ensure those partnerships' goals, and efforts to achieve those goals, are sustainable, ethically congruent, beneficial to the host, protect vulnerable populations and avoid destabilizing already fragile medical systems. In this manner, the international community can more effectively work towards neurological equity.

Seid Gugssa, MD

Chairman, AAU Department of Neurology, Addis Ababa, Ethiopia

Mehila Zebenigus, MD

Director, Global NeuroCare, Addis Ababa, Ethiopia

James C. Johnston, MD, JD

Director, Global NeuroCare, USA and Addis Ababa, Ethiopia