The State of Play of Parkinson's Disease in Africa: A Systematic Review and Point of View.

IntroductionParkinsons disease (PD) has become a global public health challenge as disability and death due to the disease are growing rapidly in comparison to other neurological disorders. There are no up-to-date comprehensive reviews on the epidemiology, environmental and genetic risk factors, phenotypic characterization, and patient-reported outcomes of PD in Africa. This data is crucial to understanding the current and future burden and suggesting actionable and/or researchable gaps aimed at improving disease outcomes. MethodologyWe conducted a systematic literature search using the electronic databases of Cochrane Central Register of Controlled Trials (CCRT), EMBASE, Medline, PsychINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Journals (AJOL) and other unpublished literature. We included all studies providing data on people with PD in Africa from the start of each database till February 2023. Studies were not restricted based on diagnostic criteria or language. Outcomes of interest were summarised based on epidemiology, genetics, environmental risk factors, clinical characteristics, patient-reported outcomes (experience and quality of life), disease management and outcomes, access to care, patient support, and healthcare workforce training. We also investigated collaboration between African countries (internal) and across continents/world regions (external) and journal impact factors. ResultsA total of 4,855 articles were identified, of which 180 were included in this review. The majority were published from North Africa (mainly from Tunisia, and involved collaboration with investigators from France, the United Kingdom, and the United States of America). West Africa (Nigeria), Southern Africa (South Africa) and East Africa (mainly Tanzania) also had a relatively high number of publications. Methodological design varied across studies. Based on the pre-determined outcomes, articles identified were genetics (67), clinical features (65), environmental risk factors (16), epidemiology (14), patient experience and quality of life (10), management and access to care (5) and education and training (3). ConclusionsThe main hubs of PD-related research output in Africa are the Northern, Western and Southern regions of Africa (although with limited involvement of countries within these regions). External collaboration (outside the continent) currently predominates. There are considerable actionable and researchable gaps across all outcomes of interest, with a dearth of published information on health workforce capacity building, disease management and access to care, patient and caregiver engagement, and quality of life of people with PD in Africa. We recommend strengthening existing and emerging intercontinental networks for research, education, training and policy formulation and funding, leveraging on more recent developments such as the International Parkinsons Disease Genomics Consortium-Africa (IPDGC-Africa), the International Parkinson and Movement Disorder Society Africa Section (MDS-AS), World Health Organisation (WHO) and initiatives with similar objectives.