By Sharon Atieno
At 80, Mary Magoma is a dementia patient. She was diagnosed with the condition some five years ago.
The symptoms began with consistent body aches including headaches. This would be combined with trouble remembering things. However, visits to the doctors often dismissed the symptoms as problems associated with old age.
It was only after the symptoms worsened -loss of sleep, difficult to engage in conversation- when her children decided to seek specialist treatment in one of the “big” private hospitals in Nairobi, Kenya’s capital that she was diagnosed with the condition.
Despite being given medicine to manage the condition, Magoma ‘s health has significantly deteriorated. Her memory keeps on failing, she can no longer remember even her children and when she is able to, it takes less than two minutes before she forgets again.
Her ability to move around has been curtailed and she requires help moving from one place to another. She is unable to even ease herself and requires a caregiver to help her in doing this and other things such as bathing.
Dementia, a group of diseases associated with losing the mental capacity for thinking, remembering, decision making and effective engagement with the surrounding, affects 55 million people globally. Two out of five of them live in low-and middle-income countries including Africa.
According to Dr. Rufus Akinyemi, Deputy Director of the Centre for Genomics and Precision Medicine College of Medicine, University of Ibadan, all types of dementia found in the Global North exist in Africa. These include Alzeihmer disease, dementia with Lewy bodies, frontotemporal dementia and vascular dementia among others.
He observed that unlike In the Global North, vascular dementia is on the rise in Africa, accounting for about 30% of dementia cases in the region.
Vascular dementia is caused by reduced blood flow to the brain. It results in a decline in thinking skills as well as memory. The symptoms may develop slowly or after a stroke or major surgery such as a heart bypass surgery or abdominal surgery.
Dr. Akinyemi notes that there are several risk factors for dementia in Africa. Non-modifiable factors such as age (65 years and above), gender (being female than male) and genetic factors (hereditary).
There are modifiable factors such as air pollution, smoking, alcohol, physical inactivity, social isolation, depression, obesity, hypertension, hearing loss, traumatic brain injury and less education.
He was speaking during the Future of Dementia in Africa: Advancing Global Partnerships Conference said in Nairobi, Kenya from 11th-12th September.
The conference was convened by Nature conferences in partnership with Davos Alzeihmer’s Collaborative, and the Aga Khan University’s Brain & Mind Institute.
According to Dr. Mary Amoakoh-Colemen, a public health physician and senior research fellow in the University of Ghana, underreporting and underdiagnosis of dementia remains a challenge in the continent.
She notes that most people suffering from dementia tend to ignore the symptoms while others associate them with ageing brushing off the need to seek medical intervention. Some take as long as long as four years before seeking help from hospital.
Besides, some of the symptoms of dementia are associated with witchcraft leading to stigma from community members.
Early signs and symptoms of dementia according to World Health Organization (WHO) include forgetting things or recent events, losing or misplacing things, getting lost while walking or driving, being confused (even in familiar places), losing track of time, difficulties solving problems or making decisions, problems following conversations or trouble finding words, difficulties performing familiar tasks and misjudging distances to objects visually.
Common changes in mood and behavior include feeling anxious, sad or angry about memory loss, personality changes, inappropriate behavior, withdrawal from work or social activities and being less interested in other people’s emotions.
Dr. Amoakoh-Colemen adds that because of culture- associating symptoms with ageing- some health care workers are unable to diagnose the disease. “In some occasions, health workers do not pay attention to what the patients tell them and end up diagnosing only physical illness such as hypertension, instead,” she noted.
“Health workers need to be educated that when patients come with these symptoms no matter their age or whatever condition, they should not down play it. Apply the necessary screening or diagnostic tools to find out if it is really dementia or something else.”
Notwithstanding, in most African countries, the number of specialists available to diagnose dementia is limited and mostly based in the urban areas. In Ghana for instance, there are 73 psychiatrists, 15 neurologists and five geriatricians while in Kenya, there are less than 30 neurologists.
Noting that that initial contact for care for people living with dementia is primary health centres yet there are no specialists at this level, Dr. Edna Bosire, Medical anthropologist, Aga Khan Brain & Mind Institute said “Access to specialist care is key in receiving diagnosis.”
According to Dr.Bosire, with most specialists living in urban areas, most of the ageing population, majority of whom live in rural areas, are forced to travel long distances to access care.
Additionally, specialist care is expensive hence out of reach for most of those who need it. Some of the tests required to diagnose dementia include history taking (looking at the patient’s history of disease) and variety of tests such as fluorodeoxyglucose (FDG)-positron emission tomography (PET), magnetic imaging (MRI) and computerised tomography (CT) scans. These are tests which target the brain and can help health workers make early diagnosis for appropriate management or prognosis.
Studies have shown that the ageing population (60 years and above) is likely to double in sub-Saharan Africa from 34 million in 2005 to over 67 million by 2030. As such, Dr.Amoakoh- Colemen is calling on African governments to invest in the older population making healthcare systems robust enough to take care of their needs and making sure that they are able to access social protection to be able to take of their needs and of their families.
