Neurophobia in Low- and Middle-income Countries (LMICs): Burden and Implications for Neurology Care and Research – A Systematic Review
Oladotun Olalusi1, Obinna Amaji2, Tobi Olajide3, samuel olawale2, Olukemi Ilori4, Morounfoluwa Olalusi5, Joseph Yaria1
1Neurology, University College Hospital Ibadan, 2Medicine, University of Ibadan, 3College of Medicine University of Ibadan, 4Pediatrics, Federal Medical Center Owo, 5Medicine, AMA School of Medicine, Makati, Philippines
Objective:
We reviewed the burden of neurophobia and described its implications for neurology care and research in low-and middle-income countries(LMICs)
Background:
Although neurological research and practice are gaining traction globally with newer therapeutic/diagnostic approaches,many medical students and trainees are reluctant to pursue a career path in the neurosciences. Amid fragile health systems and low neurologist-patient ratio, a comprehensive understanding of the burden of neurophobia in LMICs is yet lacking
Design/Methods:
We conducted a comprehensive search of PubMed, EMBASE, Google Scholar, Scopus and African Journal Online(AJOL) for publications from inception till December 2024. Data from selected studies were extracted and populated into a customized spreadsheet under pre-defined headings. The extracted data were subsequently analyzed. The protocol for this review was registered on PROSPERO (CRD42024626463)
Results:
A total of 131 studies from PubMed(n=25), AJOL (n=6),and EMBASE, CINAHL, Scopus, and Google Scholar(n=100) were screened. Ultimately, 15 studies were included, with a total sample size of 4,430 (3629 medical students and 801 postgraduate trainees). The prevalence of neurophobia ranged from as low as 6.25% among clinical medical students in Peru to as high as 91.4% among physical therapy students in Pakistan.Neurophobia was noted to increase from the preclinical stage to the clinical stage. The determinants however appeared consistent across study settings, ranging from specific individual-level characteristics(fear of making mistakes with critical care decisions), educational (lack of vertical integration between basic neuroscience and clinical neurology), sociocultural(stigma for neurologic disability) to health system-related factors(few treatment/diagnostic modalities contributing to poor outcome).
Conclusions:
The prevalence of neurophobia in LMICs varies widely.To address neurophobia, extant health policy, educational, and clinical training initiatives should be geared towards implementing and sustaining evidence-based strategies to improve clinical exposure, confidence and case-based learning.This will be critical to ensuring a steady stream of neurology workforce and, consequently, help bridge the neurology clinical care and research gap in many LMICs
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