Advertisement

Multiple Sclerosis in sub-Saharan Africa – a scoping review

  • Martin Heine
    Correspondence
    Corresponding author: Dr. Martin Heine; Institute of Sport and Exercise Medicine, Faculty of Health and Medicine, Stellenbosch University, PO. Box 19063, Tygerberg, 7505, Cape Town, South Africa.
    Affiliations
    Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa

    Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa

    IOC Research Centre, South Africa
    Search for articles by this author
  • Desiree Maartens
    Affiliations
    Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
    Search for articles by this author
  • Susan Hanekom
    Affiliations
    Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town, South Africa
    Search for articles by this author
  • Wayne Derman
    Affiliations
    Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa

    IOC Research Centre, South Africa
    Search for articles by this author

      Highlights

      • Most research on MS in sub-Saharan Africa (SSA) originates from South Africa
      • Research from SSA has largely been focussed on determining the epidemiology of MS
      • There is a paucity of research on MS focussed on the SSA context

      Abstract

      Background

      The objective of this review is to provide a synthesis of original studies in patients with MS, originating from sub-Saharan Africa. This review aims to facilitate a better understanding of the MS academic and health landscape in this region.

      Methods

      A scoping review of original research was conducted (20th of November 2019) in PubMed, SCOPUS, Web of Science and EBSCO host. A narrative synthesis of studies was provided and placed in a historical context.

      Results

      Thirty-one unique studies from sub-Saharan Africa were identified from 846 unique records. The included studies were predominantly conducted in South Africa (n=24;[77%]) and of case-control (n=11[36%]) or cross-sectional design (n=7[23%]); no randomized clinical trials were identified. Most studies focussed on understanding the epidemiology of MS, the risk of MS in specific ethnic populations, and how this may contribute to identifying the underlying causal pathways.

      Conclusion

      Albeit scarce, the research conducted in sub-Saharan Africa largely followed international trends. There is a paucity of studies that have been conducted with the primary aim of understanding MS patient care across the continuum, and management of MS in an African context. The latter may become of increasing importance in the light of an increasing prevalence of MS in this region, as well as the increasing noncommunicable disease epidemic.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Browne P
        • Chandraratna D
        • Angood C
        • Tremlett H
        • Baker C
        • Taylor B V
        • et al.
        Atlas of Multiple Sclerosis 2013: A growing global problem with widespread inequity.
        Neurology. 2014; 83: 1022-1024
      1. Healthdate.org(Global Burden of Disease - results tool)[Internet]. Available from: www.healthdata.org.

        • Heydarpour P
        • Khoshkish S
        • Abtahi S
        • Moradi-Lakeh M
        • Sahraian MA
        Multiple sclerosis epidemiology in Middle East and North Africa: A systematic review and meta-analysis.
        Neuroepidemiology. 2015; 44: 232-244
        • Rosati G
        The prevalence of multiple sclerosis in the world: An update.
        Neurological Sciences. 2001; 22: 117-139
        • Thompson AJ
        • Baranzini SE
        • Geurts J
        • Hemmer B
        • Ciccarelli O
        Multiple sclerosis.
        Lancet. 2018; 391: 1622-1636
        • Dean G
        • Bhigjee AIG
        • Bill PLA
        • Fritz V
        • Chikanza IC
        • Thomas JEP
        • et al.
        Multiple sclerosis in black South Africans and Zimbabweans.
        Journal of Neurology, Neurosurgery and Psychiatry. 1994; 57: 1064-1069
        • Dean G
        • Elian M
        Motor neuron disease and multiple sclerosis mortality in Australia, New Zealand and South Africa compared with England and Wales.
        J Neurol Neurosurg Psychiatry. 1993; 56: 633-637
        • Dean G
        • Kurtzke JF
        On the risk of multiple sclerosis according to age at immigration to South Africa.
        British Medical Journal. 1971; 3: 725-729
        • Bird AV
        • Satoyoshi E
        Comparative epidemiological studies of multiple sclerosis in South Africa and Japan.
        Journal of Neurology, Neurosurgery and Psychiatry. 1975; 38: 911-918
        • Lowe RF
        • Moore HH
        • Briggs BR
        The histocompatibility (HLA) antigen distribution in multiple sclerosis patients in Zimbabwe.
        Central African Journal of Medicine. 1980; 26: 234-236
        • Fewster ME
        • Ames FR
        • Botha MC
        Measles antibodies and histocompatibility types in multiple sclerosis.
        Journal of the Neurological Sciences. 1979; 43: 19-26
        • Fewster ME
        • Kies B
        HLA antigens in multiple sclerosis in coloured South Africans.
        Journal of the Neurological Sciences. 1984; 66: 175-181
        • Kioy PG
        Emerging picture of multiple sclerosis in Kenya.
        East African Medical Journal. 2001; 78: 93-96
        • De Villiers JNPNP
        • Treurnicht FKFK
        • Warnich L
        • Carr J
        • Van Rensburg SJSJ
        • Kotze MJMJ
        Analysis of viral and genetic factors in South African patients with multiple sclerosis.
        Metabolic Brain Disease. 2006; 21: 163-169
        • Assadeck H
        • Toudou Daouda M
        • Adehossi Omar É
        • Mamadou Z
        • Hassane Djibo F
        • Douma Maiga D
        Inflammatory demyelinating diseases of the central nervous system in Niger.
        Rev Neurol (Paris). 2019; 175: 261-268
        • Bhigjee AI
        • Moodley K
        • Ramkissoon K
        Multiple sclerosis in KwaZulu Natal, South Africa: An epidemiological and clinical study.
        Multiple Sclerosis. 2007; 13: 1095-1099
        • Dean G
        Annual Incidence, Prevalence, and Mortality of Multiple Sclerosis in White South-African-born and in White Immigrants to South Africa.
        British Medical Journal. 1967; 2: 724-730
        • Miskin DP
        • Saadi A
        • Chikoya L
        • Sloane JA
        • Koralnik IJ
        • Siddiqi OK
        Challenges in the diagnosis and treatment of CNS demyelinating disorders in Zambia.
        Multiple Sclerosis Journal - Experimental, Translational and Clinical. 2016; 2
        • Modi G
        • Mochan A
        • du Toit M
        • Stander I
        Multiple sclerosis in South Africa.
        South African Medical Journal. 2008; 98: 386-393
        • Roos I
        • Budhoo R
        • Visser L
        • Bhigjee AI
        Correlation of optic neuritis and retinal nerve fibre thickness using optical coherence tomography in a cohort of multiple sclerosis patients.
        African Vision and Eye Health. 2016; 17: 1-9
        • Herbert E
        • Engel-Hills P
        • Hattingh C
        • Fouche J-P
        • Kidd M
        • Lochner C
        • et al.
        Fractional anisotropy of white matter, disability and blood iron parameters in multiple sclerosis.
        Metabolic Brain Disease. 2018; 33: 545-557
        • Klugman TM
        • Ross E.
        Perceptions of the Impact of Speech, Language, Swallowing and Hearing Difficulties on Quality of Life of a Group of South African Persons with Multiple Sclerosis.
        Folia Phoniatrica et Logopaedica. 2002; 54: 201-221
        • Rosti-Otajärvi EM
        • Hämäläinen PI
        Neuropsychological rehabilitation for multiple sclerosis.
        Cochrane Database Syst Rev. 2014; CD009131
        • Shannon BC
        • Tollman SG.
        A neuropsychological examination of multiple sclerosis and its impact upon higher mental functions.
        South African Journal of Psychology. 1994; 24: 152-162
        • Bird AV
        • Kerrich JE
        Multiple sclerosis in South Africa.
        South African medical journal. 1969; 43: 1031-1033
        • Osuntokun BO
        The pattern of neurological illness in tropical Africa. Experience at Ibadan, Nigeria.
        Journal of the Neurological Sciences. 1971; 12: 417-442
        • Ames FR
        • Louw S
        Multiple sclerosis in coloured South Africans.
        Journal of Neurology, Neurosurgery and Psychiatry. 1977; 40: 729-735
        • Hon GM
        • Hassan MS
        • Van Rensburg SJ
        • Abel S
        • Van Jaarsveld P
        • Erasmus RT
        • et al.
        Red blood cell membrane fluidity in the etiology of multiple sclerosis.
        Journal of Membrane Biology. 2009; 232: 25-34
        • Hon G
        • Hassan M
        • Van Rensburg SJ
        • Abel S
        • Marais DW
        • Van Jaarsveld P
        • et al.
        Immune cell membrane fatty acids and inflammatory marker, C-reactive protein, in patients with multiple sclerosis.
        British Journal of Nutrition. 2009; 102: 1334-1340
        • Idris M-NA
        • Sokrab TEO
        • Ibrahim EA
        • Ali H-E-RS
        • Elzibair MA
        • Abadalatif M
        Multiple sclerosis in Sudan: a prospective study of clinical presentation and outcome.
        Mult Scler. 2009; 15: 1537-1538
        • Kanyerezi BR
        • Kiire CF
        • Obace A
        Multiple sclerosis in Mulago Hospital, Uganda.
        East African Medical Journal. 1980; 57: 262-266
        • Rosman KD
        • Jacobs HA
        • Van Der Merwe CA
        A new multiple sclerosis epidemic? A pilot survey.
        South African Medical Journal. 1985; 68: 162-163
        • Temlett JA
        • Fritz VU
        • Sneider P
        • Reef HE
        The value of magnetic resonance imaging in multiple sclerosis in South African-born patients.
        South African Medical Journal. 1988; 73: 108-111
        • Adam AM
        Multiple sclerosis: epidemic in Kenya.
        East African medical journal. 1989; 66: 503-506
        • Kotze MJ
        • De Villiers J
        • Nico P
        • Rooney RN
        • Grobbelaar JJ
        • Mansvelt EPG
        • Bouwens CSH
        • et al.
        Analysis of the NRAMP1 gene implicated in iron transport: Association with multiple sclerosis and age effects.
        Blood Cells, Molecules, and Diseases. 2001; 27: 44-53
        • Kotze MJ
        • De Villiers JNP
        • Warnich L
        • Schmidt S
        • Carr J
        • Mansvelt E
        • et al.
        Lack of clinical manifestation of hereditary haemochromatosis in South African patients with multiple sclerosis.
        Metabolic Brain Disease. 2006; 21: 109-120
        • Van Rensburg SJ
        • Kotze MJ
        • Hon D
        • Haug P
        • Kuyler J
        • Hendricks M
        • et al.
        Iron and the folate-vitamin B12-methylation pathway in multiple sclerosis.
        Metabolic Brain Disease. 2006; 21: 121-137
        • Hon GM
        • Hassan MS
        • Rensburg SJV
        • Erasmus RT
        • Matsha TE
        Assessment of Epstein-Barr virus in blood from patients with multiple sclerosis.
        Metabolic Brain Disease. 2012; 27: 311-318
        • Hon GM
        • Erasmus RT
        • Matsha TE
        Phospholipase A2, prostaglandin E2 and polyunsaturated fatty acid metabolic abnormalities in multiple sclerosis.
        Clinical and Experimental Neuroimmunology. 2013; 4: 288-295
        • Hon GM
        • Erasmus RT
        • Matsha T
        Low prevalence of human herpesvirus-6 and varicella zoster virus in blood of multiple sclerosis patients, irrespective of inflammatory status or disease progression.
        Journal Of Clinical Neuroscience: Official Journal Of The Neurosurgical Society Of Australasia. 2014; 21: 1437-1440
        • Hon GM
        • Hassan MS
        • van Rensburg SJ
        • Abel S
        • Erasmus RT
        • Matsha T
        Non-esterified fatty acids in blood cell membranes from patients with multiple sclerosis.
        European Journal of Lipid Science & Technology. 2012; 114: 703-709
        • Hon GM
        • Hassan MS
        • van Rensburg SJ
        • Abel S
        • Marais DW
        • van Jaarsveld P
        • et al.
        Erythrocyte membrane fatty acids in patients with multiple sclerosis.
        Multiple Sclerosis. 2009; 15: 759-762
        • Hon GM
        • Hassan MS
        • Van Rensburg SJ
        • Abel S
        • Erasmus RT
        • Matsha T
        Membrane saturated fatty acids and disease progression in Multiple Sclerosis patients.
        Metabolic Brain Disease. 2009; 24: 561-568
        • Hon GM
        • Hassan MS
        • Van Rensburg SJ
        • Abel S
        • Erasmus RT
        • Matsha T
        Monounsaturated fatty acids in blood cell membranes from patients with multiple sclerosis.
        Inflammation. 2011; 34: 681-687
        • Hon GM
        • Hassan MS
        • Van Rensburg SJ
        • Abel S
        • Erasmus RT
        • Matsha T
        Peripheral blood mononuclear cell membrane fluidity and disease outcome in patients with multiple sclerosis.
        Indian Journal of Hematology and Blood Transfusion. 2012; 28: 1-6
        • Davis W
        • Van Rensburg SJ
        • Cronje FJ
        • Whati L
        • Fisher LR
        • Van Der Merwe L
        • et al.
        The fat mass and obesity-associated FTO rs9939609 polymorphism is associated with elevated homocysteine levels in patients with multiple sclerosis screened for vascular risk factors.
        Metabolic Brain Disease. 2014; 29: 409-419
        • Arksey H
        • O’Malley L
        Scoping studies: towards a methodological framework.
        International Journal of Social Research Methodology. 2005; 8: 19-32
        • Assadeck H
        • Daouda MT
        • Djibo FH
        • Maiga DD
        • Omar ÉA
        [First Cases of Multiple Sclerosis in Niger].
        Bulletin De La Societe De Pathologie Exotique (1990). 2018; 111: 77-80
        • Foster RM
        • Harries JR
        Multiple sclerosis in the African.
        British Medical Journal. 1970; 3: 628
        • Mateen FJ
        Multiple sclerosis in resource-limited settings: Research opportunities in an unequal world.
        Neurology. 2019; 93: 176-180
        • Mayosi BM
        • Flisher AJ
        • Lalloo UG
        • Sitas F
        • Tollman SM
        • Bradshaw D
        The burden of non-communicable diseases in South Africa.
        Lancet. 2009; 374: 934-947
        • Birbeck GL
        Barriers to care for patients with neurologic disease in rural Zambia.
        Arch Neurol. 2000; 57: 414-417
        • Ogbole GI
        • Adeyomoye AO
        • Badu-Peprah A
        • Mensah Y
        • Nzeh DA
        Survey of magnetic resonance imaging availability in West Africa.
        Pan African Medical Journal. 2018; 30: 1-9
        • Pretorius C
        • Joubert N
        The experiences of individuals with Multiple Sclerosis in the Western Cape, South Africa.
        Health SA Gesondheid. 2014; 19: 1-12
      2. The World Bank. World Bank, International Comparison Program Database [Internet]. [cited2018 Aug 10]. Available from:http://data.worldbank.org/indicator/PA.NUS.PPP?locations=ZA%0Aitle.

        • GBD 2016 Multiple Sclerosis Collaborators
        Global, regional, and national burden of multiple sclerosis 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
        Lancet Neurol. 2019; 18: 269-285
        • Giampaolo DL
        • Bhigjee A
        • Retief C
        • Isaacs M
        • Britz M
        • Opperman D
        • et al.
        Guideline for the diagnosis and management of multiple sclerosis: A Southern African perspective.
        South African Medical Journal. 2013; 103: 670-691
        • Sokhi D
        • Jamal I
        • Mativo P
        • Hooker J
        • Wallin M
        Diagnostic audit of the largest cohort of multiple sclerosis cases in Kenya referred to a tertiary hospital in Nairobi.
        Journal of the Neurological Sciences. 2017; 381: 1061
        • Tricco AC
        • Lillie E
        • Zarin W
        • O’Brien KK
        • Colquhoun H
        • Levac D
        • et al.
        PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation.
        Ann Intern Med. 2018; 169: 467-473
        • van den Akker LE
        • Beckerman H
        • Collette EH
        • Twisk JWR
        • Bleijenberg G
        • Dekker J
        • et al.
        Cognitive behavioral therapy positively affects fatigue in patients with multiple sclerosis: Results of a randomized controlled trial.
        Multiple Sclerosis Journal. 2017; 23: 1542-1553
        • Rietberg MB
        • Veerbeek JM
        • Gosselink R
        • Kwakkel G
        • van Wegen EE
        Respiratory muscle training for multiple sclerosis.
        Cochrane Database of Systematic Reviews. 2017; ([Internet][cited 2019 Mar 25]Available from:)
        • Heine M
        • Turk-Adawi K
        • Supervia M
        • Derman W
        • Lopez-Jimenez F
        • Naidoo P
        • et al.
        Cardiac rehabilitation delivery in Africa.
        Cardiovasc J Afr. 2019; 30: 1-5
        • Heine M
        • van de Port I
        • Rietberg MB
        • van Wegen EE
        • Kwakkel G
        Exercise therapy for fatigue in multiple sclerosis.
        Cochrane Database of Systematic Reviews. 2015; ([Internet][cited 2019 Mar 25]Available from:)
        • Heine M
        • de Groot V
        Current Evidence Does Not Support Exercise Therapy for Perceived Fatigue in Multiple Sclerosis.
        Archives of Physical Medicine and Rehabilitation. American Congress of Rehabilitation Medicine. 2016; 97: 2016-2017
        • Heine M
        • Lupton-Smith A
        • Pakosh M
        • Grace SL
        • Derman W
        • Hanekom S
        Exercise-based rehabilitation for non-communicable disease in low-resource settings - a systematic scoping review.
        BMJ Global Health. 2019; 4