On-site visit reveals the progress of neurological training in Africa and the continuing need for more.
By Prof. Lawrence Tucker
WFN outgoing President Wolfgang Grisold (3rd from left) and AFAN President Lawrence Tucker (right) visit with staff at the University Teaching Hospital in Lusaka, Zambia.
The University Teaching Hospital (UTH) in Lusaka is the largest public tertiary hospital in Zambia. It is also the main institution training center for health care professionals and includes the country’s only neurology training center.
There are currently 21 neurologists in Zambia, which has an estimated population of 21 million people. Most of those 21 neurologists were trained at the UTH.
The UTH neurology training center was established in 2018 and currently graduates approximately three neurologists per year. Prior to 2018, there were only one or two neurologists in the entire country. The center trains both adult and pediatric neurologists. The establishment of this training program was led by Prof. Deanna Saylor and is supported by the Johns Hopkins Global Neurology Program.
In August, World Federation of Neurology (WFN) outgoing President Prof. Wolfgang Grisold and African Federation of Neurology (AFAN) President Prof. Lawrence Tucker visited the training center. There, they met with Prof. Saylor and several other consultants and neurology residents. They were shown around the neurology wards and neurophysiology laboratory.
During a second visit, Prof. Tucker joined a consultant-led ward round of neurology in-patients. Later, he discussed the status of Zambian neurology with members of the neurology department.
According to Dr. Stanley Zimba, a senior neurology consultant, stroke, epilepsy, primary headache disorders, and neuroinfectious diseases such as tuberculosis, various meningitides, and malaria contribute most to the neurological disease in Zambia. Central nervous system neuroinflammatory conditions, including both neuromyelitis optica spectrum disorder (NMO) and multiple sclerosis (MS), are relatively common, as are neurodegenerative diseases, especially Parkinson’s disease and dementia.
Virtually all neuroscience research in Zambia is performed at the neurology facility at UTH. Dr. Zimba confirmed that this research work has assisted in establishing the evidence-based clinical practice. This practice is being extended across the country as more neurologists graduate from the program and are appointed to state-funded neurology posts in other Zambian towns and cities.
The greatest threats to brain health in Zambia, according to Dr. Zimba, are the lack of funding to enhance neurological care, the paucity of structured programs for prevention, and limited access to treatment options for many common neurological conditions.
CT and MRI scanning facilities are available at UTC, and the neurology division has facilities to perform electroencephalograms (EEG), electromyography (EMG), and nerve conduction studies (NCS). However, access is limited by high demand and, consequently, wait times are typically long. Many patients must pay for their scans if their conditions are assessed as not being emergencies.
Although a free universal state-funded point-of-care system is available for emergencies, there is limited state funding available for nonurgent neurology (and other) health care delivery. Private health insurance is available to Zambians with financial means. Affluent patients often seek neurological investigation and treatment in South Africa or abroad.
In the short term, Dr. Zimba expects an uptick in the incidence of HIV, stroke, and epilepsy. In the longer term, he predicts these diseases will contribute increasingly to the burden of neurological disease in his country as the burden of noncommunicable disease increases consequent to progressive aging and urbanization of the Zambian population.
Our impression was that the Zambian neurology training program at UTC is well run, effective, and produces neurologists who are highly competent in managing neurological disease in a resource-constrained environment. •
Lawrence Tucker is president of African Academy of Neurology, a member of the WFN Education Committee, and served as a member of the WFN delegation to the 2025 meeting of the WHO Regional Committee for Africa.
