Objective: To evaluate the educational gaps in hyperkinetic movement disorders among a widely-varied sample of Cameroonian health providers and improve understanding through a practical training course.

Background: Epidemiological data about the prevalence of hyperkinetic movement disorders (HMD) in sub-Saharan Africa countries like Cameroon is limited[1-2]. Differential diagnosis of HMD is challenging as patients can present with more than one type of involuntary movement, and motor phenomenology can be confused with seizures or functional movement disorders. Due to the lack of neurologists in Cameroon it is imperative to train general health providers in diagnosing these disorders. Moreover, effective medications, such as propranolol, neuroleptics or anticholinergics are available.

Methods: We organised a four-day training course in Neurology in Yaoundé, Cameroon with a Spanish NGO (Recover-Hospitals for Africa). Half-a-day training was dedicated to movement disorders. Participants were trained in the differential diagnosis of HMD through video-based learning. Demographic data regarding the participants were recorded. We administered a test before and after the course. Descriptive statistics and correct answers before and after the training session were analysed. Statistical significance limit was set at p<0.01.

Results: Forty-two (52% women) health providers from rural and urban medical centres from all parts of Cameroon participated. 20% were doctors, 49% were nurses and 31% were nurses aides or psychologists. At baseline, 50% reported seeing ET patients in their clinic, 21% patients with dystonia and 9.5% patients with chorea. After the video-based learning course, these percentages decreased (17% ET patients, 7% dystonia and 2% chorea). Before the course, 23.8% of participants knew that propranolol is useful for ET treatment, 9.5% anticholinergics for dystonia, and 11.9% neuroleptics for chorea. At baseline, out of 6 treatment questions, median number of correct answers was 2 (1-3), while after the 2-hour course, the number of correct answers increased to median 4 (3-5) (p=0.001). Overall, 71% of participants improved their results after the course. No significant differences were found between groups of health providers.

Conclusions: HMD was highly misdiagnosed and poorly managed by this small sample of general health providers from rural and urban clinics in Cameroon due to lack of training in the field. A video-based educational course was highly effective in improving basic concepts and understanding of HMD among the participants.

References: 1. KANDIL, M. R., TOHAMY, S. A., FATTAH, M. A., AHMED, H. N. & FARWIEZ, H. M. 1994. Prevalence of chorea, dystonia and athetosis in Assiut, Egypt: a clinical and epidemiological study. Neuroepidemiology, 13, 202-10. 2. LEKOUBOU, A., ECHOUFFO-TCHEUGUI, J. B. & KENGNE, A. P. 2014. Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review. BMC Public Health, 14, 653.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/education-in-hyperkinetic-movement-disorders-in-cameroonian-health-providers/