Objective: We aimed to determine the prevalence of PD in Kilifi County, Kenya within the Kilifi Health and Demographic Surveillance System and evaluate the performance of an existing PD screening tool in a new population.

Background: There have been few community-based PD prevalence studies within sub-Saharan Africa (SSA) which provides a challenge in advocating for the condition to improve policy prioritisation. Hospital-based prevalence studies rely on participants’ health-seeking behaviours. This can be partially addressed with community-based studies which have found large proportions of previously undiagnosed patients unrepresented in hospital-based studies.

Method: We utilised a two-phase community-based prevalence study. After training on PD, 30 non-medical interviewers screened 81,662 people aged ≥18 as part of an existing census. Phase two involved clinical assessment in the community of the positive respondents and a random sample of negative respondents to confirm or refute the presence of PD using the MDS clinical criteria.

Results: 1,088 people responded positively to the screening tool. PD crude prevalence was calculated as 30.6/100,000 in ≥18-year-olds. Age standardised this was estimated at 38.9/100,000 against the WHO World Standard Population 2005 and 72.3/100,000 against the European Standard Population 2013. The most common differential diagnosis was osteoarthritis. Sensitivity of the screening tool was 95% and specificity was 14.4%. Of the 25 patients identified, 14 were male, with a male:female ratio of 1.27:1. 84% of patients were newly diagnosed with PD through this study. The patients with known PD were on treatment but concordance was variable due to high costs of Levodopa.

Conclusion: The determined prevalence is similar to that reported in previous studies in SSA, but variable methodologies and age cut-offs impair comparisons. After age-standardisation, the prevalence remains much lower than the estimated global mean. Contributing factors to this include lack of awareness of PD and stigma around the condition making participants less likely to volunteer symptoms, even in community-based studies. The high sensitivity is useful given the low community awareness, but generates a very high number of false positives to screen. The high rate of previously undiagnosed patients emphasises the importance of community-based studies in areas with poor awareness of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-prevalence-of-parkinsons-disease-in-kilifi-county-kenya-a-transforming-parkinsons-care-in-africa-trapcaf-study/