Research and Development Agenda
The populations of most developing countries are aging rapidly. Many neurological disorders frequently occur in the elderly, posing an emerging public health problem. As a result, developing countries should begin or expand their research and development agendas to address issues related to the prevention, identification, and management of neurological disorders. In the short term, they should focus on early identification, optimum treatment, and amelioration of distress and handicaps and on reduction of the social and economic burden on patients and their families. In the long term, they should develop and implement strategies for primary prevention of neurological disorders. Specific areas for research and development include the following:
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Conducting population-based epidemiological studies in developing countries. Population-based data from developing countries are insufficient, which limits evidence-based planning. In addition, such data may also suggest important hypotheses for research if they identify genuine differences across regions (for example, the reported difference in the incidence of AD in developed and developing countries). In addition, the identification of risk or protective factors would be useful in the primary prevention of such diseases.
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Enhancing existing health care delivery systems. In most developing countries, approximately 70 to 80 percent of patients live in rural areas, where medical care is frequently provided by nonphysician health care providers or, at best, by a general physician. Limitations in the availability of health care have resulted in a huge treatment gap for many neurological disorders. For such situations, a simple model for the management of neurological disorders by existing community-based health care providers, trained to provide such services, would be helpful. Research is needed on optimum referral systems for more difficult cases that local communities will accept and can afford. Strategies for home-based care of patients need to be systematically evaluated.
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Developing cheaper and more efficacious medicines. Many currently available medications have significant side effects and are too expensive for many patients in developing countries. Newer medications need to be developed with lower costs, fewer side effects, better efficacy, and less frequent dose schedules.
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Promoting the use of indigenous systems of medicine. Many people in developing countries use local indigenous medicines. More research needs to be done on the pharmacological properties of those medications (see chapter 69).
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Launching stigma removal campaigns. The stigmatization of patients with neurological disorders and of their families is still prevalent, particularly in rural and remote areas, and it often prevents patients from seeking and obtaining appropriate medical care. Effective strategies to address this issue need to be developed and implemented on a large scale.
