Professor Richard Walker
Northumbria Healthcare NHS Foundation Trust
Can we safely treat and monitor people with Parkinson's in Tanzania: A model for sub-Saharan Africa?
Through a door-to-door, community-based prevalence study in Hai, Tanzania, 33 patients with Parkinson’s were identified from a population of 161,000 people. This is the largest prevalence study of Parkinson’s in sub-Saharan Africa (SSA). The majority were previously undiagnosed and untreated, despite some having symptoms for many years. Drug treatment in late stage Parkinson’s can lead to a number of side effects and complications. Little is known about the effect of introducing therapy to drug-naive patients at this stage. All surviving patients (16) have received treatment for three years and we propose to follow them for another three years to titrate doses, and document and manage emerging side effects. This study would not be possible in the UK or other developed countries, as patients begin treatment at, or shortly after, diagnosis. However, we believe that many similar patients exist in developing countries for whom the care model developed may be appropriate. The study will provide information on treatment in such patients and insight into the mechanism of motor complication development and the differing contributions of disease and treatment duration. We will report on the feasibility, safety, adherence and efficacy of treating patients in a developing country, and the impact on quality of life and health beliefs. The surviving patients will be reviewed monthly by the UK-trained Tanzanian Parkinson’s nurse specialist and at least yearly by UK research doctors who will be also be available for phone and email advice. Response to treatment and any side effects will be recorded.