The Neurological Practice of an African District General Hospital.

Objectives: Whereas about 20% of emergency medical admissions in richer countries are neurological, the situation in poorer countries is less clear. To help clarify this we studied admissions data in a hospital in Nyala, Sudan and compared our findings with the results from a previous, methodologically similar study from Northern Ireland (NI). Methods: Over three months the numbers of emergency medical admissions to Nyala Teaching Hospital were recorded, along with the percentage with neurological symptoms. The following information was also noted: diagnosis, mortality, the use of investigations, and referral to neurologists and neurosurgeons. The results were compared to a study from the Downe Hospital, NI carried out in 1987. Results: Fifty-six (24%) of 234 medical admissions were neurological. Stroke (57%), infections (21%) and tumours (11%) made up 89% of neurological admissions, with epilepsy accounting for only 4%, a pattern quite different from the NI study. Mortality was 23% compared with 12% in the NI study. Referral to neurospecialists was similar. Conclusion: Although emergency neurological admissions were slightly commoner, the most striking difference between Nyala and the NI study was the high proportion of stroke admissions in Nyala to the near exclusion of other neurological conditions. The first priority to improving neurological care in Nyala, (and by implication, sub-Saharan Africa), is a stroke prevention program.