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Brain disorders in India and other developing countries

Until now, health research in developing countries like India has focused on highly pervasive infectious diseases and malnutrition. But, it is becoming increasingly important to study brain disorders as well, says an international team of neuroscientists.

About one-third of the total disease burden in developing countries comes from brain disorders. In India alone, there are 3.7 million people with dementia and the numbers are expected to double by 2030. Dementia refers to a range of symptoms that includes the loss of memory and decline in mental abilities like thinking, problem solving and language; it is caused due to brain degeneration. It is a common symptom of Alzheimer's disease (AD) and has been noted in people in their mid-60s.

The degeneration of the brain as we age is primarily a medical problem. But, with the increasing ageing population across the world, it has now become an economic issue as well. Since India will see the largest increase in elderly population in the next few years, it is important to focus on the diagnosis and treatment of these disorders. Moreover, the ethnic diversity and disparate socioeconomic development has led to a variation in the prevalence and burden of neurological, mental health, developmental and substance-use disorders (NMDS disorders) in the country.

In a paper published in Nature, researchers have compiled information about the brain disorders dominant in certain low and middle income countries across the globe: in Africa, Asia, Middle East and Latin America. They have found that while there are great similarities across regions in terms of certain common problems, region specific differences still exist. The characteristics of certain brain and nervous system disorders are different from country to country. Low and middle income countries have different population demographics, size, conflict and cultures compared to developed countries. This has an impact on their burden of NMDS diseases. These disorders are aggravated by the lack of nutrition and infectious diseases prevalent in these areas. 

In India for example, anemia is very common in women across the country, even in the middle income classes. When a child is born to an anemic mother, s/he is very likely to have irreversible intellectual impairment. Other disorders specific to India are brain disorders resulting from alcohol and drug addiction issues. Furthermore, there is an acute shortage of psychiatrists, psychologists and psychiatric social workers in India. People with neuropsychiatric disorders remain largely undiagnosed and even when they are diagnosed, they are faced with stigma and often do not have access to sustainable, affordable treatment and optimal medical care.

Sub Saharan Africa was found to be affected by disorders related to increasing longevity such as stroke, malnutrition, HIV and epilepsy. This was further worsened by the high burden of infectious diseases and poor public health infrastructure. In the Middle East and North Africa, psychiatric disorders such as depression and post-traumatic stress disorders were common because of the conflict ridden environment. In Latin America and Asia, lifestyle diseases such as stroke, dementia and vascular diseases are common. In southern Asia, including India and China, the ethnic diversity and disparate socioeconomic backgrounds have led to a wide variation in the burden of NMDS disorders. Epilepsy, dementia, cardiovascular diseases and tobacco use are common in these areas. Around 80% of the world’s epilepsy occurs in LMICs but only 20% is treated. Diagnosis and treatment of epilepsy is a low hanging fruit and can quickly make a difference.

Each country, because of the discrepancies and deviations between countries, has specific needs in terms of research priorities, prevention and treatment. The boundaries to understand the differences in the spread, type, characteristic and scale of diseases are not just physical, but also cultural and economic. Some of the other barriers that come in the way of such studies are the disproportionate distribution of scientists and insufficient resources for treatment and research.

Identifying risk and protective factors, integrating traditional methods of treatment and budgeting for health and research are some ways to address region specific research needs. Regional variations of NMDS disorders among countries implies that research priorities need to be addressed country-by-country and by regions within countries.

However, mental health is fundamentally the same across the world, be it in developed or developing countries. The authors feel that with increased cooperation in research and healthcare, the mounting problem can be managed.

About the paper:

This paper was published in Nature on 19th November, 2015.

Link to paper:

http://www.ncbi.nlm.nih.gov/pubmed/26580328

Author Information:

This paper has been written by a team of authors – Vijayalakshmi Ravindranath, Hoang-Minh Dang, Rodolfo G. Goya, Hader Mansour, Vishwajit L. Nimgaonkar, Vivienne Ann Russell & Yu Xin.

Dr. Vijayalakshmi Ravindranath is the Chairperson at the Centre for Neuroscience, Indian Institute of Science, Bangalore.