Innovation summary

Dementia is under-diagnosed in sub-Saharan Africa. Treatment is rarely available and when available, rarely accessed. The aim of this project is to set up programs to facilitate diagnosis of, and therapy for, people with dementia within local communities in Nigeria and Tanzania.

The innovation will consist of the following:

Detection

  • Validation of screening tool for dementia
  • Training of local healthcare workers to use screening tool
  • Community awareness-raising to increase detection

Treatment

  • Testing of cognitive stimulation therapy (CST) for treatment of known cases of dementia
  • Training of nurse specialist and occupational therapist in CST at each study site
  • Psychoeducation and training for primary caregivers provided by nurse specialist and occupational therapist

Impact summary

  • Forty older persons underwent CST (31 in Hai and 9 in Lalupon) 
  • Improvement in cognitive performance post-CST at both sites, with participants reporting satisfaction and benefits from the intervention, a significant reduction in caregiver burden, and a reduction in health facility visits
  • Shown to be a cost-effective and feasible intervention for managing mild to moderate dementia

"Many people with dementia are living undiagnosed in the community, with little support or education for their caregivers and no social services framework to provide extra care at home or access to institutional care."

 

-Project for the Identification and Treatment of Dementia in Sub-Saharan Africa

This innovation is funded by Grand Challenges Canada.

Innovation details

The proposed study will be conducted in Tanzania and Nigeria in three phases. The study sites will provide data on two distinct populations with differences in genetic make-up, diet, education, health systems, language, and lifestyle.

Phase I

  • Validation of dementia screening instrument
  • Pilot trial of cognitive stimulation therapy (CST)

Phase II

  • Identification of cases of dementia the community through awareness-raising and education, including:
    • Interaction with numerous organisations, utilizing some of the effective community engagement approaches already in place
    • Community-based awareness program for dementia (using text messaging and other media)

Phase III

  • Provision of effective and affordable community-based care and rehabilitation for people with dementia through
    • Training of nurse specialists and occupational therapists in CST techniques
    • Use of CST in the community
  • Provision of education and training for caregivers

     

Key drivers

Both sites have been used previously as epidemiological study sites.

A community-based prevalence study of dementia was recently conducted in Hai, Tanzania, using the instruments from the 10/66 Dementia Research Project.

The Hai district is a long established demographic surveillance site, and regular censuses are conducted.Through previous research on the prevalence and incidence of stroke and the prevalence of Parkinson’s disease, essential tremor, epilepsy, neurological disability and atrial fibrillation, project collaborators have established strong links with the research infrastructure in Hai.

Challenges

Potential barriers to diagnosis and treatment may include:

  • Lack of previously validated screening instrument for dementia in sub-Saharan Africa
  • Lack of evidence for effective, affordable and sustainable treatments for dementia in sub-Saharan Africa
  • Lack of awareness about dementia among community members and healthcare workers

Continuation

The proposed model of care for dementia will be evaluated and potentially considered for replication in Nigeria, Tanzania and elsewhere in sub-Saharan Africa.

Provided additional funding can be secured, it is envisaged that the occupational therapist and nurse specialist will continue to work in Hai and Lalupon beyond the end of the study. They will then be the leads of the “dementia team” in the area, to which primary healthcare workers could refer possible cases of dementia.

Evaluation methods

Change in quality of life will be evaluated to determine clinical effectiveness. A full cost analysis will also be carried out.

Cost of implementation

$865,086 USD grant funding provided over three years.

Impact details

Forty older persons underwent CST (31 in Hai and 9 in Lalupon). There was improvement in cognitive performance post CST at both sites with participants reporting satisfaction and benefits from the intervention. Caregiver burden was significantly reduced after the CST. Overall, the adapted CST was shown to be a cost-effective and feasible intervention for managing mild to moderate dementia in SSA. Visit to health facilities was also much reduced.

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Country

Nigeria, Tanzania, United Republic of

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