Neurophobia in low- and middle- income countries (LMICs): burden and implications for neurology care and research - a systematic review.

Abstract

<h4>Introduction</h4>Although neurological research and practice are gaining traction globally with newer therapeutic/diagnostic approaches, many medical students and trainees are reluctant to pursue careers in the neurosciences. Amid fragile health systems and low neurologist-patient ratios, a comprehensive understanding of the burden of neurophobia in low- and middle- income countries (LMICs) is yet lacking. We reviewed the burden of neurophobia and described its implications for neurology care and research.<h4>Methods</h4>We conducted a systematic search of PubMed, EMBASE, Google Scholar, Scopus, and African Journals Online (AJOL) for publications from inception till December 2024, using combinations of relevant search terms for 'neurophobia', 'burden/prevalence/patterns/predictors', our target populations, and 'low- and middle-income countries (LMICs)'. Data from selected studies were extracted and populated into a customized spreadsheet under pre-defined headings. The extracted data were subsequently analyzed.<h4>Results</h4>A total of 131 studies from PubMed (n = 25), AJOL (n = 6), EMBASE, CINAHL, Scopus, and Google Scholar (n = 100) were screened. Ultimately, 15 studies were included, with a total sample size of 4,430 participants - comprising 3,629 medical students and 801 doctors. The prevalence of neurophobia was highly variable, ranging from as low as 6.25% to as high as 91.4%. The determinants, however, appeared consistent across study settings, comprising specific individual-level characteristics educational, sociocultural, as well as health system-related factors.<h4>Conclusion</h4>The prevalence of neurophobia in LMICs varies widely. To tackle neurophobia, extant health policy, educational, and clinical training initiatives should be geared towards implementing and sustaining evidence-based strategies to improve clinical exposure and case-based learning. This will be critical to ensuring a steady stream of neurology workforce and may help bridge the neurology clinical care and research gap in LMICs.