Access to Pediatric Neurology Training and Services Worldwide: A Survey by the International Child Neurology Association

Abstract

Pediatric neurology is the medical subspecialty responsible for diagnosing and managing diseases and disorders of the nervous system in childhood and adolescence. In many, but not all, regions of the world, the discipline of pediatric neurology is recognized as a specialty or subspecialty of either neurology or pediatrics. Significant knowledge and competencies in this area are necessary to be effective in clinical practice. The need for this is driven by the high burden of disease from neurologic conditions in children and the effect on their families. As the first part of a multistaged project under the auspices of the International Child Neurology Association, in collaboration with key stakeholders, a survey was undertaken to establish which countries have practicing child neurologists. For those countries that have child neurologists, the survey established the number of practitioners and which countries have access to in-country child neurology training. Responses were obtained from 177 countries. Worldwide, there is a median of 0.07 and mean of 0.39 child neurologists per 100,000 population. The greatest deficits in child neurology specialists and access to training were evident in countries which fell under the World Bank rating of low-income country status (range of 0-0.008 child neurologists per 100,000 population). Seventy-three percent of low-income countries lack access to child neurologists: The majority are in the African and South-East Asia regions. For the population of 1.37 billion in the continent of Africa, there were 324 child neurologists, equating to a median of 0.01 per 100,000 population in comparison with a median of 0.59 child neurologists per 100,000 across high-income countries. Ninety-four countries had capacity to support in-country pediatric neurology training. Worldwide, there are inadequate numbers of child neurologists and a great need for increased training capacity.

Figure 1. Color-Coded Map of Ratios of Child Neurologists per 100,000 of Country Populations Worldwide

Colors, explained in the key, demonstrate the range of low to high prevalence in different regions.

Figure 2. Distribution of Child Neurologists According to WHO Region (A and B) and World Bank Country Income Groups (C and D)

(A) Box plot of the actual number of child neurologists according to WHO region demonstrating the range and outliers. (B) Box plot based on WHO regions for the number of child neurologists per 100,000 population demonstrating the range and outliers. (C) Box plot of the number of child neurologists according to the World Bank country income status groups showing ranges and outliers. (D) Box plot of the number of child neurologists per 100,000 according to the World Bank country income status groups showing ranges and outliers.

Figure 3. Worldwide Access to Pediatric Neurology Training Programs

(A) Percentage comparisons of the proportions of child neurologists, access to training, and capacity for in-country training across LICs, LMICs, UMICs, and HICs. (B) Subspecialty recognition and training program availability by country income groups. HIC = high-income country; LIC = low-income country; LMIC = low middle-income country; UMIC = upper middle-income country.

Figure 4. Infographic for the Sub-Saharan Africa Child Neurology Capacity Inclusive of Key Open Comments That Echoed Common Themes