Objective: The objective of the study is to analyze the clinical and socio-demographic characteristics of people with Parkinson`s (PwP) attending the adult neurology outpatient clinic at Queen Elizabeth Central Hospital (QECH) in Malawi.

Background: There is currently no published data on PD in Malawi even though patients are seen regularly at the QECH neurology clinic. With the number of individuals aged ≥ 60 in Malawi projected to increase to 8.9% of the total population by 2050, PD is also expected to become more prevalent. This highlights the need to analyze the dynamics of the disease in Malawi.

Method: Data was collected between Aug and Dec, 2023 during an ongoing study using a customized questionnaire and the MDS-UPDRS (Study protocol P.03/23/4037). Inclusion criteria were a clinical PD diagnosis, carbidopa/levodopa prescription, and being on a follow-up visit.

Results: Sixteen PwP, 8 males and 8 females, were recruited, which is half of the projected sample size. The mean ages were 60.6 ± 12.6 years at recruitment and 57.3 ± 11.9 years at PD onset, and females were younger at both. Early-onset PD (< 50 years) accounted for 37.5% (3/8) of both males and females. Three risk factors were reported: PD family history in 12.5% (2/16), head trauma in 6.3% (1/16), and toxic chemical exposure in 43.8% (7/16) of PwP, respectively. Half of the PwP were prescribed levodopa monotherapy, and the rest were supplemented with trihexyphenidyl and/or propanolol. The mean LEDD was 238 ± 101 mg. However, only 68.8 % (11/16) of PwP were on carbidopa/levodopa medication at recruitment. The most frequent comorbidities were hypertension (75%, 12/16) and HIV/AIDS (37.5%, 6/16). Consequently, 37.5% (6/16) of PwP had severe Charlson`s comorbidity index ≥ 5. Motor examination using the MDS-UPDRS Part III showed that 62.5% of PwP had severe PD with mild to severe impacts on motor and non-motor experiences of daily living.

Conclusion: Collectively, these preliminary results indicate severe motor burden in the majority of PwP at the clinic, likely due to poor carbidopa/levodopa adherence because of its cost. High burden of HIV/AIDS and hypertension largely contributes to severe comorbidity. The high prevalence of early-onset PD is markedly different from other populations and warrants further investigation. However, concrete conclusions will be drawn once the target sample size is met.

References: [1] Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020;27(1):27-42. doi:10.1111/ene.14108

[2] Collier TJ, Kanaan NM, Kordower JH. Aging and Parkinson’s disease: Different sides of the same coin?: Aging and PD. Mov Disord. 2017;32(7):983-990. doi:10.1002/mds.27037

[3] Gwedela, MNV., Phiri, TE. Parkinson`s disease in Malawi: A preliminary report from Queen Elizabeth Central Hospital (QECH) adult neurology outpatient clinic. Unpublished abstract presented at the Wellcome Connecting Science Molecular Neurodegeneration and Therapeutic Approaches Course, 23 Jan, 2024.

[4] Gwedela, MNV., Phiri, TE. A preliminary report of the clinical profile of people with Parkinson`s disease in Malawi. Unpublished abstract presented at the 5th IBRO-ARC Online Workshop on “Climate Change Effect on CNS Re-programming and Associated Disorders”, 3 Feb, 2024.

[5] Martínez-Martín P, Rodríguez-Blázquez C, Mario Alvarez, et al. Parkinson’s disease severity levels and MDS-Unified Parkinson’s Disease Rating Scale. Parkinsonism Relat Disord. 2015;21(1):50-54. doi:10.1016/j.parkreldis.2014.10.026

[6] Skorvanek M, Martinez‐Martin P, Kovacs N, et al. Differences in MDS ‐ UPDRS Scores Based on Hoehn and Yahr Stage and Disease Duration. Mov Disord Clin Pract. 2017;4(4):536-544. doi:10.1002/mdc3.12476

[7] 2018 Malawi Population & Housing Census

[8] https://www.parkinson.org/

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-preliminary-report-on-the-clinical-profile-of-people-with-pd-at-an-outpatient-clinic-in-malawi/