Brain disorders—neurological, psychiatric, and developmental—now affect at least 250 million people in the developing world, and this number is expected to rise as life expectancy increases. Yet public and private health systems in developing countries have paid relatively little attention to brain disorders. The negative attitudes, prejudice, and stigma that often surround many of these disorders have contributed to this neglect.

Lacking proper diagnosis and treatment, millions of individual lives are lost to disability and death. Such conditions exact both personal and economic costs on families, communities, and nations. The report describes the causes and risk factors associated with brain disorders. It focuses on six representative brain disorders that are prevalent in developing countries: developmental disabilities, epilepsy, schizophrenia, bipolar disorder, depression, and stroke.

The report makes detailed recommendations of ways to reduce the toll exacted by these six disorders. In broader strokes, the report also proposes six major strategies toward reducing the overall burden of brain disorders in the developing world.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON NERVOUS SYSTEM DISORDERS IN DEVELOPING COUNTRIES
• BOARD ON GLOBAL HEALTH
• REVIEWERS
• Preface
• Acknowledgments
• Part I
  • Executive Summary
    • BACKGROUND
    • SCOPE
    • MAGNITUDE OF THE PROBLEM
    • FINDINGS AND FUTURE STRATEGIES
    • CONCLUSION
  • 1. Introduction
    • NEUROLOGICAL, PSYCHIATRIC, AND DEVELOPMENTAL DISORDERS
    • CHALLENGES FOR THE CARE OF BRAIN DISORDERS
    • GOALS OF THE STUDY
    • STUDY APPROACH
    • ORGANIZATION OF THE REPORT
    • REFERENCES
  • 2. The Magnitude of the Problem
    • EFFECTS ON COMMUNITIES AND NATIONS
    • EFFECTS ON INDIVIDUALS AND FAMILIES
    • THE ROLES OF POVERTY AND GENDER INEQUALITY
    • CAPACITY TO ADDRESS BRAIN DISORDERS
    • CONCLUSION
    • REFERENCES
  • 3. Integrating Care of Brain Disorders into Health Care Systems
    • THE ROLE OF PRIMARY CARE IN ADDRESSING BRAIN DISORDERS
    • DEVELOPING A SYSTEM OF CARE
    • BUILDING CAPACITY THROUGH TRAINING
    • COLLABORATION WITH OTHER HEALTH AND NONHEALTH SECTORS
    • THE COST OF INTEGRATING SERVICES
    • BUILDING RESEARCH CAPACITY THROUGH COLLABORATION
    • POLICY IMPLICATIONS
    • INTERNATIONAL SUPPORT FOR SYSTEMS OF PRIMARY CARE
    • NATIONAL CENTERS FOR TRAINING AND RESEARCH
    • CONCLUSION
    • REFERENCES
  • 4. Findings and Future Strategies
    • REDUCING THE DISEASE BURDEN NOW
    • CREATING OPTIONS FOR THE FUTURE
    • CONCLUSION
• Part II
  • INTRODUCTION
  • 5. Developmental Disabilities
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • CONCLUSION
    • REFERENCES
  • 6. Epilepsy
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • ANNEX 6-1 Neurocysticercosis
    • REFERENCES
  • 7. Schizophrenia
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • REFERENCES
  • 8. Bipolar Disorder
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • REFERENCES
  • 9. Depression
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • REFERENCES
  • 10. Stroke
    • DEFINITION
    • SCOPE OF THE PROBLEM
    • PREVALENCE AND INCIDENCE
    • Incidence
    • RISK FACTORS
    • INTERVENTIONS
    • CAPACITY
    • REFERENCES
• Epilogue
  • ESTABLISHING NATIONAL AND LOCAL PRIORITIES FOR ADDRESSING BRAIN DISORDERS
  • THE POTENTIAL FOR PREVENTION
  • INCREASING THE CLINICAL AND RESEARCH PROFESSIONAL CAPACITY IN DEVELOPING COUNTRIES
  • COLLABORATIVE RESEARCH INTO GLOBAL HEALTH PROBLEMS
  • ACCESS TO AND AFFORDABILITY OF ESSENTIAL PHARMACEUTICAL PRODUCTS
  • AN INVESTMENT IN FUTURE OPPORTUNITIES
• APPENDIX A The Study Approach
• APPENDIX B Measurement Issues in Calculating the Global Burden of Disease
• APPENDIX C Workshop Agenda
• APPENDIX D Economic Analysis
• APPENDIX E Committee and Staff Biographies
• Glossary
• Acronyms

Support for this project was provided by Centers for Disease Control and Prevention, Global Forum for Health Research, National Institute for Child Health and Human Development, National Institute for Mental Health, National Institute for Neurological Disorders and Stroke, and the Fogarty International Center of the National Institutes of Health. The views presented in this report are those of the Institute of Medicine Committee on Nervous System Disorders in Developing Countries and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.