Semin Neurol 2024; 44(02): 147-158
DOI: 10.1055/s-0044-1785539
Review Article

Neurology Training and Medical Education in Resource-Limited Settings: Building and Growing the First Neurology Residency Program in East Africa

Hanna D. Belay
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Meron A. Gebrewold
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Biniyam A. Ayele
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Dereje M. Oda
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Fikru T. Kelemu
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Yared Z. Zewde
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Selam K. Melkamu
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Mehila Z. Wuhib
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Seid A. Gugssa
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Abenet T. Mengesha
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
Guta Z. Metaferia
1   Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
› Author Affiliations


The burden of neurological disease disproportionately affects low- and middle-income countries, where the lowest number of neurologists are located. Building local training opportunities in resource-limited settings is a foundational step to enhancing the neurological workforce and improving access to neurological care in these regions. In this article, we describe the development and growth of the first neurology residency program in East Africa, which was established in 2006 at Zewditu Memorial Hospital and the Tikur Anbessa Specialized Hospital, Addis Ababa University, Ethiopia. We highlight the impact of the program on clinical care, research, collaborations between neurologists across Ethiopia, and ways to build educational opportunities and mentorship while faced with limited resources. The main challenges in starting the residency program included lack of faculty with neurological expertise, lack of a precedent for subspecialty training in our setting, as well as limited resources and space. The formation of sustainable international collaborations with clinicians at established institutions in high-income countries and neurological societies has been a major source of support in developing the initial infrastructure, curriculum and educational content, knowledge assessments, and mentored research projects. Local partnerships with related medical specialties, including internal medicine, critical care, neurological surgery, and psychiatry, were also instrumental in creating training opportunities. As the program continues to evolve, many challenges remain, including limited diagnostics, lack of access to advanced treatment modalities, lack of fellowship training opportunities in various neurological subspecialties, and insufficient training and experience in scientific writing. Despite these challenges, the residency program has persevered and its creation resulted in many positive changes: since its inception in 2006, we graduated 80 neurologists and the number of practicing neurologists in Ethiopia has increased from 5 to 78, our institution has evolved into a national referral center for neurology, graduates have published 61 articles in the past 3 years and contributed to international neurology research, and alumni of the program have grown the Association of Ethiopian Neurologists. Future directions include development of fellowship opportunities, creation of international rotations, and implementation of teleneurology to further strengthen neurological care across Ethiopia.

Publication History

Article published online:
17 April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Feigin VL, Vos T, Nichols E. et al. The global burden of neurological disorders: translating evidence into policy. Lancet Neurol 2020; 19 (03) 255-265
  • 2 The burden of neurological diseases on Europe [FACT SHEET]. European Academy of Neurology. Accessed March 28, 2024 at:
  • 3 Kissani N, Liqali L, Hakimi K. et al. Why does Africa have the lowest number of neurologists and how to cover the gap?. J Neurol Sci 2022; 434: 120119
  • 4 Bergen DC, Good D. Neurology training programs worldwide: a world federation of neurology survey. J Neurol Sci 2006; 246 (1–2): 59-64
  • 5 Bower JH, Asmera J, Zebenigus M, Sandroni P, Bower SM, Zenebe G. The burden of inpatient neurologic disease in two Ethiopian hospitals. Neurology 2007; 68 (05) 338-342
  • 6 Aarli JA, Diop AG, Lochmüller H. Neurology in sub-Saharan Africa: a challenge for World Federation of Neurology. Neurology 2007; 69 (17) 1715-1718
  • 7 Ayele BA, Zewde YZ, Tafesse A, Sultan A, Friedman JH, Bower JH. Non-motor symptoms and associated factors in Parkinson's disease patients in Addis Ababa, Ethiopia: a multicenter cross-sectional study. Ethiop J Health Sci 2021; 31 (04) 837-846
  • 8 Ayele BA, Wuhib MZ, Zenebe BG, Metaferia GZ. Serum vitamin D level among multiple sclerosis patients in the tropics: experience from a private clinic in addis ababa, Ethiopia. Ethiop J Health Sci 2021; 31 (03) 611-618
  • 9 Kassa SB, Anfucho AA, Loge BY, Ewunetu BD, Diba LA, Assefa AK. Magnitude of stroke subtypes and associated risk factors among patients admitted to Hawassa University Compressive Specialized Hospital. Int J Neurol Phys Therap 2022; 8 (02) 11-19
  • 10 Abebe K, Deresse B, Negeri KG. Non adherence to treatment and the associated factors in patients with epilepsy in Southern Ethiopia. Healthc Low Resour Settings 2022; 10 (01) 56-60
  • 11 de Souza AC, Sebastian IA, Zaidi WAW. et al. Regional and national differences in stroke thrombolysis use and disparities in pricing, treatment availability, and coverage. Int J Stroke 2022; 17 (09) 990-996
  • 12 Ayele BA, Amogne W. Central Nervous System Tuberculosis (CNS-TB) in treated HIV-infected adults in Tikur Anbessa Specialized Hospital, Ethiopia: a cross sectional study. J Clin Tuberc Other Mycobact Dis 2021; 24: 100252
  • 13 Deresse B. The pattern and burden of in-patient neurologic diseases at a tertiary hospital in southern Ethiopia: a retrospective hospital-based study. Ethiopian J Med Health Sci 2021; 1 (01) 32-39
  • 14 Fantu E, Hailu W, Bekele N, Tsegaye T, Tadesse M, Asres MS. Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study. BMC Neurol 2022; 22 (01) 446
  • 15 Zewde YZ, Ayele BA, Belay HD. et al. Electrodiagnostic referrals and neuromuscular disease pattern in East Africa: experience from a tertiary hospital in Ethiopia. Clin Neurophysiol Pract 2022; 7: 65-70
  • 16 Ayele BA, Belay HD, Oda DM. et al. electroencephalographic findings, antiepileptic drugs and risk factors of 433 individuals referred to a tertiary care hospital in Ethiopia. Ethiop J Health Sci 2022; 32 (05) 905-912
  • 17 Molla S, Demissie H, Ayele BA, Tsehayneh F, Ali S, Zenebe G. Factors associated with antiepileptic drug adherence in epileptic patients at a tertiary care center in Ethiopia: a cross sectional study. Afr J Neurol Sci 2021; 40 (02) 3-10
  • 18 Ayele BA, Tesfaye H, Wuhib MZ, Zenebe G. Factors associated with EEG slowing in individuals with Parkinson's disease. Ethiop J Health Sci 2022; 32 (01) 73-80
  • 19 Tamrat EG, Gufue ZH, Getachew S, Yifru YM, Gizaw M. Factors associated with the longer-term unmet supportive care needs of stroke survivors in Ethiopia: a multicentre cross-sectional study. BMJ Open 2022; 12 (01) e053579
  • 20 Mengesha AT. Frequency and factors associated with orthostatic hypotension in individuals with Parkinson's disease: a case-control observational study. Ethiop J Health Sci 2022; 32 (06) 1167-1174
  • 21 Zena D, Tadesse A, Bekele N, Yaregal S, Sualih N, Worku E. Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia. SAGE Open Med 2022; 10: 20 503121221100612
  • 22 Roushdy T, Aref H, Kesraoui S. et al. Stroke services in Africa: What is there and what is needed. Int J Stroke 2022; 17 (09) 972-982
  • 23 Abdella A, Deginet E, Weldegebreal F, Ketema I, Eshetu B, Desalew A. Tuberculous meningitis in children: treatment outcomes at discharge and its associated factors in Eastern Ethiopia: a five years retrospective study. Infect Drug Resist 2022; 15: 2743-2751
  • 24 Schumacher-Schuh AF, Bieger A, Okunoye O. et al; Global Parkinson's Genetics Program (GP2). Underrepresented populations in Parkinson's genetics research: current landscape and future directions. Mov Disord 2022; 37 (08) 1593-1604
  • 25 Melka D, Demisse H, Assefa H. et al. Epidemiological and clinical profile of amyotrophic lateral sclerosis in Ethiopia: a 5-year multicenter retrospective study. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24 (7–8): 1-9
  • 26 Habtamu A, Argaw R, Tuli W, Moges A. Magnitude and determinant factors of pediatrics seizures in pediatrics emergency unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020: a retrospective and descriptive study. Behav Neurol 2023; 2023: 3967899
  • 27 Misiker SY, Getachew S, Addissie A, Yifru YM. Magnitude and factors associated with seizure-related injury among patients with epilepsy at Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia. Ethiop Med J 2023; 61 (02) 143-150
  • 28 Endayen D, Ayalew M, Getahun M. Multiple anti-seizure medications use and pattern of seizure control in children with epilepsy at neurology follow up clinic, Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. Afr Health Sci 2023; 23 (02) 732-742
  • 29 Kim CY, Sardar Z, Ayele BA. et al. Neurological diagnoses in hospitalized COVID-19 patients during the B.1.1.529 surge. Ann Clin Transl Neurol 2023; 10 (08) 1433-1441
  • 30 Gelaw NB, Muche AA, Alem AZ. et al. Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021. PLoS One 2023; 18 (08) e0276472
  • 31 Ayele BA, Wuhib MZ, Zenebe BG, Zewde YZ, Wolde YT, Metaferia GZ. Neuroimaging features and associated factors in multiple sclerosis patients: a perspective from a private care center in Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 31 (05) 1043-1052
  • 32 Shewalem Geremew Denboba AW. Lower back pain among neurological and neurosurgical adult patients at an armed forces hospital Addis Ababa, Ethiopia. Am J Int Med 2021; 9 (03) 127-137
  • 33 Gebreegziabher EG, Mekonnen NG, Amogne MT, Umer SA, Takele GM, Huluka DK. Clinical characteristics and outcomes of patients with COVID-19 infection and acute ischemic stroke at Eka Kotebe general hospital in Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32 (02) 229-234
  • 34 Ayele BA, Ibrahim R, Tsegaye K, Birhanu T, Assefa H, Ergete W. Clinico-pathological diagnosis of facioscapulohumeral dystrophy in a 22-year-old male. Sudan. J Med Sci 2021; 16 (01) 135-142
  • 35 Ayele BA, Wako A, Tadesse J. et al. Pott's paraplegia and role of neuroimaging in resource limited setting: a case report and brief review of the literatures. J Clin Tuberc Other Mycobact Dis 2021; 25: 100283
  • 36 Deginet E, Tilahun R, Bishaw S, Eshetu K, Moges A. Probable vanishing white matter disease: a case report and literature review. Ethiop J Health Sci 2021; 31 (06) 1307-1310
  • 37 Ayele BA, Demissie H, Awraris M. et al. SARS-COV-2 induced Parkinsonism: the first case from the sub-Saharan Africa. Clin Park Relat Disord 2021; 5: 100116
  • 38 Ayele BA, Ali K, Mulatu E. Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures. Allergy Asthma Clin Immunol 2021; 17 (01) 88
  • 39 Mohammed A, Bane A, Mengistu G, Ayalew F, Seid AS. Acquired hepatocerebral degeneration after a splenorenal shunt in the Sub-Saharan Africa Context: a case report and brief review of literature. Cureus 2022; 14 (03) e23064
  • 40 Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?. Lancet Neurol 2020; 19 (05) 383-384
  • 41 Melka D, Zebenigus M. Probable HTLV-I/II tropical spastic paraparesis patient from Ethiopia: a case report. Ethiop J Health Sci 2022; 32 (04) 865-868
  • 42 Ayele BA, Abdella RI, Wachamo LZ. Reversible anomia and cerebral venous thrombosis: a case report and review of the literature. J Med Case Rep 2022; 16 (01) 56
  • 43 Gebresilassie BM, Ayele BA, Zenebe G, Tafese A. Case report Huntington's disease in a 31-year-old Ethiopian patient: a case report and a brief literature review. Ethiop Med J 2023; 61 (02) 2
  • 44 Melka D, Zebenigus M. Idiopathic harlequin syndrome in a patient from Ethiopia: a case report. Ethiop J Health Sci 2023; 33 (02) 383-386
  • 45 Abay Z, Bekele N, Alemye F, Belayneh E, Worku A, Tadesse A. Diagnosis of ‘sclerodermatomyositis’ in Ethiopian woman. Int J Clin Rheumatol 2021; 16 (07) 210-215
  • 46 Zewde YZ. Melkersson-Rosenthal syndrome misdiagnosed as recurrent Bell's palsy: a case report and review of literature. Allergy Asthma Clin Immunol 2021; 17 (01) 8
  • 47 Ayele BA, Tadesse Y, Guta B, Zenebe G. Millard-Gubler syndrome associated with cerebellar ataxia in a patient with isolated paramedian pontine infarction–a rarely observed combination with a benign prognosis: a case report. Case Rep Neurol 2021; 13 (01) 239-245
  • 48 Yaregal S, Bekele N, Gebrewold Y, Tadesse A. Neuromyelitis optica spectrum disorder: a case report. Int Med Case Rep J 2021; 14: 643-648
  • 49 Ayele BA, Getu Z, Samuel A. New-onset focal seizure as a presenting feature of HIV infection: a case report and mini review to the challenge in resource-limited settings. AIDS Res Ther 2021; 18 (01) 12
  • 50 Stirland LE, Ayele BA, Correa-Lopera C, Sturm VE. Authenticity and brain health: a values-based perspective and cultural education approach. Front Neurol 2023; 14: 1206142
  • 51 Anbessie MN, Belete YL, Ayele BA. et al. Media for advocacy of mental health in the Ethiopian context. Current practice, gaps, and future directions. Front Psychiatry 2023; 14: 1248827
  • 52 Akinyemi R, Sarfo F, Abd-Allah F. et al. Conceptual framework for establishing the African Stroke Organization. Int J Stroke 2021; 16 (01) 93-99
  • 53 Ayele BA, Ali S, Anbessie M. et al. The need for a tailored national dementia plan in Ethiopia: a call for action. Front Neurol 2023; 14: 1126531
  • 54 Johnston JC, Sartwelle TP, Zebenigus M, Arda B, Beran RG. Global neurology: the good, the bad, and the ugly. Neurol Clin 2023; 41 (03) 549-568
  • 55 Arsovska A. Rare Causes of Stroke: A Handbook:. Cambridge, MA: Cambridge University Press; 2022
  • 56 Maestre G, Carrillo M, Kalaria R. et al; African Dementia Consortium. The Nairobi Declaration-Reducing the burden of dementia in low- and middle-income countries (LMICs): Declaration of the 2022 Symposium on Dementia and Brain Aging in LMICs. Alzheimers Dement 2023; 19 (03) 1105-1108
  • 57 Steiner TJ, Jensen R, Katsarava Z. et al; Lifting The Burden: the Global Campaign against Headache. Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description. J Headache Pain 2021; 22 (01) 78
  • 58 Ayele BA, Zewde YZ, Degefa MT, Mengesha AT. Data set for demography, clinical characteristics, and risk factors of trigeminal neuralgia patients in Addis Ababa, Ethiopia. BMC Res Notes 2021; 14 (01) 9
  • 59 Ayele BA, Guta B, Tesfaye H. et al. Role of neuroimaging in suspected dementia patients: utilization of structural imaging algorithmic-based diagnosis in resource limited settings. J Alzheimer Assoc 2022
  • 60 Anbessie MN, Gebrehanna E, Zewde YZ, Ayele BA. Suicidality and non-fatal self-injury behaviors among people living with epilepsy attending neurology clinic at Zewditu memorial hospital and Amanuel mental specialized hospital, Addis Ababa, Ethiopia: a cross-sectional study. Clin Psychol 2023
  • 61 Okunoye OC, Zewde YZ, Azar J. et al. The state of play of Parkinson's disease in Africa: a systematic review and point of view. medRxiv 2023; 2023.07 . 07.23292392.
  • 62 Ayele BA, Gulelat H, Zebenigus M, Tadesse Y, Zenebe G. White matter hyperintensity in Parkinson's disease patients in Addis Ababa,. Ethiopia. 2021
  • 63 Mohammed S, Haidar J, Ayele BA, Yifru YM. Post-stroke limitations in daily activities: experience from a tertiary care hospital in Ethiopia. BMC Neurol 2023; 23 (01) 364
  • 64 Mohammed S, Abebe FT, Negash HA. et al. Tuberculoma masquerading as an en plaque Meningioma leading to a Diagnostic and Therapeutic Dilemma; a Case Report and a Multidisciplinary Perspective. Tumors 2023
  • 65 Zewde Y, Alem A, Seeger SK. Magnitude and predictors of poststroke cognitive impairment among Ethiopian stroke survivors: a facility-based cross-sectional study. Res Sq 2023
  • 66 Mohammed S, Tsehayneh F, Kifelew S. Charcot-Marie-Toothe Disease presenting with tremor; a rare presentation of hereditary polyneuropathy. Res Sq 2023
  • 67 Godebo TR, Jeuland M, Tekle-Haimanot R. et al. Bone quality in fluoride-exposed populations: a novel application of the ultrasonic method. Bone Rep 2019; 12: 100235
  • 68 Godebo TR, Jeuland M, Tekle-Haimanot R. et al. Association between fluoride exposure in drinking water and cognitive deficits in children: a pilot study. Neurotoxicol Teratol 2023; 100: 107293
  • 69 Ayele BA, Godebo TR, Tekle-Haimanot R, Yifru YM. Neuro-medical manifestations of fluorosis in populations living in the Main Ethiopian Rift Valley. Environ Geochem Health 2022; 44 (03) 1129-1136
  • 70 Zewde YZ, Zebenigus M, Demissie H. et al. The prevalence of headache disorders in children and adolescents in Ethiopia: a schools-based study. J Headache Pain 2020; 21 (01) 108