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Malaria Infection Socio-Economic Factors in the Outpatients in District Hospitals, Sub-Saharan Africa

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Research Article

Malaria Infection Socio-Economic Factors in the Outpatients in District Hospitals, Sub-Saharan Africa

  • Tuyapeni Sharon Grace 1
  • Sheehama Jacob 2,4*
  • Hermine Iita 3

*Corresponding Author: Sheehama Jacob, Department of Public Health, University of Namibia, Oshakati, Namibia, School of Health Sciences, Cardiff University, Wales, UK.

Citation: Tuyapeni Sharon Grace, Sheehama Jacob and Hermine Iita, (2022), Malaria Infection Socio-Economic Factors in the Outpatients in District Hospitals, Sub-Saharan Africa. J. Biomedical Research and Clinical Reviews. 8(2); DOI:10.31579/2692-9406/149

Copyright: © 2023, Sheehama Jacob. this is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 14 March 2023 | Accepted: 21 March 2023 | Published: 28 March 2023

Keywords: malaria; transmission; infection; prevention

Abstract

Background: Malaria has become a threat in Namibia,more especially in Engela Districtsince 2010, with cases being reported to increase and the number of deaths rising as well. With the rising of these cases, the economy was slowly decreasing due to purchasing of mosquito nets, repellents and others. Based on a malaria case investigation done in Namibia for 5 years, it is stated that the incidence fell from 53.6 to3.6 cases per 1000 population, and then increased again to 47.3/1000.

Method: A preliminary search will be conducted in the databasessuch as: GoogleScholar, the PubMed,and the Library. This scoping review was also conducted by using key words such as malaria, social factors, economic factors, effects and outpatients. Scoping review framework used in the study is by Joanna Briggs Institute that will be followed throughout the review process and the reporting of the main reviewwill follow the PRISMA-ScR.

Results: The evaluation of the studies that have occurred some have indicated gaps in their research due to reasons unknown. The use of long lasting insecticide nets was indicated although not all were in accordance with the WHO requirements of malariaprevention. Lack of income, strongsocial support was also observedand indicated to be the major cause of Malariain many areas of the world.

Conclusion: This scoping review will assist in the mapping out of evidence on the socioeconomic factors of malaria effects on outpatients which can help out the Health Professional with the right approaches to be used in terms of elimination of malaria, educating the patients about malaria itself before prescribing them medications.

Introduction

Malaria is a major public health problem in the world where cases are also increasing and recorded. Based on the latest World malaria report, released in December 2019, there were 228 million casesof malaria in 2018 comparedto the 231 million cases in 2017. The estimated number of malaria deaths stood at 405 000 in 2018, comparedwith 416 000 deaths in 2017.

There were 228 million estimatedcases malaria worldwide and the estimated number of malaria deaths stood at 405 000 in 2018 as well. Children with ages below 5 years are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272 000) of all malaria deaths worldwide. The African Region carriesa disproportionately high share of the global malaria burden. In 2018, the region was home to 93% of malaria cases and 94% of malaria deaths. Total funding of malaria control and elimination reached an estimatedUS$ 2.7 billion in 2018. Contributions from governments of endemic countriesamounted to US$ 900 million,representing 30% of total funding. In 2018, 6 countries accounted for more than half of all malaria cases worldwide: Nigeria (25%), the Demographic Republicof the Congo (12%),Uganda (5%), and Cote d’Ivoire,Mozambique and Niger (4% each).Most importantly, malariais typically found in tropicaland sub tropicalclimates where the parasites can live. The WHO statesthat, in 2016, there were an estimated 216 million casesof malaria in 91 countries.

In the United States, the Centers for Disease control and Prevention (CDC) reported 1700 cases of malaria annually. Most cases of malaria develop in peoplewho travel to countries where malaria is more common. [1]

Malaria remains a major global public health concern, as in 2014, an estimated 214 million cases and 438 000 deaths were reported worldwide, hence the significance of the research is to improve and engage in more efficient solutions on how to eliminate malaria, to decrease the death cases of malaria and educate the population on the dangers of malaria and its prevention and control measures altogether. The research will also serve as an educational platform and implication of changes on how to control transmission of malaria from other African countries at the borders.

It appears that factors influencing malaria includes lack of long –lasting insecticide treated nets, poor hygienic surrounding with the presence of swamps, grass, and wastes, poor education on malaria. It is mostly believed to be influenced by the fact that some people are ignorant to signs of malaria, uneducated and also ignorant when it comes to taking prevention measures of malaria. Future consequences of Malaria may include severe malaria, which is deadly, increase in number of death cases and increasedgovernment expenditure towards malaria in terms of medication and nets. The other social and economic factors that can increase malaria and its cases include whetherthe outpatients are most likelyto live in rural areas,they lack enoughresources to acquire required protective gear of malaria like mosquito nets as mentioned earlier, it is also believed to be influenced by alcohol abuse by the people who in the end run out of money, use of traditional treatment of malaria is also believedto have an impact and lastly they might be uneducated. [2]

Methods

Study design

It evaluates and assesses the socioeconomic factorsof Malaria on outpatients. This qualitative scopingreview protocol was done followingthe Joanna Briggs Institute, (JoannaBriggs Institute, 2015) methodology scoping reviews. Collection of information from the library books, journals and websitessuch as chrome,Google scholar will be used. This will be done following five stages such as: identifying the research question, identifying the relevant studies,study selection, chartingof data and collating, summarizing and reporting the results and an optional step of a consultation which is to validate the findings from the scoping review.

Study Population and Period of Evaluation

The study population used included all those articles that ranged from 2006 to 2020 were included in the study. All articles that were written in English and were in correlation with the study’s objectives, aims and title were included in the study. It considered also both the published and unpublished studies,and it was done using words like socioeconomics, malaria,effects and outpatients. The databases used and chosen contained due studies relevantto the research question. [3]

Study Sites

Amongst all those continents where Malaria existed,the articles done in Sub- SaharanAfrica were used as a site due to the fact that it containedmuch cases and deaths due to Malaria. These articles all ranged or came from different departments including Epidemiology, Public Health, Economics, Science and many others.These sites were all part of the same continent that contained similarclimates, weather and economic status,as they were easier to compare and locate. [4]

Descriptions Of Interventions and Contributing Factors Education level

This indicated that those who had formal education about malaria or just different types of diseases in particular are less likely to get malaria as they know all about its prevention measures, and those who lacked formal education tend to get more sick due to the fact that they might not get jobs to support their families and buy measures to prevent against malaria such as building houses with proper windows and doors.

Age

The young people with ages between 15 and 27 are more at least of malaria as they tend to be more ignorant in its prevention, treatment and health education campaigns. Although all ages can be infected or can get malaria especially babies and the elderlyor those with low immune system.

Attitudes

Those with the wrong attitude towards malaria are more likely to suffer the consequences of malaria. This involves not taking part in any of malaria programs such as having your house sprayedagainst mosquitoes, not attending health education or so on.

More research needs to be done on the socioeconomic factors of malaria as malaria cases keep increasing every now and then as it has become an everyday thing or occurrence. Some studies focused on general factors of malaria only, others on socioeconomics whilst others focused on both the factors which results in less information being given to each of the factors individually. [5]

Data Collection Procedures

During the study period, all the articles with similarities with the title of the study were being recorded in a table form and described according to their findingsand characteristics. In all the sites or articles, eligibility and screening was being used to identified the most needed and important articles.The table below shows the results and hw the data was collected:

AuthorMain characteristics and findings
Shr-Jie Wang

A cross sectional study, with a sample size of 200 and controls of 200 in total as well. The Plasmodium falciparum infection ranged in a total of 1 054 subjects and only 705 were mainly children under 5. 425 subjects declared havinghad a malaria attack withinone month of the survey. Among them, 60.7%were treated by traditional herbs and healers, 27.8% in health facilities, while 5.2% of the sample population only purchased drugs in a pharmacy or a drugoutlet. The prevalence of malaria parasites was low: 0.8%, 1.4%, 2.7% and 3.7% in the centre, intermediate, periphery and surrounding rural areas, respectively. Health facilities surveysshowed that only37/717 (5.2%) of presenting fevercases and 22/781(2.8%) of

non-fever cases. A remarkably high coverage of insecticide-treated nets and a corresponding reduction in malarial infection risk were found.(13)

Anne Caroline Krefis, Norbert               Georg Schwarz

A diagnostic assessment with a sample size of 1496 children and adults. It was found that those factors indicating the family's socioeconomic status the proportion of literate fatherswas very high(> 75%) and evenly distributed under children withand without malaria. Likewise, the variables "house type",

"income manage", "membership in a health insurance", "existence of an indoor kitchen" and "mother's

 

and father's occupation" did not showany distinct association with malaria (Seeadditional file 1 describing characteristics of the study group). In the univariate analysis, the variables "existence of electricity", "indoor toilet", "use of freezing as food conservation", "mother's ability to readand write" anda "closed water supply" were negatively associated with malaria odds (OR = 0.72, OR = 0.67, OR

= 0.63, OR = 0.68, OR = 0.70, respectively, all p-values < 0 xss=removed>

in children from families, which reported the use of mosquito protection measures

Ivan Mboambogoh Yakum,            GodfreyForgha Njimanted

A cross sectional studyand indicator surveywith a samplesize of 400 households. Thisstudy found thatamongst the respondents’ knowledge of malaria prevention methods, 0.75% of the respondents indicated that they did not know how best malaria can be prevented, 25% of the respondents indicated good personal hygiene as the best way of preventing malaria, 18.3% of them indicated that malaria can be prevented by avoiding excessive heat, 0.3% of them said malaria can be prevented while 5% of them indicated that it can be preventing through eating balanced diet. Amongst all the respondents on ways tobest prevent malaria, the study found that 56.6% indicated that the best way is to clear bushes around while 28.7% of them indicated creating a good drainage system as the best way to prevent malaria and 17% of them indicated the use of insect sprays to be the best practice to prevent malaria. Among the measures to prevent mosquito bites, 30.5% of the respondents indicated always closing doors and windows, 34.8% of them indicated the use of repellents, 15.8% of them indicated the fitting of nets on doors and windows (housemodification) and 92% of themindicated sleeping under ITNswhile 26% of them indicated the frequent useof anti-malaria drugs.However, among themeasures indicated, measures best known by the respondents are firstly theuse of ITNs,secondly clearing of bushes aroundand thirdly the use of repellents. The finding also involves the fact that many households chose malaria prevention options that is free(34.3%), seconded by those thatare cheaper (26.5%), then those thatchoose because it is the one they know (20.8%), those that choose because it is readily available (19.3%), no particular

reason (6.3%) and lastly those that prefer an optionbecause it is effective (1.3%).

Pascalia            Chanda,

Marianela        Castillo- Riquelme

An observational study, which had indicated that about 60

Results

The findings of the study were presented in tables, narrative summaries as well as figures. The 10 used studies and their findings are summarized into different categories for easier identification and are denoted by descriptive labels.

The following tables and figures represent the possible contributing general factors and socioeconomic factors based on the number of studies that acertain factor has appeared in.

Table 1: Number of studies per age group of outpatients (n=10)

Sixty percent of the viewed studies studied and concentrated more on the working youth and education level, making it a much contributing factor to malariaother others. Others also found that being unemployed contributes to malariaillness too.

Table 2: Number of studiesfocusing on marital status(n=10)

Majority of studies included and concluded that whetherbeing single, marriedor not, malariadoes not discriminate, hence it can affect anyone,although the socioeconomic factors mostly affectedsingle people.

Table 3: Education levelon the symptoms and treatment of malaria (n=10)

The lack of formal education on malaria has lead to the increasein malaria cases, the spread and deaths. Majority of those that lack knowledgeon malaria have suffered the consequences.

Table 4: Actions taken against malaria (n=10)

These actionshave been indicated by many studiesto be the contributing factorsof malaria as they were never done or taken into consideration by community members.

Table 5: Sources of bed nets (n=10)

Studies have found that majority of own nets that are used have contributed greatly to the spread and increase of cases of malaria in Sub-Sahara.

Discussion

According to a research on “Cost effectiveness analysis of the available strategies for diagnosing malaria in outpatients”, and another research by Obumneke A. Obieche,it is stated that the treatments and diagnosis procedures of Malaria were too much expensive for the outpatients to undergo, hence the slow progression involved in eliminating the health condition for good. Furthermore, those patients with health care insurance found the treatments very affordable and others without the insurances thought otherwise. Based on certain read article, it is stated that the highest costs of malaria treatmentdone affected the patients in such a way that many failed to undergo for tests, days were lost for that and lastly, earnings were foregone.It also accountsfor 15% of health relatedabsenteeism from school.Malaria’s cost is not entirely due to the fact that the outpatients could not afford it, but it is also due to the fact that they do not necessary considerit to be that much of a problem or of higher concern for them, hence without malaria confirmation, it is difficult to exclude fevers, which are not due to malaria, thus the true burdenof the disease proves difficultto quantify, whileObumneke A. Obieche stated that despite the provision of free malaria services, households incur significant direct and indirect costs associated with the disease. Lastly, once the bread winner of the family gets malaria, they might lose their jobs due to too much absenteeism and the family members fail to pay for health care spending for treating the person, lack of moneyto buy bread occurs. The malaria drainsthe resources of families and overall, households in Africa lose up to 25% of incometo the disease. [8]

The mentioned and searched studiesidentified different socioeconomic factors of malaria, although there are some studies that found out same or similar factors such as low income level, low and lack of formal education, house qualities and geographical access to health care facilities. There are a number of increasing cases of malaria indicated in the studies which are caused mostly by lack of awareness to malaria, absence of treated mosquito nets, malariacampaign programmers in most affectedand at-risk communities and also negligence among the people. These studies were all done in similar regions or countries in the Sub-Sahara, which are all the risk of getting malaria and having low or moderate economic rates and other unmentioned characteristics. Malaria cases are tracked in different ways in order to treat, prevent or minimize the spread of its transmission through ways such as house visits of both the suspected and confirmed case by healthprofessionals, outreach points such as health centers or community halls for health education and distribution of mosquito nets and spray days and finally also at the hospital were the victimgoes him/ herself for tests.

When it comes to comparing these findings to Namibia, given that they were done in all the Sub-Saharan region of which Namibia is a part of, we can conclude that these factors are also likely to occur in Namibia since they all share similar weather conditions, economic rates and developing nations. Although this was the case, some socioeconomic factorsand study review of cases occurrence and knowledge done in Namibia are not so similar or common in other countries, but this is not much of a bigger problem as they can be concluded to not being exactly the same, given that each of these countrieshave their own differentclimate conditions, healthcare systems and settingsand also their profiles differs.

Figure 1: Malaria followsup visits

Studies have shown that malaria casesor visits among the youth that have not been done are mostlythe ones affectedby malaria, but it does not mean that other age groupsare safe. They too are atrisk of getting malariaif no visits have been done at either health points.

Figure 2: Socioeconomic factorsof Malaria

Studies have indicated and found that the above socioeconomic factors, although not all were mentioned, are the major causes of malaria in especially people living average lives and those that are considered to be poor.

Limitations

These are influences or certain factors that a researcher is unable or cannot control at all duringthe research. These involve the conditions or influences, shortcomings that cannot be controlled by the researcher and tends to place restrictions on the researcher’s conclusions and methodology during the conduction f the research. Impressions and conclusions of or about the generality and effectiveness of the findings cannot be made due to the fact that a scoping review does not by any way formally evaluate the quality of evidence and they also often gather evidence from wide range of study designs and methods. Some studies have been over looked or excluded because of language used, location, titles or aims and in other cases some human errors, although efforts were made and done in order to access and review the relevant studiesto be used. Finally, the researcher could not fullycarry out the planned field research study due to the state of the emergency or lock down brought about by COVID-19. [9]

Conclusion

In conclusion, research on socioeconomic factors of malaria has increased although not only in sub Saharan regions but also in other partsof the world those have the mosquito Plasmodium that causes malaria, even though not all countries have really placed much effort in preventing or overcoming malaria. The focus of malaria should be more on the less advantaged groups such as those with low income levels or those that do not earn a thing, pregnantmothers and their unborn babiesas they tend to be more at risk, also on communities with the highest occurrence of malaria cases due to the presence of mosquitoes, the youth as well since they are more at risk due to their negligence and lack of participation in malaria control programs and also on other factors that were less considered in the reviewed studies. The governments of these countries need to be more effort and much money on carryingout prevention measuresof malaria such as the provision of insecticides treated mosquito nets, giving out health education on how the communities can protect themselves from malaria, asking for loans for their malaria programs in case they do not have enough money to carry them out on their own. The researcher has concluded that there are many factors causing malaria, not only the socioeconomic ones but also the general ones. These factors include low income distributions, lack of formal education, low quality houses,negligence, cultural factors as well as the age. [10]

References

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"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner