Implementation and Evaluation of a Teleneurology Clinic Serving Vulnerable Populations in Zambia During the COVID-19 Pandemic.

By : M Asukile1 , L Chishimba2 , M Chomba2 , M Mataa2 , F Mutete1 , N Mwendaweli1 , K Yumbe1 , S Zimba1 , D Saylor1,3

1 Department of Internal Medicine, University Teaching Hospital, Lusaka Zambia,

2 Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia,

3 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD

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Telemedicine increased during the COVID19 pandemic as a safe and feasible alternative to in-person care but was limited to high-income settings.    Zambia has only eight neurologists and one crowded outpatient neurology clinic.  The suspension of this clinic during the peak of COVID19 resulted in the urgent need for an alternative, and so a telemedicine solution was implemented. Our aim was to evaluate patient and physician acceptance of and satisfaction with teleneurology visits for adults usually attending in-person visits at the University Teaching Hospital (UTH) Neurology Clinic in Lusaka, Zambia.


Patients scheduled for neurology outpatient appointments in  June and  July  2020  and those with missed appointments between  March and  May  2020  were called to ask if agreeable to a  televisit.  Neurologists conducted teleneurology visits over the phone, WhatsApp video, or Zoom calls, based on patient accessibility, and they documented visit outcomes.  Data on patient and provider satisfaction were collected through telephone and online surveys, respectively.


Of 300 patients, 186 (62%) were reachable, and 74% (133) of those alive agreed to a televisit. Stroke (30%), seizures (20%), and headache (16%) were the commonest diagnoses.  Most televisits (80%) were by telephone call, 14% by WhatsApp video, and 6% by Zoom. Sixty patients and seven neurologists completed satisfaction surveys.  Neurologists reported greater confidence in their assessment with Zoom calls. Televisit outcomes showed 30% of patients were stable and discharged to their local clinic, 32% only required medication refills, and 19% required an in-person visit. Patients who preferred televisits noted they were less expensive and less time-consuming, while those preferring in-person visits cited the desire for a physical examination. Overall, 98% of patients and 100% of physicians were satisfied with televisits.


Teleneurology visits were an acceptable means of service provision for adults attending the UTH neurology clinic. They are a promising supplement to in-person visits in resource-limited settings, even when video-call support is absent.