To demonstrate the effectiveness and usability of a novel tele-neurology service in Nairobi.

There is severe shortage of neurology healthcare workers in low-/lower-middle income countries (LLMICs), especially in Africa. Tele-neurology consultations (TNC), necessitated widely due to the COVID-19 pandemic, have been demonstrated to be effective in bridging neurology service gaps, but there is little evidence of TNC effectiveness in LLMICs.

We conducted a prospective cross-sectional study, enrolling neurology patients referred to our tertiary referral neurology outpatients center over 12 months from October 2020. We measured satisfaction and acceptability using Likert scales, and compared TNC to face-to-face (F2F) consultations. TNC were delivered as per 2020 British and American guidelines. Descriptive data are presented as median (inter-quartile range) and statistical comparisons made using paired student t-test.

From 219 enrolled patients, 66.7% (146/219) responded [74% (108/146) had both F2F and TNC]: age 40.9 (30.6-55.2) years; 63.0% (92/146) female; 2.7% (4/146) from neighboring countries; follow-up period with neurologist (DSS) 6.8 (1.5-29.8) months; and most common presentations were headache [30.8% (45/146)], seizure [26.0% (38/146)] and neurodegenerative [15.1% (22/146)] disorders. For TNC, >90%: (i) found it just as comfortable as F2F (p=0.35) and not in violation of their privacy; (ii) saved time [3.0 (2.0-4.0) hours], travel [11.0 (7.2-21.1) km] and cost [$10 (5-20)]; (iii) felt satisfied with the care and that their neurological concerns were adequately addressed; and (iv) would use TNC again. Conversely, 15.1% (22/146) did not agree with TNC being as effective as F2F, including the neurologist identifying all their health problems satisfactorily (p=0.03). In total, our TNC service saved our patients $6,125, 1,143 hours, and 25,506km of travel, equating to 3.5 tons (21 trees) of carbon dioxide emissions.

Our study demonstrates that our regionally unique TNC service is an acceptable, efficient, effective, and environmentally-friendly care delivery model in our resource-poor setting.