By Lloyd Gideon Makonese: Public Health Specialist
An emerging body of research suggests that Parkinson’s disease (PD) may be significantly underdiagnosed within Zimbabwe’s ageing population. Elderly individuals, particularly those in their sixties and seventies, frequently undergo repeated clinical consultations for progressive motor symptoms but often receive incorrect or delayed diagnoses. This issue, as reported by Dotchin and Walker (2008) in their Tanzanian prevalence study, mirrors broader challenges in sub-Saharan Africa where the condition is commonly mistaken for normal ageing or other chronic illnesses. According to Winkler et al. (2010), the lack of community-based neurological assessment in African health systems has contributed to widespread under-recognition of PD.
As published by the World Health Organization (2022), Zimbabwe has experienced a notable rise in life expectancy, creating a demographic context in which neurodegenerative diseases like PD are likely to increase. However, as acknowledged in systematic reviews by Fothergill-Misbah et al. (2023) and Pereira et al. (2024), Africa continues to face critical shortages in diagnostic capacity, access to essential medication, and specialist care, which perpetuates the invisibility of Parkinson’s within public health frameworks.
This article draws on personal clinical encounters and current evidence to examine how one case of PD, correctly identified at Chinhoyi Provincial Hospital after years of missed opportunities, reflects deeper systemic gaps in Zimbabwe’s diagnostic and treatment landscape.
Demographic Pressures and Epidemiological Gaps in Zimbabwe
Zimbabwe is undergoing demographic changes that are likely to increase the burden of age-related disorders such as Parkinson’s disease. According to the World Health Organization (2022), healthy life expectancy at birth in Zimbabwe improved from 40.5 years in 2000 to 51.2 years by 2021. Additionally, as reported by Macrotrends (2023), overall life expectancy rose from 60.1 years in 2021 to 62.8 years in 2023. These improvements reflect advances in public health and access to care. However, longer life spans also increase the likelihood of age-associated neurodegenerative diseases.
As published by the United Nations Department of Economic and Social Affairs (2023), the proportion of Zimbabweans aged 65 and above has increased from 3.0 percent in 2000 to approximately 4.6 percent today. Despite this upward trend in older adult populations, there is currently no centralised registry for neurological disorders in Zimbabwe. The limited number of practising neurologists, compounded by resource constraints in district and provincial hospitals, significantly hampers early detection and epidemiological tracking.
Clinical Vignette: A Case from Chinhoyi
In a recent clinical encounter, the author met two elderly patients in Hurungwe, Mashonaland West, Zimbabwe who presented with classical Parkinsonian symptoms, including resting tremor, bradykinesia, rigidity, and postural instability. Over a period of nearly four years, both individuals sought medical assistance from several facilities, including Harare’s central hospitals, private medical practices, and even the well-regarded Mutendi Mission Hospital in Zambia. Despite their frequent healthcare engagement, neither received a neurological diagnosis.
Though limited in number, the two cases reveal a wider diagnostic challenge. Prolonged delays in reaching a diagnosis can contribute to a collective desensitisation, where communities come to view debilitating symptoms as a routine aspect of ageing rather than signs of a treatable neurological condition. This normalisation risks reinforcing systemic inaction.
According to the patient’s records, various diagnoses were suggested, ranging from arthritis to age-related muscle degeneration. Medications were prescribed, but no improvement followed. The author eventually escorted one of the patients, a woman in her late 50s, to Chinhoyi Provincial Hospital. There, Dr Nyamudhela, a general medical officer with a keen clinical interest in neurology, carried out a thorough assessment and, based on the patient’s symptomatology, initiated levodopa therapy. The patient was subsequently referred to Dr Chinwada, a travelling physician at the hospital, who independently confirmed the diagnosis of idiopathic Parkinson’s disease.
This case, diagnosed at a provincial-level hospital, stands in contrast to the repeated missed opportunities in better-resourced and popular institutions. It raises an important question: how can a diagnosis as clear as Parkinson’s disease go undetected through multiple consultations across private, public, and mission hospital settings? The case illustrates a broader pattern that is likely affecting many Zimbabweans, especially in rural or under-supported health systems.
Addressing the Structural Gaps
The challenges surrounding Parkinson’s disease recognition and management in Zimbabwe reflect wider patterns across the African continent. According to a 2023 systematic review published by Fothergill-Misbah and colleagues in BMC Neurology, Parkinson’s remains underdiagnosed due to limited workforce capacity, low awareness among general practitioners, and absence of national-level prevalence studies. The review highlighted how conditions such as PD are often excluded from health priorities due to misconceptions that they are rare in African populations.
Furthermore, as shown by Pereira et al. (2024) in npj Parkinson’s Disease, a meta-analysis of 57 studies conducted in low- and middle-income countries found a regional PD prevalence of approximately 49 per 100,000. The study linked prevalence rates strongly with life expectancy, reinforcing that Zimbabwe’s ageing population could be at increasing risk.
With regard to treatment, access to essential medication remains limited. A national survey conducted in Ghana and published by the International Parkinson and Movement Disorder Society (2018) found that levodopa was stocked in only 11 percent of pharmacies as was the case only one pharmacy in Chinhoyi had levodopa in stock. Most patients in Ghana, like in most parts of Zimbabwe, either paid out-of-pocket or were unable to access treatment due to stockouts in public health facilities. Similarly, Owolabi et al. (2020) reported that levodopa and other Parkinson’s medications were consistently available in fewer than half of African countries surveyed. These medications are more consistently available in high-income regions, with 79.1 percent of European countries reporting reliable access.
Addressing these challenges requires a coordinated strategy. According to Dotchin et al. (2007), targeted professional education for primary healthcare workers significantly improves early PD detection. National training curricula need to include neurodegenerative disorders as part of general practice and internal medicine modules. Moreover, international development partners could assist in strengthening supply chains for essential medications and in building tele-neurology systems to reach underserved areas.
Additionally, as proposed by Dekker et al. (2020) in Frontiers in Neurology, culturally sensitive public health education is necessary to destigmatise PD symptoms, encourage help-seeking behaviours, and reduce community misperceptions that tremors or stiffness are merely signs of normal ageing or spiritual affliction.
Finally
Zimbabwe’s healthcare system stands at a crossroads. On one hand, it has achieved steady gains in life expectancy and access to basic care. On the other hand, it now faces emerging health demands associated with an ageing population. The clinical vignette presented in this article illustrates that with clinical vigilance and appropriate knowledge, Parkinson’s disease can be diagnosed even at provincial hospitals. Yet the broader healthcare landscape is ill-prepared to manage the growing number of such cases.
As evidence from sub-Saharan Africa consistently shows, underdiagnosis is not a result of rarity but of systemic under-recognition. Zimbabwe must therefore prioritise investments in epidemiological surveillance, professional training, medication access, and public awareness. Only through these multifaceted interventions can the silent burden of Parkinson’s disease be properly addressed and older citizens receive the care and dignity they deserve.