TITLE:
Healthcare Pathways and Access to Care for Patients with Functional Neurological Disorder in Senegal: From Traditional Healers to Neuropsychiatrists—A Cross-Sectional Study
AUTHORS:
Momar Camara, N’godo Marie Inès Constance Kouakou, Sokhna Seck, Rokhaya Gueye, Ndeye Awa der Dieye, Ibra Diagne, Maïmouna Dieye, El Hadji Makhtar Ba, Aïda Sylla
KEYWORDS:
Functional Neurological Disorder, Healthcare Pathway, Traditional Healer, Access to Care, Senegal, Africa
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.16 No.1,
January
20,
2026
ABSTRACT: Background: Functional neurological disorder (FND) is the second most common reason for neurological consultation worldwide. However, healthcare pathways in sub-Saharan Africa remain poorly documented. Objective: This study aimed to describe the therapeutic itineraries, diagnostic delays, and quality of diagnostic communication for patients with FND in Senegal. Methods: A cross-sectional descriptive study with retrospective and prospective data collection was conducted from January to June 2024 at the Child Psychiatry and Neurology Department of CHNEAR, Dakar, Senegal. All patients diagnosed with FND according to DSM-5 criteria during the study period were included (n = 8, all female). Sociodemographic data, diagnostic delay, healthcare pathways, diagnosis disclosure, and understanding were collected. A comprehension/disclosure (C/D) ratio was calculated as the proportion of patients who understood their diagnosis among those who received it. Results: Eight female patients were included (mean age: 27.6 years; range: 13 - 69). Patients presented with polysymptomatic FND; the most frequent symptoms were headaches (87.5%) and muscle cramps (75%), followed by functional seizures, loss of consciousness, and memory disturbances (37.5% each). The mean delay before specialised consultation was 19 months (range: 4 - 60 months). Five types of healthcare resources were identified: word-of-mouth, traditional healers, general practitioners, neurologists, and psychiatrists. The pathways were classified as simple (50%) or complex (50%). Word-of-mouth dominated simple pathways (75%), whereas complex itineraries systematically involved traditional healers or multiple general practitioners as entry points. The diagnosis was disclosed to 87.5% of the patients and understood by 62.5%, yielding a C/D ratio of 0.71. Conclusion: Healthcare pathways for FND in Senegal are characterised by significant diagnostic delays and frequent recourse to traditional healers. The circulation between general practitioners, neurologists, and psychiatrists without effective coordination contributes to therapeutic wandering. Improved training of healthcare professionals and coordinated care pathways are needed to reduce diagnostic delays.