Neuro-cognitive impairment
Although developmental psychologists are in very limited supply in the typical African setting, a multidisciplinary team for the management of NF should include not just clinicians and surgeons, but also parents and educationalists (including teachers, educational psychologists, developmental psychologists) as well35. Poor school performance was identified in 2 (5.8%) of our cases. In our analysis, we used school performance as a surrogate for neuro-cognitive impairment, since this was not specifically tested. However, this low prevalence should not be misleading. When specifically screened, neuro-cognitive impairment has been found in up to 40% of cases of NF153. In this study, we observed the failure to assess or document relevant information about cognitive function in more than 90% of cases. Cognitive impairment, in majority of NF cases, is often mild 54. We therefore suggest that school teachers or administrators could be trained, as part of a multidisciplinary team for management of NF, to identify and refer individuals with consistently poor performance for their age, for medical and ophthalmic screening to exclude NF and other neurological complications. Furthermore, school age patients on follow up for NF could have annual assessment of their cognitive function to facilitate early diagnosis of impairments54.