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Aricò M, Mastrangelo M, Di Noia SP, Mabusi MS, Kalolo A, Pisani F. The impact of a newly established specialized pediatric epilepsy center in Tanzania: An observational study. Epilepsy Behav 2023; 148:109454. [PMID: 37776594 DOI: 10.1016/j.yebeh.2023.109454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE This study evaluated the impact of a newly established clinic for the diagnosis of pediatric epilepsy in a resource-limited center (Ifakara, Tanzania). METHODS Patients aged 0-18 years referred to the Pediatric Epilepsy Unit of Saint Francis Referral Hospital were recruited. Demographic and clinical data were collected through Kobo Toolbox and analyzed through a descriptive analysis.. RESULTS 143 patients were evaluated, and for 48 of them an EEG was recorded (abnormalities were detected in 80.85% of the cases). The diagnosis of epilepsy was confirmed in 87 patients. Focal epilepsy was diagnosed in 57 patients, generalized epilepsy in 24 patients, and forms of unknown onset in 6 patients. Epilepsy was excluded for 9 children. Etiologies included hypoxic-ischemic encephalopathy (39%), central nervous system infections (3.4%), and genetic diseases (3.4%). A specific epilepsy syndrome was diagnosed in 16 patients. 74 patients were under treatment; the most used antiseizure medication (ASM) was phenobarbital (43.36%), followed by carbamazepine (16.08%), sodium valproate (11.19%), phenytoin (2.8%), and lamotrigine (0.7%). Therapeutic changes were proposed to 95 patients, more frequently consisting of withdrawing phenobarbital (39.16%), switching to sodium valproate (27.97%), switching to or adjusting carbamazepine dosage (27.27%), and starting prednisone (2.8%). 76% of the patients with confirmed epilepsy achieved complete seizure freedom at the fourth follow-up consultation. CONCLUSIONS Our data depicted the epilepsy spectrum and highlighted the prognostic implications of improving the availability of ASMs such as sodium valproate and second- and third-generation ones in resource-limited countries.
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Affiliation(s)
- Miriam Aricò
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; UOC Neuropsichiatria Infantile, Azienda Unità Sanitaria Locale Bologna, Italy
| | - Mario Mastrangelo
- Department of Women/Child Health and Urological Science, Sapienza-University of Rome, Italy; Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy.
| | - Sofia Pia Di Noia
- Division of Child and Adolescent Neurology and Psychiatry, Azienda Ospedaliero Universitaria Ospedali Riuniti Foggia, Italy; Department of Neuroscience, University of Florence, Florence, Italy
| | - Mgabo Siboti Mabusi
- Outpatients Department, Pediatric Epilepsy Unit, Saint Francis Referral Hospital, Ifakara, Tanzania
| | - Albino Kalolo
- Department of Public Health, Saint Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Francesco Pisani
- Division of Child and Adolescent Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy; Child Neurology and Psychiatry Unit, Azienda Ospedaliero Universitaria Policlinico Umberto I, Rome, Italy
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Winter SF, Walsh D, Grisold W, Jordan JT, Singhi P, Cross JH, Guekht A, Hawrot T, Destrebecq F, Feigin VL, Kariuki SM, Owolabi MO, Singh G, Dietrich J, Craven A, Amos A, Mehndiratta MM, Secco M, Baker GA, Sofia F. Uniting for global brain health: Where advocacy meets awareness. Epilepsy Behav 2023; 145:109295. [PMID: 37348407 DOI: 10.1016/j.yebeh.2023.109295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Sebastian F Winter
- International Bureau for Epilepsy (IBE), Washington, DC, USA; OneNeurology Partnership, Brussels, Belgium; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
| | - Donna Walsh
- International Bureau for Epilepsy (IBE), Washington, DC, USA; OneNeurology Partnership, Brussels, Belgium
| | | | - Justin T Jordan
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Pratibha Singhi
- International Child Neurology Association (ICNA), Leuven, Belgium
| | - J Helen Cross
- International League Against Epilepsy (ILAE), Flower Mound, TX, USA
| | - Alla Guekht
- International League Against Epilepsy (ILAE), Flower Mound, TX, USA
| | - Tadeusz Hawrot
- OneNeurology Partnership, Brussels, Belgium; European Federation of Neurological Associations (EFNA), Brussels, Belgium
| | - Frédéric Destrebecq
- OneNeurology Partnership, Brussels, Belgium; European Brain Council (EBC), Brussels, Belgium; European Brain Foundation, Brussels, Belgium
| | - Valery L Feigin
- OneNeurology Partnership, Brussels, Belgium; National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, NZ
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Kilifi 80108, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana 141001, Punjab, India; Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Audrey Craven
- European Brain Foundation, Brussels, Belgium; Migraine Association of Ireland (MAI), Dublin, Ireland
| | - Action Amos
- International Bureau for Epilepsy (IBE) - African Region
| | - Man Mohan Mehndiratta
- Department of Neurology, BLK Hospital, Rajendra Place, India; International Bureau for Epilepsy (IBE) - South East Asian Region
| | - Mary Secco
- International Bureau for Epilepsy (IBE), Washington, DC, USA
| | - Gus A Baker
- International Bureau for Epilepsy (IBE), Washington, DC, USA
| | - Francesca Sofia
- International Bureau for Epilepsy (IBE), Washington, DC, USA
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Singh G, Singh MB, Ding D, Maulik P, Sander JW. Implementing WHO's Intersectoral Global Action Plan for epilepsy and other neurological disorders in Southeast Asia: a proposal. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 10:100135. [PMID: 37197018 PMCID: PMC7614540 DOI: 10.1016/j.lansea.2022.100135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 05/19/2023]
Abstract
The World Health Assembly approved the Intersectoral Global Action Plan for epilepsy and neurological disorders. Member states, including those in Southeast Asia, must now prepare to achieve IGAP's strategic targets by embracing novel approaches and strengthening existing policies and practices. We propose and present evidence to support four such processes. The opening course should engage all stakeholders to develop people-centric instead of outcome-centric approaches. Rather than caring for convulsive epilepsy alone, as currently done, primary care providers should also be skilled in diagnosing and treating focal and non-motor seizures. This could reduce the diagnostic gap as over half of epilepsies present with focal seizures. Currently, primary care providers lack knowledge and skills to manage focal seizures. Technology-enabled aids can help overcome this limitation. Lastly, there is need to add newer "easy to use" epilepsy medicines to Essential Medicines lists in light of emerging evidence for better tolerability, safety and user-friendliness.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, India
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ding Ding
- Institute of Neurology, Fudan University Hospital, Shanghai, China
| | - Pallab Maulik
- George Institute for Global Health, New Delhi, India
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, the Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China
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The WHO intersectoral global action plan and epilepsy cascade target: Towards a roadmap for implementation. Seizure 2022; 103:148-150. [DOI: 10.1016/j.seizure.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022] Open
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Singh G, Sharma S, Bansal N, Sharma M, Chowdhury A, Sharma S, Bansal RK, Goraya JS, Setia RK, Paul BS, Sander JW. A cluster-randomized trial comparing home-based primary health care and usual clinic care for epilepsy in a resource-limited country. Epilepsia Open 2022; 7:781-791. [PMID: 36213959 PMCID: PMC9712458 DOI: 10.1002/epi4.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To ascertain whether home-based care with community and primary healthcare workers' support improves adherence to antiseizure medications, seizure control, and quality of life over routine clinic-based care in community samples of people with epilepsy in a resource-poor country. METHODS Participants included consenting individuals with active epilepsy identified in a population survey in impoverished communities. The intervention included antiseizure medication provision, adherence reinforcement and epilepsy self- and stigma management guidance provided by a primary health care-equivalent worker. We compared the intervention group to a routine clinic-based care group in a cluster-randomized trial lasting 24 months. The primary outcome was antiseizure medication adherence, appraised from monthly pill counts. Seizure outcomes were assessed by monthly seizure aggregates and time to first seizure and impact by the Personal Impact of Epilepsy scale. RESULTS Enrolment began on September 25, 2017 and was complete by July 24, 2018. Twenty-four clusters, each comprising ten people with epilepsy, were randomized to either home- or clinic-care. Home-care recipients were more likely to have used up their monthly-dispensed epilepsy medicine stock (regression coefficient: 0.585; 95% confidence intervals, 0.289-0.881; P = 0.001) and had fewer seizures (regression coefficient: -2.060; 95%CI, -3.335 to -0.785; P = 0.002). More people from clinic-care (n = 44; 37%) than home-care (n = 23; 19%) exited the trial (P = 0.003). The time to first seizure, adverse effects and the personal impact of epilepsy were similar in the two arms. SIGNIFICANCE Home care for epilepsy compared to clinic care in resource-limited communities improves medication adherence and seizure outcomes and reduces the secondary epilepsy treatment gap.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia,Department of NeurologyDayanand Medical CollegeLudhianaIndia,UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Meenakshi Sharma
- Non‐communicable Diseases DivisionIndian Council of Medical ResearchNew DelhiIndia
| | - Anurag Chowdhury
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | | | - Josemir W. Sander
- UCL Queen Square Institute of NeurologyLondon WC1N 3BGLondonUK,Chalfont Centre for EpilepsyChalfont St Peter SL9 0RJLondonUK,Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands,Neurology DepartmentWest of China Hospital, Sichuan UniversityChengduChina
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Temporal trends in the epilepsy treatment gap in low- and low-middle-income countries: A meta-analysis. J Neurol Sci 2022; 434:120174. [DOI: 10.1016/j.jns.2022.120174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/01/2022] [Accepted: 01/24/2022] [Indexed: 11/22/2022]
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Krishnan A, Chowdhury D. Burden, Disability and Public Health Importance of Headache Disorders in India. Neurol India 2021; 69:S4-S9. [PMID: 34003143 DOI: 10.4103/0028-3886.315984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. The aim of this study was to document epidemiological and economic burden due to headache globally and in India and suggest a public health approach to address headache disorders for India. We reviewed the available literature on burden due to headache, its management using a primary health care approach and health system barriers, with special emphasis on India. Globally, it has been estimated that prevalence of current headache disorder (symptomatic within last year) among adults is about 50%, around 30% report migraine and headache on 15 or more days every month affects 1.7-4% people. The Global Burden of Disease Study 2016 estimated that migraine caused 45·1 million (95% UI 29·0-62·8) and tension-type headache 7·2 million (95% UI 4·6-10·5) years of life lived with disability. Limited data available in India support such high burden. These studies also indicate high diagnostic and treatment gaps for headache disorders in India. Major challenges in addressing headache disorders effectively in India are low perceived severity, absence of burden data, lack of standard treatment protocols for headache disorders and primary care models for neurological disorders in developing country context. There needs to be a better appreciation of the burden and a public health approach among all stakeholders, if burden of headache disorders is to be addressed effectively in India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Debashish Chowdhury
- Department of Neurology, GB Pant Institute of Post graduate Medical Education and Research, New Delhi, India
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Nicoletti A, Todaro V, Cicero CE, Giuliano L, Zappia M, Cosmi F, Vilte E, Bartoloni A, Crespo Gómez EB. The impact of COVID-19 pandemic on frail health systems of low- and middle-income countries: The case of epilepsy in the rural areas of the Bolivian Chaco. Epilepsy Behav 2021; 118:107917. [PMID: 33735816 PMCID: PMC9760068 DOI: 10.1016/j.yebeh.2021.107917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Coronavirus disease 2019 (COVID-19) has put some health systems under pressure, especially in low- and middle-income countries. We aimed at evaluating the impact of COVID-19 emergency on the management of people with epilepsy (PWE) living in the rural communities of the Gran Chaco area of the Plurinational State of Bolivia. MATERIALS AND METHODS We selected a sample of PWE living in the rural communities of the Bolivian Chaco. A standardized questionnaire was developed, consisting of six questions addressing drug availability, drug discontinuation, personnel responsible for drug retrieval during the lockdown, and the presence of seizures in the two months preceding the interview. Questionnaires were administered by community health workers of the rural health centers in September 2020. RESULTS Seventy PWE (38 men, 54.3%; mean age 26.9 ± 16.7) were interviewed. During the lockdown the large majority of them (n = 51, 73.9%) reported an irregular medication intake mainly due to the lack of antiseizure medications in the local health posts, leading to an increase in seizure frequency. CONCLUSION The COVID-19 pandemic has unmasked the frailty of the Bolivian health system, especially for the management of chronic diseases such as epilepsy in the rural communities.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Neuroscience Section, University of Catania, Catania, Italy.
| | - Valeria Todaro
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Neuroscience Section, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Neuroscience Section, University of Catania, Catania, Italy
| | - Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Neuroscience Section, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Neuroscience Section, University of Catania, Catania, Italy
| | | | - Estela Vilte
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
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Singh G, Singhal S, Sharma S, Paul BS, Bansal N, Chaudhary A, Sharma S, Bansal RK, Goraya JS, Setia RK, Sander JW. Clinical characteristics of epilepsy in resource-limited communities in Punjab, Northwest India. Epilepsia Open 2020; 5:582-595. [PMID: 33336129 PMCID: PMC7733663 DOI: 10.1002/epi4.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/26/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe clinical characteristics of a community-based epilepsy cohort from resource-limited communities in Punjab, Northwest India. METHODS The cohort was gathered following a two-stage screening survey. We cross-sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness. RESULTS The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug-resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years. SIGNIFICANCE Existing classifications schemes should be better suited to field conditions in resource-limited communities in low- and middle-income countries. The finding of drug-resistant epilepsy in nearly at least a third in a community-based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up.
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Affiliation(s)
- Gagandeep Singh
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
- Department of NeurologyDayanand Medical CollegeLudhianaIndia
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
| | - Sachi Singhal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Suman Sharma
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | | | - Namita Bansal
- Research & Development UnitDayanand Medical CollegeLudhianaIndia
| | - Anurag Chaudhary
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | - Sarit Sharma
- Department of Social & Preventive MedicineDayanand Medical CollegeLudhianaIndia
| | | | | | | | - Josemir W. Sander
- NIHR University College London Hospitals Biomedical Research CentreUCL Queen Square Institute of NeurologyLondonUK
- Chalfont Centre for EpilepsyChalfont St PeterUK
- Stichting Epilepsie Instellingen Nederland (SEIN)HeemstedeThe Netherlands
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Patel AA, Ciccone O, Nkole KL, Kalyelye P, Sham L, Kielian A, Berger T, Huff HV, Johnson HF, Sulu M, Mathews M, Mazumdar M. Development and Evaluation of a Pediatric Epilepsy Training Program for First Level Providers in Zambia. Glob Pediatr Health 2020; 7:2333794X20968718. [PMID: 33225022 PMCID: PMC7649896 DOI: 10.1177/2333794x20968718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/08/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction. The developing world continues to face challenges in closing the large treatment gap for epilepsy, due to a high burden of disease and few experienced providers to manage the condition. Children with epilepsy are susceptible to higher rates of developmental impairments and refractory disease due to delays or absence of appropriate management as a result. We demonstrated that a structured education intervention on pediatric epilepsy can improve knowledge, confidence, and impact clinical practice of first level providers in Zambia. Methods. Three first-level facilities across Zambia were included. After initial pilot versions and revisions, the final course was implemented at each site. Pre- and post-intervention knowledge and confidence assessments were performed. Additionally, chart reviews were conducted prior to intervention and 4 months after completion of training at each site to assess change on management. Results. Twenty-three of the original 24 participants from all 3 sites completed the training; 48% clinical officers, 43% nurses, 9% other expertise. Of the 15 concepts tested by knowledge assessment, 12 showed trends in improvement, 7 of which were significant (P < .05). Chart reviews demonstrated significant improvement in documentation of seizure description (P = .008), seizure frequency (P = .00), and possible causes of seizures/epilepsy (P = .034). Discussion. Key elements of success to this program included hands on clinical skills building and case-based teaching, development of a program with direct and ongoing input from the target audience, and inclusion of assessments to monitor impact on clinical practice. Future studies looking at health outcomes are necessary to determine sustained impact.
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Affiliation(s)
- Archana A Patel
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA.,University of Zambia, School of Medicine, Department of Paediatrics and Child Health, Lusaka, Zambia
| | - Ornella Ciccone
- University Teaching Hospital- Children's Hospital, Lusaka, Zambia
| | | | - Prisca Kalyelye
- University Teaching Hospital- Children's Hospital, Lusaka, Zambia
| | - Lauren Sham
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Agnieszka Kielian
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Tamar Berger
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA, USA
| | - Hanalise V Huff
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Hannah F Johnson
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Mercy Sulu
- Arthur Davison Children's Hospital, Ndola, Zambia
| | - Manoj Mathews
- University of Zambia, School of Medicine, Department of Paediatrics and Child Health, Lusaka, Zambia.,Ministry of Health, Lusaka, Zambia
| | - Maitreyi Mazumdar
- Boston Children's Hospital, Department of Neurology, Harvard Medical School, Boston, MA, USA
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Mortality implications and factors associated with nonengagement in a public epilepsy care initiative in a transient population. Epilepsy Behav 2020; 112:107438. [PMID: 32977110 DOI: 10.1016/j.yebeh.2020.107438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Community-based, public care programs are a requisite to close the epilepsy treatment gap in disadvantaged communities in low- and middle-income countries (LMICs). Potential beneficiaries may, however, choose not to engage in these programs. AIMS The aim of the study was to describe factors associated with and mortality consequences of nonacceptance of a public epilepsy care initiative. METHODS In this cross-sectional study, we contacted 207 (36%) people out of 575 who screened positive for epilepsy during a population-based survey of 59,509 people. They were invited for neurological evaluation and care provision (including antiseizure medications (ASMs)) but chose not to engage. Structured questionnaires and qualitative interviews were conducted to determine reason for their nonengagement. Factors associated with nonengagement were evaluated by univariate and multivariate analysis. We conducted verbal autopsies for those who had died. RESULTS Ten (5%) of the 207 individuals died since the initial screening; six with epilepsy-related causes. Of those who could be contacted (n = 48), 40 (19%) were confirmed to have epilepsy. Nonengaging individuals were likely to be older (odds ratio (OR): 1.02; 95% confidence interval (CI), 1.01, 1.11), locals (OR: 4.32; 95% CI, 1.55, 12.03), and earn less than US$ 78/month (OR: 3.6; 95% CI, 1.62, 8.06). Reasons for not engaging included a belief that epilepsy is inconsequential, loss of daily wages owing to healthcare facility visit and physical infirmity. CONCLUSIONS Nonacceptance of a community-based public epilepsy care initiative is associated with high premature mortality, mostly attributed to epilepsy-related causes. Older age, ethnic status, and economic deprivation are factors associated with nonacceptance, though the underlying reasons may be varied.
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Boumediene F, Chhour C, Chivorakoun P, Souvong V, Odermatt P, Hun C, Thebaut C, Bounlu M, Chum N, Vorachit S, Ros S, Chan S, Preux PM. Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 4:100042. [PMID: 34327389 PMCID: PMC8315387 DOI: 10.1016/j.lanwpc.2020.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022]
Abstract
Background Epilepsy affects more than 50 million people worldwide, 80% of whom live in low- and middle-income countries (LMICs). In Southeast Asia, the prevalence is moderate (6‰), and the main public health challenge is reducing the treatment gap, which reaches more than 90% in rural areas. Methods This 12-month comparative study (intervention vs. control areas) assessed the community effectiveness of two different strategies for the identification and home follow-up of people with epilepsy by Domestic Health Visitors for epilepsy (DHVes). In Lao PDR, DHVes were health center staff covering several villages via monthly visits; in Cambodia, DHVes were health volunteers living in the villages. Findings At baseline, the treatment gap was >95% in Lao PDR and 100% in Cambodia. After 12 months, the treatment gap in Lao PDR decreased by 5·5% (range: 4·0–12·2) in the intervention area and 0·5% (range: 0·4–0·8) in the control area (p<0·0001). In Cambodia, the treatment gap decreased by 34·9% (range: 29·0–44·1) in the intervention area and 8·1% (range: 6·7–10·2) in the control area (p<0·0001). Among the PWEs followed at home by the DHVes, the proportion adhering to drug treatment was 85·2% in Lao PDR and 78·1% in Cambodia. The cost associated with strategy implemented in Cambodia, compared with the control area, was lower than the cost associated with strategy implemented in Lao PDR.” Interpretation The treatment gap was significantly reduced with both intervention strategies, but the effect was larger in Cambodia. The results of this cost analysis pave the way for scaling-up in rural areas of Lao PDR and Cambodia, and experimental adaptation in other LMICs. Funding The study was funded by the Global Health Department of Sanofi and Grand Challenges Canada (grant number 0325–04).
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Affiliation(s)
- Farid Boumediene
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, 2 rue du Docteur Marcland, 87025 Limoges, France
| | | | | | - Vimalay Souvong
- Association for Patient with Epilepsy in Laos, Vientiane, Lao Democratic People's Republic
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Clémence Thebaut
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, 2 rue du Docteur Marcland, 87025 Limoges, France
| | - Mayoura Bounlu
- Association for Patient with Epilepsy in Laos, Vientiane, Lao Democratic People's Republic
| | - Navuth Chum
- Cambodia Society of Neurology, Phnom Penh, Cambodia
| | - Somchit Vorachit
- Association for Patient with Epilepsy in Laos, Vientiane, Lao Democratic People's Republic
| | - Sina Ros
- Cambodia Society of Neurology, Phnom Penh, Cambodia
| | - Samleng Chan
- Cambodia Society of Neurology, Phnom Penh, Cambodia
| | - Pierre-Marie Preux
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, 2 rue du Docteur Marcland, 87025 Limoges, France
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What's happening in Innovations in Care Delivery. Neurology 2020. [DOI: 10.1212/wnl.0000000000009090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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