Our objective was to assess the ability of a smartphone-based electroencephalography (EEG) application, the Smartphone Brain Scanner-2 (SBS2), to detect epileptiform abnormalities compared to standard clinical EEG. The SBS2 system consists of an Android tablet wirelessly connected to a 14-electrode EasyCap headset (cost ~ 300 USD). SBS2 and standard EEG were performed in people with suspected epilepsy in Bhutan (2014–2015), and recordings were interpreted by neurologists. Among 205 participants (54% female, median age 24 years), epileptiform discharges were detected on 14% of SBS2 and 25% of standard EEGs. The SBS2 had 39.2% sensitivity (95% confidence interval (CI) 25.8%, 53.9%) and 94.8% specificity (95% CI 90.0%, 97.7%) for epileptiform discharges with positive and negative predictive values of 0.71 (95% CI 0.51, 0.87) and 0.82 (95% CI 0.76, 0.89) respectively. 31% of focal and 82% of generalized abnormalities were identified on SBS2 recordings. Cohen’s kappa (κ) for the SBS2 EEG and standard EEG for the epileptiform versus non-epileptiform outcome was κ = 0.40 (95% CI 0.25, 0.55). No safety or tolerability concerns were reported. Despite limitations in sensitivity, the SBS2 may become a viable supportive test for the capture of epileptiform abnormalities, and extend EEG access to new, especially resource-limited, populations at a reduced cost.
There are potentially modifiable associations with low QOLIE. Addressing the educational level and self-perceived stigma of PWE may have an especial impact. The low QOLIE in Bhutan may reflect cultural approaches to epilepsy, health services, or other factors including those outside of the health sector.
Introduction
To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among people with epilepsy (PWE) in a neurocysticercosis-endemic, resource-limited setting, and to identify the proportion and putative structural brain causes of drug resistant epilepsy cases.
Methods
PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014–2015). Each participant completed clinical questionnaires and a 1.5 tesla brain MRI. Each MRI was reviewed by at least one radiologist and neurologist in Bhutan and the U.S.A. A working definition of drug resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least one seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables.
Results
217 participants [125 (57%) female; 54 (25%) <18 years old; 199 (92%) taking AEDs; 154 (71%) with a seizure in the prior year] were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n=115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n=26, 12%, including one child) and congenital/perinatal abnormalities (n=29, 14%, including 14 children). The number of AEDs (odds ratio=0.59, p=0.03) and duration of epilepsy (odds ratio=1.11, p=0.02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio=0.47, p=0.01). 25 (12%) participants met our definition of drug resistant epilepsy with mesial temporal sclerosis (n=10), congenital malformations (n=5), and neurocysticercosis (n=4) being the more frequent findings.
Conclusions
The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high due to a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug resistant epilepsy accounted for 12% of the referral population in a conservative estimation.
While knowledge of epilepsy was overall fairly high, PWE more often held certain stigmatizing beliefs, including theories of contagion and a relationship between seizures and spiritual powers. Higher educational level and seizure freedom were associated with lower stigma, underscoring their importance in stigma reduction.
Neurocysticercosis was associated with 6-25% of epilepsy in a Bhutanese cohort. Combining EITB and MRI would aid the diagnosis of neurocysticercosis among PWE since no test identified all cases.
Introduction: Respectful Maternity Care (RMC) acknowledges that respects for woman’s rights, choices and dignity during labor and childbirth is vital component of health care quality. This cross-sectional descriptive study intended to gain in-depth understanding on knowledge, attitude and practices of nurse midwives working in referral hospitals of Bhutan on RMC. The study also looked into determinants of RMC.
Methods: The sample consisted of 83 nurse midwives who were working in birthing and maternity unit of three regional referral hospitals of Bhutan. The sites were chosen purposefully due to their high delivery volume. A survey instrument was piloted in Paro hospital prior to study. Data was collected from July to October 2017. Analysis was mainly descriptive, simple percentages were used to calculate frequency distribution of aspects and determinants of respectful maternity care.
Results: Four in five of the respondents knew and practiced woman’s right to information and communication during childbirth process. However, providers were found lacking on some aspects of the knowledge and practices related to respecting choices and rights of the women during childbirth and recounted their experiences of observing events which are described as abusive in maternal health literatures. Inadequate facilities, overworked staffs and limited trainings were found as detrimental factors.
Conclusion: Aspects of RMC were not duly practiced. Providers must be made aware of the woman’s right to respectful care which is crucial to improve maternal health services. Individual Health Facility must provide conducive environment to practice RMC. Future studies on RMC from receiver end are recommended.
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