Demonstration project on epilepsy in Brazil: situation assessment

Abstract

-Purpose: To provide a situation assessment of services for people with epilepsy in the context of primary health care, as part of the Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign 'Epilepsy out of the shadows'. Methods: We performed a door-to-door epidemiological survey in three areas to assess the prevalence of epilepsy and its treatment gap. We surveyed a sample of 598 primary health care workers from diff e rent regions of Brazil to assess their perceptions of the management of people with epilepsy in the primary care setting. Results: The lifetime prevalence of epilepsy was 9.2/1,000 people [95% CI 8.4-10.0] and the estimated prevalence of active epilepsy was 5.4/1,000 people. Thirty-eight percent of patients with active epilepsy were on inadequate treatment, including 19% who were taking no medication. The survey of health workers showed that they estimated that 60% of patients under their care were seizure -f ree. They estimated that 55% of patients were on monotherapy and that 59% had been re f e rred to neurologists. The estimated mean percentage of patients who were working or studying was 56%. Most of the physicians (73%) did not feel confident in managing people with epilepsy. Discussion: The epidemiological survey in the areas of the Demonstration Project showed that the prevalence of epilepsy is similar to that in other resource-poor countries, and that the treatment gap is high. One factor contributing to the treatment gap is inadequacy of health care delivery. The situation could readily be improved in Brazil, as the primary health care system has the key elements re q u i re d for epilepsy management. To make this effective and efficient re q u i res: i) an established re f e rral network, ii) continuous provision of AEDs, iii) close monitoring of epilepsy management via the notification system (Sistema de Informação da Atenção Básica -SIAB) and iv) continuous education of health pro f e s s i o n a l s . The educational program should be broad spectrum and include not only medical management, but also psycho-social aspects of epilepsy.KEY WORDS: epilepsy, anti-epileptic drug, primary care, seizure.Projeto demonstrativo em epilepsia no Brasil: avaliação situacional RESUMO -Objetivo: Avaliar a situação da assistência à epilepsia no contexto da atenção primária sob o P rojeto Demonstrativo em epilepsia no Brasil, parte da Campanha Global Epilepsia Fora das Sombras da W H O / I L A E / I B E . Método: Fizemos um levantamento epidemiológico para definir a prevalência e lacuna de tratamento em epilepsia. Avaliamos a percepção de 598 profissionais de saúde da atenção básica de d i f e rentes regiões do Brasil sobre epilepsia e seu manejo na rede básica de saúde. Resultados: A pre v a l ê ncia acumulada de epilepsia foi de 9,2/1000 pessoas (95%IC= 8,4-10) e a prevalência estimada de epilepsia ativa foi de 5,4/1000 pessoas. Trinta e oito porcento dos pacientes com epilepsia ativa estavam sendo tratados inadequadamente, incluindo 19% que estavam sem medica...

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