Déficits de traitement et épilepsie dans six unités de soins périphériques du Togo de 2007 à 2009

Guinhouya, Kokou Mensah; Aboki, Adodo; Kombate, D; Kumako, Vinyo Kodzo; Apétsè, Kossivi; Belo, Mofou; Balogou, Agnon Ayélola Koffi; Grunitzky, K

doi:10.1684/san.2010.0193

Cited by 9 publications

(7 citation statements)

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“…Furthermore, the dosage, dosing schedule and indication of the AEDs were not always appropriate and adjustments were needed. The 67% treatment and access gap is in line with the reported 75% of PwE living in low-income countries being untreated [ 15 – 17 ]. Over 30% of study participants had at some stage been seen by traditional healers and had received traditional herbal medicine ( i.e ., roots, barks and leaves of trees and plants) or were treated with rites and prayers.…”

Section: Discussionsupporting

confidence: 61%

Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap

Bora¹,

Malamba-Lez²,

Luwa³

et al. 2015

Pan Afr Med J

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IntroductionEpilepsy is the most common of serious neurological disorders, yet despite considerable efforts, good access to medication, appropriate social and societal acceptance and acceptable quality of life (QoL) are difficult to achieve especially in developing countries. It is estimated that over 500,000 people suffer from epilepsy in the DRC. There is no report, in our knowledge on the epilepsy in Lubumbashi.MethodsA descriptive study was undertaken in individuals with a clinical diagnosis of epilepsy who presented at the CNPJG outpatient clinic in Lubumbashi over a 12 months period. A 64-item questionnaire was used to collect information from the patients. Case records were reviewed and relevant demographic, social, professional, medical history, medical condition data were extracted.ResultsAmong 3,540 patients who presented to a neuropsychiatric clinic run by the Fracarita charity over a 1-year period, 423 (11.9%) were identified as having epilepsy, and 179 were subsequently included in the survey after they (or their parent/guardian) provided informed consent and completed an EEG investigation. Data were collected using a standardized, 64-item questionnaire. Epilepsy had negative impact on the lives of individuals with the condition; 40.8% had either no education or had completed primary education only, 38.0% were unemployed and the majority (64.6%; n = 113) were unmarried or divorced. Family history of epilepsy (first or second degree) was present in 23.5% of cases. Other reported factors that could potentially precipitate epilepsy included obstetric and perinatal factors (15.1%) and central nervous system infections during infancy (8.4%). Consumption of alcohol or recreational drugs accounted for 10.6%. The treatment gap was above 67% and the delay between first seizure and first consultation was 15 months. When asked to describe their condition, or its cause, 55.3% of participants (or their families) considered epilepsy to be of spiritual/ religious origin, while 25.1% had almost no insight and could not provide any description.ConclusionThis first epidemiological study shows a high prevalence of epilepsy among patients presenting to the clinic in Lubumbashi, DRC, and reveals a significant treatment gap.

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Section: Discussionsupporting

confidence: 61%

Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap

Bora¹,

Malamba-Lez²,

Luwa³

et al. 2015

Pan Afr Med J

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“…Bridging the gap between PWE and health facilities is a major issue that can only be overcome with a dramatic improvement of health staff knowledge [21,22]. Since the launching of Initiative for Epilepsy in the Lao PDR, activities aiming at improving health staff knowledge are currently being carried out [23,24].…”

Section: Discussionmentioning

confidence: 99%

Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR?

Harimanana

Chivorakul

Souvong

et al. 2013

BMC Health Serv Res

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BackgroundThe treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2) patient attendance at health facilities.MethodsWe conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009.ResultsOverall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5%) recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9%) was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20%) health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%). A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low.ConclusionsThe low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.

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“…Similarly, mental health is an enormous, grossly underappreciated problem [13]. Treatment gaps for depression, epilepsy, substance abuse, and stroke approach 100% in many of these settings [14-17], despite the existence of cost-effective packages of mental health care that could be integrated into primary care systems [18,19]. …”

Section: Introductionmentioning

confidence: 99%

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

et al. 2011

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BackgroundGlobally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases.MethodsWe conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia.ResultsSix key lessons emerge from this analysis: (i) the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases; (v) mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority; and (vi) better information systems and data management are needed at all levels of the health system.ConclusionsThe way forward for chronic diseases in Liberia will require an increased emphasis on quality over quantity, better data management to inform rational health sector planning, corrective mechanisms to more efficiently align health infrastructure and personnel with existing needs, and innovative methods to improve long-term retention in care and bridge the rural health delivery gap.

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Déficits de traitement et épilepsie dans six unités de soins périphériques du Togo de 2007 à 2009

Cited by 9 publications

References 0 publications

Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap

Living with epilepsy in Lubumbashi (Democratic Republic of Congo): epidemiology, risk factors and treatment gap

Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR?

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

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