Effectiveness of Involvement of Community Health Workers in Identification and Referral of Persons Living With Epilepsy in Rural Rwanda

Abstract

IntroductionAs part of an interventional study on epilepsy and depression as co-morbidity, persons living with epilepsy (PwE) were enrolled in villages associated with three health centers (HCs) in the Musanze district, Rwanda. Due to slower than expected enrolment based on an estimated prevalence of 47.7‰, we engaged Community Healthcare Workers (CHWs) in the identification and referral of PwE. MethodsCHWs of villages associated to three HC participated in a one-day training on epilepsy and on the Kinyarwanda version of the Limoges epilepsy screening questionnaire. CHWs returned to their villages and identified persons responding positive to one or more questions. After one week, CHWs accompanied possible PwE to their respective HC for clinical evaluation and diagnosis of epilepsy by neurologistsResults A total of 1308 patients screened positive. Clinical diagnosis of epilepsy was confirmed in 589. We observed an unexpected effect of an additional 93 non-screened patients also presenting to HCs, all confirmed with epilepsy. The number of PwE increased from 48 persons prior to the intervention to 682 (a 14.2-fold increase). In the Gataraga, Kimonyi and Karwasa HC, the patient number increased from 18 to 161, 11 to 193 and 19 to 328, respectively. Relative increases at each HC were 8.9-, 17.5- and 17.3-fold, respectively. Conclusion This observation illustrates that involving CHWs, equipped with an easy-to-administer screening tool, enhances possible case detection and decreases epilepsy diagnosis and treatment gaps. The involvement of CHWs impacted the lives of many PwE. Study supported by: UCB Pharma