Epilepsy field workers, a smartphone application and telephone telemedicine: Safe and effective epilepsy care in rural Nepal

Abstract

A B S T R A C TPurpose: Most people with epilepsy live in low-or middle-income countries (LMICs) where there are relatively few doctors. Over 50% of people with epilepsy in these countries are untreated so other models of care are needed. In this report we evaluate a novel model of care. Methods: We trained four residents of Myagdi, a rural district in Nepal as epilepsy field workers (EFWs). They provided epilepsy awareness to their communities. When they identified someone with possible epilepsy they used a smartphone application (app) to determine the probability score for an episode being epileptic and contacted an epilepsy specialist by phone. If the specialist thought treatment was indicated this was arranged by the EFW. We recorded mortality, change of diagnosis at face-to-face consultation and drug-related events as measures of safety. Seizure frequency and general wellbeing were also recorded, and a questionnaire was devised to measure satisfaction. Results: 112 patients with app scores suggesting epileptic seizures were identified and managed in 18 months, of whom 15 had provoked seizures. Forty-three percent of epilepsy patients were untreated. At follow-up one had died of a cause other than epilepsy. Diagnostic agreement at face-to-face assessment was 93%. Overall 5% had side-effects of medication. Seizures were stopped in 33% and reduced in 57%. Ninety-six percent of patients preferred this service to travelling to other doctors. Conclusion: This novel service met all criteria of safety and was effective in reducing frequency of seizures. Patients preferred it to conventional services. It should be transferable to other LMICs. [13]. The sensitivity of this app was 92% and 86% in two previous https://doi.

Two-Way Short Message Service (SMS) Communication May Increase Pre-Exposure Prophylaxis Continuation and Adherence Among Pregnant and Postpartum Women in Kenya

“…28 mHealth applications have successfully facilitated monitoring and mitigation of medication side effects for other health conditions in low-and middle-income countries. 29,30 Promoting selfmanagement of PrEP side effects and empowering women by filling PrEP knowledge gaps could be a mechanism by which the mWACh-PrEP platform improved PrEP continuation in this study. We found diminished response to automated messages after 1 month, which suggests that a timelimited mHealth intervention may be sufficient to address concerns and support onboarding to sustained PrEP use.…”

<p>Telemedicine in Resource-Limited Setting: Narrative Synthesis of Evidence in Nepalese Context</p>

“…Review identified many reasons behind the lack of accessibility, such as poor communication system, land slide or flash flood during rainy season, etc. In total 20 papers reported the telemedicine features of addressing challenges of geographic remoteness [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and 11 papers reported time saving [29][30][31][32][33]40,41,[47][48][49][50] character. 4 papers reported communication and transportation 30,32,46,49 related issues.…”

“…30,44,48 Rural-urban disparity and lack of services in rural areas block the way to increased accessibility. 2 papers reported the issue of addressing challenges of disparity in terms of rural-urban difference in Rajbhandari et al 2019 47 Most people with epilepsy live LMI countries like Nepal; especially in rural areas where there are relatively few doctors coupled with lack of quality services, treatment gaps, etc. Smartphone application using tab was launched in order to reach this population group.…”

“…The current review identified 11 papers reporting the issue of shortage of healthcare service providers. 29,39,[42][43][44][45][46][47][53][54][55][56] 3 papers have highlighted the issue of inadequate health facilities. 29,41,54 These three papers discussed one common thing, which was the lack of skilled and specialized healthcare service providers outside of the mega cities of Nepal.…”

“…Challenges of ensuring quality services in rural areas create an extra burden when Nepal is working hard to reach the coverage of health service and proper diagnosis to all its population with limited resources. This review found 9 papers discussing about service quality 31,32,35,40,44,46,47,50,56 and 2 paper discussing about proper diagnosis 49,56 as key benefits of using telemedicine.…”