Evaluation of Kilifi Epilepsy Education Programme: A randomized controlled trial

Abstract

ObjectivesThe epilepsy treatment gap is largest in resource-poor countries. We evaluated the efficacy of a 1-day health education program in a rural area of Kenya. The primary outcome was adherence to antiepileptic drugs (AEDs) as measured by drug levels in the blood, and the secondary outcomes were seizure frequency and Kilifi Epilepsy Beliefs and Attitudes Scores (KEBAS).MethodsSeven hundred thirty-eight people with epilepsy (PWE) and their designated supporter were randomized to either the intervention (education) or nonintervention group. Data were collected at baseline and 1 year after the education intervention was administered to the intervention group. There were 581 PWE assessed at both time points. At the end of the study, 105 PWE from the intervention group and 86 from the nonintervention group gave blood samples, which were assayed for the most commonly used AEDs (phenobarbital, phenytoin, and carbamazepine). The proportions of PWE with detectable AED levels were determined using a standard blood assay method. The laboratory technicians conducting the assays were blinded to the randomization. Secondary outcomes were evaluated using questionnaires administered by trained field staff. Modified Poisson regression was used to investigate the factors associated with improved adherence (transition from nonoptimal AED level in blood at baseline to optimal levels at follow-up), reduced seizures, and improved KEBAS, which was done as a post hoc analysis. This trial is registered in ISRCTN register under ISRCTN35680481.ResultsThere was no significant difference in adherence to AEDs based on detectable drug levels (odds ratio [OR] 1.46, 95% confidence interval [95% CI] 0.74–2.90, p = 0.28) or by self-reports (OR 1.00, 95% CI 0.71–1.40, p = 1.00) between the intervention and nonintervention group. The intervention group had significantly fewer beliefs about traditional causes of epilepsy, cultural treatment, and negative stereotypes than the nonintervention group. There was no difference in seizure frequency. A comparison of the baseline and follow-up data showed a significant increase in adherence—intervention group (36–81% [p < 0.001]) and nonintervention group (38–74% [p < 0.001])—using detectable blood levels. The number of patients with less frequent seizures (≤3 seizures in the last 3 months) increased in the intervention group (62–80% [p = 0.002]) and in the nonintervention group (67–75% [p = 0.04]). Improved therapeutic adherence (observed in both groups combined) was positively associated with positive change in beliefs about risks of epilepsy (relative risk [RR] 2.00, 95% CI 1.03–3.95) and having nontraditional religious beliefs (RR 2.01, 95% CI 1.01–3.99). Reduced seizure frequency was associated with improved adherence (RR 1.72, 95% CI 1.19–2.47). Positive changes in KEBAS were associated with having tertiary education as compared to none (RR 1.09, 95% CI 1.05–1.14).SignificanceHealth education improves knowledge about epilepsy, but once only contact does not improve adherence. However, sustained educ...

A systematic review and narrative synthesis of group self-management interventions for adults with epilepsy

“…and controlSignificant increase in satisfaction in int. vs controlIbinda et al [34]738 PWE randomised581 data analysed≥ 1 seizure in the past yr1 day educational int.Information about epilepsy provided using role play, discussion, narratives and brochure on the topics was givenGroup size: up to 20. Discrete int.Non-specific ‘researchersand field staff’WCAED adherence, seizure frequency, KEBAS(Kilifi epilepsy beliefs andAttitudes scores)Pre-int.…”

Burden, causes, and outcomes of people with epilepsy admitted to a rural hospital in Kenya

“…The observed incidence of admission adds a significant burden to rural hospitals, which are already under‐resourced, given that epilepsy requires specialized management. The incidence remained high in the first 6 years, but appeared to decrease thereafter …”

“…The prevalence of epilepsy in the community is high . The treatment gap remains a challenge, although it has dropped from 70% in 2003 to 62% in 2008 following health education and sensitization programs in the community, and to 33% in those prescribed antiepileptic drugs (AEDs) following the introduction of the Kilifi Epilepsy Education Programme (KEEP) . Most patients are treated with standard AED such as phenobarbital, phenytoin, carbamazepine, and sodium valproate, according to the national guidelines .…”

Children with poor adherence to antiepileptic drugs during the first 6 months of treatment are less likely to be seizure free after 4 years

“…Considering these points and the results of the reviewed study into account, the question remains whether measures to improve adherence at the outset of treatment could influence longer term outcomes for children with epilepsy. Interventions targeted at improving adherence including epilepsy-specific education and teaching of problem-solving skills have been reported to be of benefit in a variety of settings 3 – 5. Education to improve awareness of the benefits of adherence should be considered.…”