Explanatory factors of adherence to community-based management of epilepsy in Lao PDR

Bounlu, Mayoura; Auditeau, Emilie; Vorachit, Somchit; Chivorakoun, Phetvongsinh; Souvong, Vimalay; Sengxeu, Noudy; Preux, Pierre‐Marie; Boumédiène, Farid

doi:10.1016/j.yebeh.2018.08.034

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…The prevalence of epilepsy in Lao PDR was 7.7/1000 with a high treatment gap exceeding 90% 13,14 . The management of epilepsy has improved in recent years to reduce the treatment gap, resulting in a greater number of neurologists (a rise from two in 2011 to nine in 2018).…”

Section: Introductionmentioning

confidence: 99%

“…The management of epilepsy has improved in recent years to reduce the treatment gap, resulting in a greater number of neurologists (a rise from two in 2011 to nine in 2018). Electroencephalography (EEG) and brain imaging (CT), which are considered essential for accurate classification of seizure types and epilepsy syndromes, are currently available in many provinces 14,15 16 .…”

Section: Introductionmentioning

confidence: 99%

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Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

et al. 2020

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Objective Epilepsy is a chronic condition treatable by cost‐effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long‐term AEDs in Lao PDR. Method A cross‐sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1‐26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1‐26.6] of samples were classified as of poor quality. Significance We quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

et al. 2020

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“…Furthermore, In Cambodia the DHVes had about 988 subjects to cover (mean population of the villages) compared to about 3143 in Lao PDR. Surprisingly, the proportion of PWEs refusing care was high despite offering home delivery of medicine [25] . In Cambodia, the DHVes lived in the villages.…”

Section: Discussionmentioning

confidence: 99%

Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia

Boumédiène

Chhour²,

Souvong³

et al. 2020

The Lancet Regional Health - Western Pacific

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Background Epilepsy affects more than 50 million people worldwide, 80% of whom live in low- and middle-income countries (LMICs). In Southeast Asia, the prevalence is moderate (6‰), and the main public health challenge is reducing the treatment gap, which reaches more than 90% in rural areas. Methods This 12-month comparative study (intervention vs. control areas) assessed the community effectiveness of two different strategies for the identification and home follow-up of people with epilepsy by Domestic Health Visitors for epilepsy (DHVes). In Lao PDR, DHVes were health center staff covering several villages via monthly visits; in Cambodia, DHVes were health volunteers living in the villages. Findings At baseline, the treatment gap was >95% in Lao PDR and 100% in Cambodia. After 12 months, the treatment gap in Lao PDR decreased by 5·5% (range: 4·0–12·2) in the intervention area and 0·5% (range: 0·4–0·8) in the control area ( p <0·0001). In Cambodia, the treatment gap decreased by 34·9% (range: 29·0–44·1) in the intervention area and 8·1% (range: 6·7–10·2) in the control area ( p <0·0001). Among the PWEs followed at home by the DHVes, the proportion adhering to drug treatment was 85·2% in Lao PDR and 78·1% in Cambodia. The cost associated with strategy implemented in Cambodia, compared with the control area, was lower than the cost associated with strategy implemented in Lao PDR.” Interpretation The treatment gap was significantly reduced with both intervention strategies, but the effect was larger in Cambodia. The results of this cost analysis pave the way for scaling-up in rural areas of Lao PDR and Cambodia, and experimental adaptation in other LMICs. Funding The study was funded by the Global Health Department of Sanofi and Grand Challenges Canada (grant number 0325–04).

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“…For example, in India and Nepal, carbamazepine is both effective and affordable in treating focal seizures and so will be recommended for untreated focal epilepsy. In other countries such as Laos for example it may not be so readily available [25].…”

Section: What?mentioning

confidence: 99%

The development of a smartphone application to help manage epilepsy in resource-limited settings

Patterson

2020

Seizure

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Epilepsy is treatable but in low-and middle-income countries (LMICs) it goes untreated with dire consequences for people with it and their families. There are not enough available doctors to treat it so it has been suggested that non-physician health workers (NPHWs) take a role in diagnosis and management. Tools will be essential to help them. A smartphone application (app) for episode diagnosis has proved safe and effective; this paper describes an app for epilepsy management. Methods: Questions were devised which captured temporal characteristics of episodes, diagnosis of episodes, seizure types, and epilepsy type, together with information on previous investigations, treatment, drug reactions, and current treatment. For untreated patients a management plan was suggested. The app generated a summary which could be sent to a remote specialist for advice. The finished app was evaluated in 23 people presenting with possible epilepsy by four doctors in training and one NPHW; its summary was compared to face-to-face evaluation by a neurologist. Results: The app was correct in 22 of 23 (96 %) patients for episode diagnosis, 2 of 2 for symptomatic seizures,18/20 (90 %) for epilepsy type and 9/10 (90 %) for treatment suggestion in untreated patients. The app took less than 15 min to complete. Conclusion:The initial results suggest that this management app is a worthwhile tool to help inexpert doctors or NPHWs manage suspected epilepsy. Its accuracy is well within reported inter-observer agreement. In its present form it requires input from a remote epilepsy specialist. This combination is a potential solution to managing epilepsy in LMICs.• offline where data is entered and the app produces output readable

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Explanatory factors of adherence to community-based management of epilepsy in Lao PDR

Cited by 5 publications

References 19 publications

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia

The development of a smartphone application to help manage epilepsy in resource-limited settings

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