Knowledge, attitudes and practices regarding epilepsy in the Kingdom of Bhutan

Brizzi, Kate; Deki, Sonam; Tshering, Lhab; Clark, Sarah J.; Nirola, Damber Kumar; Patenaude, Bryan; McKenzie, Erin; McLane, Hannah C.; Cash, Sydney S.; Dorji, Chencho; Mateen, Farrah J.

doi:10.1093/inthealth/ihw017

Cited by 14 publications

(9 citation statements)

References 12 publications

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“…Family members of PWE are also affected, with other adults in the family missing an average of seven days of work each year to provide care for an adult with epilepsy, and nearly 17 days for a child with epilepsy. Overall, our findings indicate that, even in a setting where direct medical costs are low, indirect costs of epilepsy from lost productivity can place a major economic burden on families, particularly when control of seizures is poor and stigma towards those with epilepsy remain high [25].…”

Section: Discussionmentioning

confidence: 73%

The economic burden of epilepsy in Bhutan

Wibecan

Fink

Tshering

et al. 2018

Tropical Med Int Health

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Summary Objective: To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care. Methods: A cross-sectional survey was conducted of patients with epilepsy receiving care at Jigme Dorji Wangchuk National Referral Hospital from January to August, 2016. Data were collected on clinical features of epilepsy, cost of care, impact of epilepsy on school or work, and household economic status of participants and matched comparisons (a sibling or neighbor from a separate household without epilepsy). Results: A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean annual direct out-of-pocket costs for epilepsy care was 6,054 BTN (91 USD), of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 ± 9.0 days of work or school per year on average, and children missed 18.6 ± 34.7 days of school. Of adult participants, 23 (18%) abandoned employment or school because of epilepsy; among school-age children, seven (18%) stopped school because of epilepsy. Households with a person with epilepsy had lower monthly per-person income (6,434 BTN) than comparison households without epilepsy (8,892 BTN; p = 0.027). Significance: In this lower-middle-income country, despite universal health care services, households of people with epilepsy face a significant economic burden. Cost of transportation for epilepsy care contributes a major proportion of the direct cost burden. Indirect costs, including negative effects on school achievement and employment, disrupt the economic potential of people with epilepsy in Bhutan. Household economic well-being is impacted by the direct and indirect costs of epilepsy.

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Section: Discussionmentioning

confidence: 73%

The economic burden of epilepsy in Bhutan

Wibecan

Fink

Tshering

et al. 2018

Tropical Med Int Health

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“…Advertisements were made through a local newspaper, The Kuensel , as well as radio. Details of our study recruitment and design have been reported previously (Brizzi et al, 2016; McKenzie et al, 2016). …”

Section: Methodsmentioning

confidence: 99%

Yield of Brain MRI in Clinically Diagnosed Epilepsy in the Kingdom of Bhutan: A Prospective Study

Bruno

Klein

Nidup³

et al. 2017

Annals of Global Health

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Introduction To report the diagnostic yield of brain MRI and identify clinical associations of abnormal MRI findings among people with epilepsy (PWE) in a neurocysticercosis-endemic, resource-limited setting, and to identify the proportion and putative structural brain causes of drug resistant epilepsy cases. Methods PWE were prospectively enrolled at the Jigme Dorji Wangchuck National Referral Hospital in Bhutan (2014–2015). Each participant completed clinical questionnaires and a 1.5 tesla brain MRI. Each MRI was reviewed by at least one radiologist and neurologist in Bhutan and the U.S.A. A working definition of drug resistant epilepsy for resource-limited settings was given as (a) seizures for >1 year, (b) at least one seizure in the prior year, and (c) presently taking 2 or more antiepileptic drugs (AEDs). Logistic regression models were constructed to test the cross-sectional association of an abnormal brain MRI with clinical variables. Results 217 participants [125 (57%) female; 54 (25%) <18 years old; 199 (92%) taking AEDs; 154 (71%) with a seizure in the prior year] were enrolled. There was a high prevalence of abnormal brain MRIs (176/217, 81%). Mesial temporal sclerosis was the most common finding (n=115, 53%, including 24 children), exceeding the number of PWE with neurocysticercosis (n=26, 12%, including one child) and congenital/perinatal abnormalities (n=29, 14%, including 14 children). The number of AEDs (odds ratio=0.59, p=0.03) and duration of epilepsy (odds ratio=1.11, p=0.02) were significantly associated with an abnormal MRI. Seizure in the prior month was associated with the presence of mesial temporal sclerosis (odds ratio=0.47, p=0.01). 25 (12%) participants met our definition of drug resistant epilepsy with mesial temporal sclerosis (n=10), congenital malformations (n=5), and neurocysticercosis (n=4) being the more frequent findings. Conclusions The prevalence of abnormalities on brain MRI for PWE in resource-limited settings is high due to a diffuse range of etiologies, most commonly mesial temporal sclerosis. Drug resistant epilepsy accounted for 12% of the referral population in a conservative estimation.

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“…There are several reasons for which women did not have formal employment, including frequent seizures leading to self-perceived stigma (Brizzi, 2016A), pregnancy, caring for small children, working as a housewife, and not having formal education to obtain employment. Table 3 illustrates the attendance of pre-natal visits and fetal ultrasounds stratified by employment and educational attainment level in WWE, irrespective of the chronology of pregnancy and epilepsy.…”

Section: Resultsmentioning

confidence: 99%