The social and economic impact of epilepsy in Zambia: a cross-sectional study

Birbeck, Gretchen L.; Chomba, Elwyn; Atadzhanov, Masharip; Mbewe, Edward; Haworth, Alan

doi:10.1016/s1474-4422(06)70629-9

Cited by 130 publications

(130 citation statements)

References 23 publications

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“…The SES and food security were measured using a previously developed instrument. 20 A three-item instrument previously used in Zambia with a possible score range of 0-3 was used to measure stigma. 20 Neurocognitive status was assessed using the International HIV Dementia Scale (IHDS) 21 and the Zambian mini-mental state exam (zMMSE).…”

Section: Methodsmentioning

confidence: 99%

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Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

Birbeck¹,

Kvalsund²,

Byers³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Abstract. We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.

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Section: Methodsmentioning

confidence: 99%

“…20 A three-item instrument previously used in Zambia with a possible score range of 0-3 was used to measure stigma. 20 Neurocognitive status was assessed using the International HIV Dementia Scale (IHDS) 21 and the Zambian mini-mental state exam (zMMSE). 22 Symptoms of anxiety and depression were quantified using the Shona Symptom Scale.…”

Section: Methodsmentioning

confidence: 99%

Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

Birbeck¹,

Kvalsund²,

Byers³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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“…24 This instrument creates a ranked score for stigma severity and has been used in this setting previously. 25 Maternal psychiatric morbidity was assessed using the Shona Symptom Questionnaire (SSQ), which is a 14-item screening instrument that queries culturally relevant symptoms of psychological disorders. 26 This instrument has been used successfully with other populations in Zambia and was not modified for this study.…”

Section: Instrumentsmentioning

confidence: 99%

“…Economic status was assessed using a measurement that enumerates and values common household items. 25 Child developmental disability was assessed using the 'The Ten Questions' screen, which has been validated to detect moderate to severe cognitive, motor, vision and hearing disabilities in children as young as 2 years using a caregiver report. 30 This screen has been previously used successfully in Lusaka.…”

Section: Instrumentsmentioning

confidence: 99%

Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia

Elafros

Sakubita-Simasiku

Atadzhanov

et al. 2013

International Health

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Background: Epilepsy-associated stigma contributes substantially to the social, medical, and economic burden of disease for people with epilepsy (PWE), but little is known about its impact on caregivers of PWE.Methods: To better understand stigma experienced by caregivers of PWE, factors that influence caregiver stigma, and the effect of stigma on a caregiver's psychologic well being, we interviewed 100 caregivers of children with epilepsy in Zambia. Questions assessed maternal knowledge, attitudes, and practices related to epilepsy, maternal stigma, mother's proxy report of child stigma, and maternal psychiatric morbidity.Results: Of 100 mothers, 39 (39%) indicated that their child was stigmatized because of his or her epilepsy. Maternal proxy report of child stigma was highly correlated with maternal stigma (OR: 5.4, p¼0.04), seizure frequency (p¼0.03) and seizure severity (p¼0.01). One in five of 100 mothers (20%) reported feeling stigmatized because of their child's epilepsy. Higher maternal stigma was associated with lower familial and community support (ORs: 65.2 and 34.7, respectively; both p,0.0001) as well as higher psychiatric morbidity (OR: 1.2; p¼0.002). Formal education and epilepsy knowledge were associated with decreased maternal stigma (ORs: 0.8 and 0.7, respectively; both p,0.001).Conclusions: One in five mothers of PWE feel stigmatized because of their child's epilepsy. As maternal stigma is associated with psychiatric morbidity, educating caregivers about epilepsy and screening for anxiety and depression are warranted.

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“…When AEDs are only available through private pharmacies, the cost is likely prohibitive for many PWE, because the average monthly income in Zambia is $125, 16 with median household incomes being < $2/day, and PWE as a group have a particularly low socioeconomic status. 17 In resource-poor countries like Zambia, work undertaken by physicians in developed countries is often taken over by other healthcare personnel, such as clinical officers. One might consider the need to develop formal training for pharmacy dispensers in a setting where adequate numbers of fully trained pharmacists are not readily available.…”

mentioning

confidence: 99%

The Current Availability of Antiepileptic Drugs in Zambia: Implications for the ILAE/WHO “Out of the Shadows” Campaign

Chomba¹,

Haworth²,

Mbewe³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Recent concerns regarding antiepileptic drug (AED) availability in Zambia led us to conduct a study in the Lusaka and Southern Provinces to quantify the availability and cost of AEDs and assess determinants. Among 111 pharmacies, almost one-half did not carry AEDs (N = 54; 49.1%). Available AEDs were phenobarbitone (21; 18.9%), carbamazepine (27; 24.3%), valproic acid (4; 3.6%), and phenytoin (3; 2.7%). Adult out-of-pocket monthly costs ranged from US $7 to $30. Pediatric syrups were universally unavailable. Interviews revealed several barriers to AED provision, including that handling phenobarbitone (historically the most affordable AED) has become increasingly difficult because of newly enforced regulatory requirements. Personal communications with epilepsy-care providers in other low income countries suggest that this problem may be widespread. Improved enforcement of existing drug regulations may be contributing to the AED shortage. Social programs aimed at encouraging people with epilepsy to come “out of the shadows” must be preceded by improved AED access.

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The social and economic impact of epilepsy in Zambia: a cross-sectional study

Cited by 130 publications

References 23 publications

Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia

The Current Availability of Antiepileptic Drugs in Zambia: Implications for the ILAE/WHO “Out of the Shadows” Campaign

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