Background: The campaign against epilepsy is hampered by the difference between those with the active disorder and the number of them receiving appropriate treatment (treatment gap) in sub-Saharan Africa. Identifying the determinants of this gap is crucial to providing and achieving optimal care. Objective: To identify the determinants of epilepsy treatment gap (ETG) in children and adolescents (Subjects) with epilepsy in a rural community. Methods: Subjects were identified through a community house to house survey. Information obtained from Subjects and their care givers included: sociodemographic characteristics, type and frequency of epileptic seizures, current and past treatment options utilized, reasons for treatment options used, and treatment options utilized for other health complaints. Results: Twenty three Subjects (6.4/1000 of the child and adolescent population) were identified as having epilepsy. Their age range was 4-19 years (mean 14.3±4.7 years). Most were males (82.6%) and adolescents (78.3%). Seizures were mostly generalized (95.7%) and occurred most frequently daily. Current treatment modalities were use of traditional medication (100%) and prayers (34.8%).None was currently on orthodox medical therapy (ETG, 100%) but 5(21.7%) had utilized orthodox medical therapy in the past. The main determinants of the ETG were strong cultural belief, weakness in the health system to epilepsy treatment and low socioeconomic status. Fever was the commonest other health complaint and use of orthodox medical therapy was significantly (p˂ 0.05) the main (16, 69.6%) treatment option utilized. Conclusion: Cultural belief, weak health system and low socioeconomic status were determinants of an absolute ETG. It highlights the need to strengthen initiatives that enhance accessibility to standard epilepsy treatment.