Introduction Engagement and training of community health workers (CHWs) have demonstrated their value in different conditions. Despite repeat epilepsy trainings of CHWs in Northern Rwanda, the treatment gap remained high. We hypothesized that effectiveness of CHWs on mobilization of patients living with epilepsy (PwE) could be improved using a validated tool for epilepsy screening. Methods CHWs associated with health centers (HCs) of Gataraga, Kimonyi and Karwasa attended a 1-day training on epilepsy and Limoges epilepsy screening questionnaire (Kinyarwanda version). Thereafter, CHWs screened households in their villages for persons with one or more positive answer. CHWs then accompanied positively screened persons to a consultation for clinical evaluation and diagnosis by neurologists, and demographic data were collected. CHW variables were collected retrospectively. Results A total of 1308 persons were screened positive by 281 CHWs. Clinical diagnosis of epilepsy was confirmed in 589 and in 93 additional unscreened PwE, presenting voluntarily at the consultation. Pre-intervention number of 48 PwE increased to 682 after, a 14.2-fold increase. The overall treatment gap amounted to 93.0%. The age distribution of male PwE preponderance at younger age inverted to females at older age. CHW characteristics showed non-significant differences within and across HCs. Logistic regression did not relate CHW age, gender, and experience to screening results. Discussion Equipping CHWs with a validated screening tool was effective in identifying and mobilizing PwE in a short time frame and offers opportunity for future scaling. Nonetheless, barriers to sustainability of care will need to be addressed before.

IntroductionAs part of an interventional study on epilepsy and depression as co-morbidity, persons living with epilepsy (PwE) were enrolled in villages associated with three health centers (HCs) in the Musanze district, Rwanda. Due to slower than expected enrolment based on an estimated prevalence of 47.7‰, we engaged Community Healthcare Workers (CHWs) in the identification and referral of PwE. MethodsCHWs of villages associated to three HC participated in a one-day training on epilepsy and on the Kinyarwanda version of the Limoges epilepsy screening questionnaire. CHWs returned to their villages and identified persons responding positive to one or more questions. After one week, CHWs accompanied possible PwE to their respective HC for clinical evaluation and diagnosis of epilepsy by neurologistsResults A total of 1308 patients screened positive. Clinical diagnosis of epilepsy was confirmed in 589. We observed an unexpected effect of an additional 93 non-screened patients also presenting to HCs, all confirmed with epilepsy. The number of PwE increased from 48 persons prior to the intervention to 682 (a 14.2-fold increase). In the Gataraga, Kimonyi and Karwasa HC, the patient number increased from 18 to 161, 11 to 193 and 19 to 328, respectively. Relative increases at each HC were 8.9-, 17.5- and 17.3-fold, respectively. Conclusion This observation illustrates that involving CHWs, equipped with an easy-to-administer screening tool, enhances possible case detection and decreases epilepsy diagnosis and treatment gaps. The involvement of CHWs impacted the lives of many PwE. Study supported by: UCB Pharma