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

Abstract

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).

A cluster‐randomized trial comparing home‐based primary health care and usual clinic care for epilepsy in a resource‐limited country

“…Home‐care has been applied to improve outcomes in chronic medical disorders, notably hypertension, with mixed results 30 . It has also been implemented for epilepsy previously, e.g., in Kenya, Laos and Cambodia 12,31–33 . The studies from communities in Laos and Cambodia used facility‐ and community‐based health visitors.…”

“…30 It has also been implemented for epilepsy previously, e.g., in Kenya, Laos and Cambodia. 12,[31][32][33] The studies from communities in Laos and Cambodia used facility-and community-based health visitors. Our model encompassed home-care provided by the community-and primary care providers with backup by neurologists.…”

Diagnosis of Epilepsy by Traditional Healers and Its Implications on Management in the Selected Rural Communities of Limpopo and Mpumalanga Provinces: A Qualitative Study

“…These findings are similar to other authors who found that epilepsy is characterized by recurring seizures that can be accompanied by unconsciousness and loss of bowel or bladder function stiff muscles, uncontrollable jerking movements of the arms and legs, dizziness, and anxiety are all symptoms of epilepsy. 29,30 Epilepsy was diagnosed as a result of these observations. Furthermore, a study conducted by Nass, 31 Stutton 32 shows that epilepsy can be identified with basic blood tests (complete blood count, urea, creatinine, electrolytes, liver function tests, and glucose).…”

The impact of COVID-19 pandemic on frail health systems of low- and middle-income countries: The case of epilepsy in the rural areas of the Bolivian Chaco

“…The reduction in epilepsy TG in the rural areas of the Bolivian Gran Chaco has been the main aim of different projects performed by our group over the last 20 years in this area [11] , [12] , [13] , [14] , [15] , [16] . In agreement with the WHO guidelines [17] , and likewise other campaigns carried out in other LMIC [18] , [19] , during our long-lasting activity in rural Bolivia, we performed several epidemiological and interventional surveys including an anthropological survey, training programs directed to General Practitioners (GPs), nurses and Community Health Workers (CHWs) of the rural communities of the Chaco region as well as communities awareness programs [13] , [14] , [15] . These activities have increased the level of knowledge and awareness about epilepsy in this region, and facilitated the access to care leading to a reduction in the TG in this area [20] .…”