Health service provision for people with epilepsy in sub-Saharan Africa: A situational review

Abstract

We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments.

Global Health: Pediatric Neurology

“…29 Further improvement can be made with continued training, as delivery of neurologic care through primary health providers is one of the main models of successful care in Africa. 30 Ancillary resources for patients with neurologic disorders vary substantially by country. In a study conducted by the World Health Organization (WHO), 29 only 56 countries responded to questions regarding supportive neurologic services, including neuroradiology, physical therapy, occupational therapy, and speech therapy.…”

“…58 While in high-income countries, there is a growing ability to determine the etiology of childhood epilepsy, with a particular attention to genetic and metabolic syndromes and to target treatment to specific epileptic disorders, the diagnostic and therapeutic possibilities in most LMICs remain limited. 30,53,54 In most resource-limited settings, there is a paucity of specialized medical personnel and limited availability of EEG, laboratory, and neuroimaging services. 23,24,26,37,46 The same disparity between high-and low-income countries applies to access to antiseizure drugs (ASDs).…”

“…61,62 Other nonpharmacological interventions such as the ketogenic diet, vagal nerve stimulation, and other epilepsy surgeries are largely not available in low-resource settings, as they require a high level of medical expertise and financial resources. For example, only three countries in Sub-Saharan Africa (Kenya, South Africa, and Uganda) offer epilepsy surgery, 30 and according to the recent data from the WHO, only 16% of the responding 105 countries have epilepsy surgery units. However, with a few exceptions, a few of those centers are located in or accessible to patients in LMICs.…”

“…Efforts thus far by international organizations such as WHO and International League Against Epilepsy to improve care of epilepsy through dialogue with different stakeholders, local governments and pharmaceutical companies need to be further expanded and maximized. 9,30,38,48 Additional information on epilepsy globally within the adult population can be found in this issue's chapter on epilepsy.…”

Epilepsy surgery in low- and middle-income countries: A scoping review

“…Some of the most important factors for the high surgical treatment gap are the lack of organized structured care, lack of infrastructure, shortage of specialists and the cost of surgery [21,[23][24][25]. A recent review observed that barriers to epilepsy surgery are perpetuated by the uncertainty portrayed by medical practitioners towards surgical treatments, reflecting the knowledge gap, which may be more pervasive in LMIC [26].…”