Epilepsy Care in Kenya: Gaps and Opportunities from Targeted Survey of Health Workers
Main Article Content
Abstract
Background: The epilepsy treatment gap in sub-Saharan Africa is 75 to 90%, compared to less than 10% in high-income countries. The Addis Clinic, a U.S.-based nongovernmental organization, uses telemedicine technology to connect frontline health workers in Kenya with specialist physicians. Epilepsy specialists hypothesized that The Addis Clinic platform and network of healthcare workers in Kenya could be utilized to identify factors contributing to the epilepsy treatment gap and point to opportunities for intervention.
Methods: Online survey of frontline health workers in The Addis Clinic network, and health professionals associated with Kenya’s Moi Teaching and Referral Hospital examined six domains: demographics and practice type, epilepsy understanding, formal training and confidence, utilization of Kenya National Guidelines for the Management of Epilepsy, resources and barriers, and use of telemedicine.
Results: Among 210 health care workers, survey response rate was 62.9%. There were no statistically significant associations between healthcare workers’ characteristics, practice setup and region. Respondents were generally knowledgeable about the causes, diagnosis, and treatment of epilepsy, though some gaps in knowledge were identified. 67.9% of respondents defined epilepsy based on the longstanding definition, and 22.9 % knew the new definition. Approximately 60% of respondents reported receiving formal epilepsy training, 45% received post-graduation continued education. Over 95% provided care to patients with epilepsy, and over 95% expressed interest in further training. Majority of respondents reported some or extreme barriers to epilepsy care related to community beliefs, stigma, limited access or high costs of testing, medications, and specialists.
Conclusion: Health workers commonly reported awareness of the Kenya National Guidelines for the Management of Epilepsy, had exposure to epilepsy and experience in epilepsy care, and showed basic background knowledge of epilepsy; however, knowledge gaps were identified. The greatest barriers to epilepsy care reported include community beliefs, stigma, and lack of resources, with regional variability found. The Addis Clinic partnership with regional local leaders and epilepsy specialists will utilize these findings to develop focused interventions.
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References
2. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. Feb 3 2000;342 (5):314-9. doi:10.1056/NEJM200002033420503
3. Chin JH. Epilepsy treatment in sub-Saharan Africa: closing the gap. Afr Health Sci. Jun 2012;12 (2):186-92. doi:10.4314/ahs.v12i2.17
4. Aliyu MH, Abdullahi AT, Iliyasu Z, et al. Bridging the childhood epilepsy treatment gap in northern Nigeria (BRIDGE): Rationale and design of pre-clinical trial studies. Contemp Clin Trials Commun. Sep 2019;15:100362.
doi:10.1016/j.conctc.2019.100362
5. Ngugi AK, Bottomley C, Kleinschmidt I, et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies. Lancet Neurol. Mar 2013;12(3):253-63. doi:10.1016/S1474-4422 (13)70003-6
6. Ngugi AK, Bottomley C, Scott JA, et al. Incidence of convulsive epilepsy in a rural area in Kenya. Epilepsia. Aug 2013;54(8):1352-9. doi:10.1111/epi.12236
7. Meyer AC, Dua T, Ma J, Saxena S, Birbeck G. Global disparities in the epilepsy treatment gap: a systematic review. Bull World Health Organ. Apr 2010;88(4):260-6. doi:10.2471/BLT.09.064147
8. Kenya National Guidelines for the Management of Epilepsy: A Practical Guide for Healthcare Workers (2016).
9. Mbuba CK, Ngugi AK, Fegan G, et al. Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol. Aug 2012;11(8):688-96. doi:10.1016/S1474-4422 (12)70155-2
10. Ibinda F, Odermatt P, Kariuki SM, et al. Magnitude and factors associated with nonadherence to antiepileptic drug treatment in Africa: A cross-sectional multisite study. Epilepsia Open. Jun 2017;2(2):226-235. doi:10.1002/epi4.12052
11. Patel AA, Wibecan L, Tembo O, Kalyelye P, Mathews M, Ciccone O. Improving paediatric epilepsy management at the first level of care: a pilot education intervention for clinical officers in Zambia. BMJ Open. Jul 24 2019;9(7):e029322. doi:10.1136/bmjopen-2019-029322
12. Patterson V. Managing Epilepsy by Telemedicine in Resource-Poor Settings. Front Public Health. 2019;7:321.
doi:10.3389/fpubh.2019.00321
13. Kim EJ, Fox S, Moretti ME, Turner M, Girard TD, Chan SY. Motivations and Barriers Associated With Physician Volunteerism for an International Telemedicine Organization. Front Public Health. 2019;7:224. doi:10.3389/fpubh.2019.00224
14. Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet. Nov 27-Dec 3 2004;364(9449):1984-90. doi:10.1016/S0140-6736(04)17482-5
15. Birbeck GL, French JA, Perucca E, et al. Evidence-based guideline: Antiepileptic drug selection for people with HIV/AIDS: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Ad Hoc Task Force of the Commission on Therapeutic Strategies of the International League Against Epilepsy. Neurology. Jan 10 2012;78(2):139-45. doi:10.1212/WNL.0b013e31823efcf8
16. Menon S, Siewe Fodjo JN, Weckhuysen S, et al. Women with epilepsy in sub-Saharan Africa: A review of the reproductive health challenges and perspectives for management. Seizure. Oct 2019; 71:312-317. doi:10.1016/j.seizure.2019.08.016
17. Russell AJ, Macpherson H, Cairnie V, Brodie MJ. The care of pregnant women with epilepsy--a survey of obstetricians in Scotland. Seizure. Dec 1996;5(4):271-7. doi:10.1016/s1059-1311(96)80020-3
18. Kenya Health Workforce Report: The Status of Healthcare Professionals in Kenya, 2015 (2015).
19. Trevathan E. The Childhood Epilepsy Treatment Gap in Northern Nigeria. 2022:
20. Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet. Sep 29 2012;380(984 8):1193-201. doi:10.1016/S0140-6736(12)61381-6
21. Sambo LGWHOROfA. The health of the people: what works: the African Regional Health Report 2014. 2014.
https://iris.who.int/handle/10665/137377
22. Okoroafor SC, Kwesiga B, Ogato J, et al. Investing in the health workforce in Kenya: trends in size, composition and distribution from a descriptive health labour market analysis. BMJ Glob Health. Aug 2022;7(Suppl 1) doi:10.1136/bmjgh-2022-009748
23. Birbeck GL. The health care workforce for epilepsy in resource-poor settings: what will work? What is realistic? Epilepsia. Sep 2008;49(9):1642-3. doi:10.1111/j.1528-1167.2008.01580_3.x
24. Abdulmalik J, Kola L, Fadahunsi W, et al. Country contextualization of the mental health gap action programme intervention guide: a case study from Nigeria. PLoS Med. Aug 2013;10(8):e1001501. doi:10.1371/journal.pmed.1001501
25. Aliyu MH, Blevins M, Audet CM, et al. Integrated prevention of mother-to-child HIV transmission services, antiretroviral therapy initiation, and maternal and infant retention in care in rural north-central Nigeria: a cluster-randomised controlled trial. Lancet HIV. May 2016;3(5):e202-11. doi:10.1016/S2352-3018(16)00018-7
26. Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health. Apr 13 2017;15(1):29. doi:10.1186/s12960-017-0200-9
27. Gureje O, Abdulmalik J, Kola L, Musa E, Yasamy MT, Adebayo K. Integrating mental health into primary care in Nigeria: report of a demonstration project using the mental health gap action programme intervention guide. BMC Health Serv Res. Jun 21 2015;15:242. doi:10.1186/s12913-015-0911-3
28. Jacoby A. Epilepsy and stigma: an update and critical review. Curr Neurol Neurosci Rep. Jul 2008;8(4):339-44. doi:10.1007/s11910-008-0052-8
29. Carrizosa J, Braga P, Albuquerque M, et al. Epilepsy for primary health care: a cost-effective Latin American E-learning initiative. Epileptic Disord. Oct 1 2018;20(5):386-395. doi:10.1684/epd.2018.0997