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.