Abstract
BackgroundMany patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received.MethodsA cross sectional study was conducted across 87 out of 312 villages in Masindi district. A total of 305 households having patients with epilepsy were surveyed using an interviewer administered questionnaire. Data was entered and analysed in Epi-info ver 7 for univariate and bivariate analysis, and in Stata SE ver 15.0 for multivariable analysis. Sequences of health providers consulted in care seeking, rationale and drugs used, and factors associated with choice of provider were assessed.ResultsA total of 139 out of 305 (45.6%) households offered some treatment regimen at home when patients got symptoms of epilepsy with 44.6% (62/139) giving herbs and 18.0% (25/139) offering prayers. Eight different types of providers were consulted as first contact providers for treatment of epilepsy. Health centres received the highest percentage 35.4% (108/305) followed by hospitals 20.9% (64/305). A total of 192 of 305 (63.0%) households received anti-epileptic drugs, 13.1% (40/305) received prayers and 21.6% (66/305) received herbs at the first contact care seeking. Compared to a health centre as the first choice provider, other facilities more significantly visited were; hospitals if they were perceived as nearer (adj. Coeff 2.16, 95%CI 0.74, 3.59, p = 0.003), churches / mosques if cure for epilepsy was expected (adj. Coeff 1.91, 95%CI 0.38, 3.48, p = 0.014), and traditional healer for those aged ≥46 years (adj. Coeff 5.83, 95%CI 0.67, 10.99, p = 0.027), and friends/neighbour for traders (adj. Coeff 2.87, 95%CI 0.71, 5.04, p = 0.009).ConclusionPatients with epilepsy seek treatment from multiple providers with the public sector attending to the biggest proportion of patients. Engaging the private sector and community health workers, conducting community outreaches and community sensitization with messages tailored for audiences including the young, older epileptics, traditional healers as stakeholders, and traders could increase access to appropriate treatment for epilepsy.
Highlights
Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment
The objective of this study was to assess the providers through whom the patients with epilepsy in Masindi district pass as they seek care, where they terminate their care seeking and the remedies offered from these various providers
Descriptive statistics Characteristics of respondents A total of 305 respondents were interviewed from 87 villages in 25 parishes cutting across all the nine subcounties of the district
Summary
Many patients with epilepsy in sub-Saharan Africa do not receive adequate treatment. The purpose of the study was to identify the health care providers where patients with epilepsy sought care and what treatment they received. In sub-Saharan Africa, about 60% of the patients do not receive treatment due to social or economic reasons [1]. The treatment gap for epilepsy in Uganda has been estimated at 78% [2]. Care seeking for chronic illnesses like epilepsy takes a long time and patients pass through various providers. Information on the different providers through whom the patients pass and the treatment options they receive is critical to developing strategies to increase coverage of epilepsy patients receiving effective evidence-based modern treatments and remedies
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