Abstract
SummaryObjectivePeople with epilepsy (PWE) develop complications and comorbidities often requiring admission to hospital, which adds to the burden on the health system, particularly in low‐income countries. We determined the incidence, disability‐adjusted life years (DALYs), risk factors, and causes of admissions in PWE. We also examined the predictors of prolonged hospital stay and death using data from linked clinical and demographic surveillance system.MethodsWe studied children and adults admitted to a Kenyan rural hospital, between January 2003 and December 2011, with a diagnosis of epilepsy. Poisson regression was used to compute incidence and rate ratios, logistic regression to determine associated factors, and the DALY package of the R‐statistical software to calculate years lived with disability (YLD) and years of life lost (YLL).ResultsThe overall incidence of admissions was 45.6/100,000 person‐years of observation (PYO) (95% confidence interval [95% CI] 43.0–48.7) and decreased with age (p < 0.001). The overall DALYs were 3.1/1,000 (95% CI, 1.8–4.7) PYO and comprised 55% of YLD. Factors associated with hospitalization were use of antiepileptic drugs (AEDs) (odds ratio [OR] 5.36, 95% CI 2.64–10.90), previous admission (OR 11.65, 95% CI 2.65–51.17), acute encephalopathy (OR 2.12, 95% CI 1.07–4.22), and adverse perinatal events (OR 2.87, 95% CI 1.06–7.74). Important causes of admission were epilepsy‐related complications: convulsive status epilepticus (CSE) (38%), and postictal coma (12%). Age was independently associated with prolonged hospital stay (OR 1.02, 95% CI 1.00–1.04) and mortality (OR, 1.07, 95% CI 1.04–1.10).SignificanceEpilepsy is associated with significant number of admissions to hospital, considerable duration of admission, and mortality. Improved supply of AEDs in the community, early initiation of treatment, and adherence would reduce hospitalization of PWE and thus the burden of epilepsy on the health system.
Highlights
Epilepsy is a common neurologic disorder directly affecting about 70 million people in the world, with about 90% residing in lower-and middle-income countries.[1]
We further examined the risk factors associated with the major outcomes among People with epilepsy (PWE)
The treatment gap remains a challenge, it has dropped from 70% in 200311 to 62% in 2008 following health education and sensitization programs in the community,[12] and to 33% in those prescribed antiepileptic drugs (AEDs) following the introduction of the Kilifi Epilepsy Education Programme (KEEP).[13]
Summary
Epilepsy is a common neurologic disorder directly affecting about 70 million people in the world, with about 90% residing in lower-and middle-income countries.[1] The treatment gap for epilepsy is large (up to 90%) in these areas, and this is in part due to negative attitudes toward biomedical services, cost of accessing diagnosis and treatment, and traditional beliefs about the cause of epilepsy.[2,3] People with epilepsy (PWE) are thought to have more hospital admissions than those with other chronic neurologic disorders,[4] and is the third most common after stroke and spinal cord injuries in sub-Saharan Africa (SSA).[5]
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