Epilepsy treatment gap and determinants of access to care in Nigeria

Abstract

BackgroundThis study assessed the epilepsy treatment gap (ETG) and factors associated with access to care and adherence from three sites of Afikpo, Ijebu-Jesa and Gwandu in the Southeast, Southwest and Northwest regions of Nigeria respectively. MethodologyPeople with active epilepsy were recruited from a door-to-door survey undertaken between February and April 2018 using set criteria. The sociodemographic, pattern of care access and treatment-related information were obtained. ETG was defined according to International League Against Epilepsy criteria. Potential factors for ETG were examined using multivariate logistic regression with multiple imputations. ResultsA total of 252 subjects were recruited from the three sites. The self-reported therapeutic gap was 83.3% (95% CI:78.1–87.7), while the ETG was 94.4% (95% CI: 90.9, 96.9) considering the diagnostic gap with no difference across sites (P=0.230). The potential factors associated with failure to access to care include stigma (OR 0.16, 95% CI: 0.04–0.71; P=0.016), cultural beliefs (OR: 0.31, 95% CI: 0.16–0.62; P=0.001), difficulty reaching a health facility (OR 0.33, 95% CI: 0.14–0.75; P=0.008), and non-acceptance of diagnosis (OR 0.36, 95% 0.15–0.85; P=0.021). Factors associated with non-adherence include cultural beliefs (OR 28.68, 95% CI: 1.70– 483.97; P=0.020), afternoon seizures (OR 0.006, 95% CI: 0.001–0.58; P=0.029), learning difficulty (OR 0.16, 95% CI: 0.03–0.88; P=0.035), and difficulty reaching a health facility (OR 25.44, 95% CI: 0.88–735.88; P=0.059). ConclusionThe treatment gap is high in Nigeria. The negative cultural belief can be improved by patient and community education.