Quality Indicators for Epilepsy Care in Zambia: Roadwork for the WHO Mental Health Gap Action Programme (mhGAP) Guidelines (P07.116)

Abstract

Objective: To develop quality indicators for epilepsy/seizure care before implementation of the World Health Organization9s mhGAP programme. Background mhGAP evidence-based guidelines are aimed at improving care in lower-middle income countries (LMICs). Design/Methods: Healthcare workers with neurologic expertise developed abstraction forms aimed at capturing key aspects of care. Forms were piloted and adapted before evaluation at four sites including one non-general, specialty hospital where epilepsy care is frequently rendered. For ∼2 months, all charts were screened. Those with any seizure-related diagnoses, events or investigations were reviewed for abstraction. Results: 169 outpatient and 95 inpatient charts met criteria for abstraction. Quality of care varied substantially across institutions. Among outpatients, mean age was 27 years (SD 14.9) with male predominance (58.5%, p=0.013). Temperature was documented in 61/169 (36%) and weight in 48/169 (28.4%) with trends toward better documentation in children under 5 (p=0.053 and 0.022, respectively). Among adults based upon standard dosing, AEDs were frequently under-dosed (51/86, 59%). For people with epilepsy, seizure frequency and AED side effects were not routinely noted (present in 20/90, 22%). Folate was prescribed for only 3% of women on AEDs. Among patients prescribed AEDs, 10% received concurrent antipsychotics. Inpatients were younger (mean 18 years, SD 15.4) and 54% male. Temperature documentation remained suboptimal, 67/95(70.5%), though under-5s were more likely to have their temperature recorded (p Conclusions: Quality indicators for epilepsy/seizure care in LMICs offer important insights into areas for improvement within the scope of locally available resources. Further refinement of these indicators will be needed given the heterogeneity of epilepsy care settings and providers in such countries, and to ensure improvement in outcomes based on selected indicators. Supported by: NIH 1R01NS061693 and NIH 1R01NS061693-03S1. Disclosure: Dr. Kvalsund has nothing to disclose. Dr. Mbewe has nothing to disclose. Dr. Mulenga has nothing to disclose. Dr. Atadzhanov has nothing to disclose. Dr. Haworth has nothing to disclose. Dr. Chomba has nothing to disclose. Dr. Birbeck has nothing to disclose.