Abstract
PurposeTo evaluate the RARE (Réseau Action-Recherche sur l’Epilepsie) program, a model of managing and treating people with epilepsy (PWE) at a primary health-care level in rural areas of Mali, we assessed treatment efficacy and compliance of patients who underwent the first year follow-up.MethodsA network of rural general practitioners (GPs) settled in six rural districts of the regions of Koulikoro, Segou and Sikasso, was involved in the diagnosis, evaluation and monitoring of all the identified PWE and in the distribution of phenobarbital (PB). All the participants were included in a prospective database and followed-up by GPs at 4 months intervals during the first year. Seizure frequency, treatment doses and appearance of adverse events (AEs) were systematically recorded. Efficacy was evaluated in terms of reduction of seizures frequency while noncompliance in terms of time to study withdrawal for any cause.Key findings596 patients treated with PB were included in the analysis. Of these, 74.0% completed the first year follow-up. At the final visit, 59.6% were seizure-free: 31.0% for 12 months, 10.2% for 8 months and 18.4% for 4 months. Adults and patients with convulsive seizures were the most drug-resistant (p<0.002). Few AEs were recorded. The multivariate analysis showed that being a woman, presenting convulsive seizures, having more than 5 seizures/month and had never be treated were predictors of withdrawal (p≤0.05) at 12 months.SignificanceThis study showed a good response and compliance to the treatment and allowed the identification of some factors associated with failure of management in a setting very near to clinical practice. Awareness campaigns are needed to assure a broader accessibility to treatment and to improve the compliance and continuity with treatment programs.
Highlights
Epilepsy is one of the most common worldwide neurological disorder that could be effectively treated, representing a significant proportion of treatable burden of disease [1]
We focused the analysis on 596 patients who started treatment with PB, excluding an exiguous group of patients (42 people) treated with others medications
The RARE program was aimed at implementing treatment and management of epilepsy in rural areas of Mali at a primary healthcare level within the existing services
Summary
Epilepsy is one of the most common worldwide neurological disorder that could be effectively treated, representing a significant proportion of treatable burden of disease [1]. The cooperation between the AMC (Association des Medecins de Campagne), a group of general practitioners (GPs) settled in rural areas, and Sante-Sud, a nongovernmental organization (NGO), gives rise to a comprehensive, self-sustained program called the RARE: Reseau Action-Recherche sur l’Epilepsie, Research-action network on epilepsy [10] The aim of this network was to provide practical and efficient tools for the management of PWE located in the area and to promote research activities. In 2003 the domiciliary monitoring was stopped and the treatment program was expanded to all PWE requiring assistance to their health-care centers, creating a treatment setting very close to clinical practice To evaluate this case management model developed at a community based level, we assessed program efficacy and compliance at first year follow-up for patients who started treatment between December 2003 and December 2005
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