Conference abstract
Community-based epilepsy care in an onchocerciasis endemic area in Mahenge, Tanzania: a three-year cohort study
Pan African Medical Journal - Conference Proceedings. 2024:21(37).29
Apr 2024.
doi: 10.11604/pamj-cp.2024.21.37.2326
Archived on: 29 Apr 2024
Contact the corresponding author
Keywords: Community-based epilepsy care, onchocerciasis endemic area, cohort study
Oral presentation
Community-based epilepsy care in an onchocerciasis endemic area in Mahenge, Tanzania: a three-year cohort study
Dan Bhwana1,2,&, Luís-Jorge Amaral3, Olivia Kamoen3, William Matuja4, William Makunde2, Bruno P Mmbando2, Robert Colebunders3
1Health division, Karatu District, Karatu, Tanzania, 2National Institute of Medical Research, Tanga Research Centre, Tanga, Tanzania, 3Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 4Global Health Institute, University of Antwerp, Antwerp, Belgium
&Corresponding author
Introduction: epilepsy afflicts over 50 million people globally, with over 80% living in low- and middle-income countries. In onchocerciasis endemic areas, including Mahenge, a high epilepsy burden has been reported, with stigma and treatment gap being among the challenges facing people with epilepsy (PWE). This is a documentation of findings from a community-based epilepsy treatment program using community health care workers (CHWs) in Mahenge, Tanzania.
Methods: this prospective cohort study involved PWE identified in previous surveys in four rural villages (Mdindo, Msogezi, Mzelezi, and Sali) in the Mahenge area between 2019 and 2022. From each village, two CHWs were trained in epilepsy screening using a standard tool. Additionally, CHWs were trained on preventing epilepsy-related accidents, distributing anti-seizure medications (ASMs), and monitoring seizure-related events on a monthly basis. A negative binomial model was used to determine the temporal relationship between risk factors and the mean weekly number of seizures.
Results: two hundred and thirty-seven (237) (51.5% females) PWE were enrolled in the program during the 3.25 years of follow-up. Of the 237 PWE, 30% never attended school, and 15 (5.5%) died during the study period. Th e number of PWE with seizure freedom increased from 66.2% in 2019 at enrolment to 82.6% in 2021. The majority of PWE (213, 89.9%) were on phenobarbital. PWE who were enrolled in the cohort for longer periods, who had good adherence to ASM, and who visited the clinic often had a lower risk of reporting weekly seizures (p<0.001). Moreover, patients on carbamazepine (IRR 0.75, 95% CI 0.60-0.94), phenytoin, or lamotrigine (IRR 0.44, 95%CI 0.23-0.84) were at lower risk of seizures than those PWE on phenobarbital.
Conclusion: well-established community-based epilepsy care using community health workers is crucial to scaling up epilepsy care in Mahenge, Tanzania.
Community-based epilepsy care in an onchocerciasis endemic area in Mahenge, Tanzania: a three-year cohort study
Dan Bhwana1,2,&, Luís-Jorge Amaral3, Olivia Kamoen3, William Matuja4, William Makunde2, Bruno P Mmbando2, Robert Colebunders3
1Health division, Karatu District, Karatu, Tanzania, 2National Institute of Medical Research, Tanga Research Centre, Tanga, Tanzania, 3Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 4Global Health Institute, University of Antwerp, Antwerp, Belgium
&Corresponding author
Introduction: epilepsy afflicts over 50 million people globally, with over 80% living in low- and middle-income countries. In onchocerciasis endemic areas, including Mahenge, a high epilepsy burden has been reported, with stigma and treatment gap being among the challenges facing people with epilepsy (PWE). This is a documentation of findings from a community-based epilepsy treatment program using community health care workers (CHWs) in Mahenge, Tanzania.
Methods: this prospective cohort study involved PWE identified in previous surveys in four rural villages (Mdindo, Msogezi, Mzelezi, and Sali) in the Mahenge area between 2019 and 2022. From each village, two CHWs were trained in epilepsy screening using a standard tool. Additionally, CHWs were trained on preventing epilepsy-related accidents, distributing anti-seizure medications (ASMs), and monitoring seizure-related events on a monthly basis. A negative binomial model was used to determine the temporal relationship between risk factors and the mean weekly number of seizures.
Results: two hundred and thirty-seven (237) (51.5% females) PWE were enrolled in the program during the 3.25 years of follow-up. Of the 237 PWE, 30% never attended school, and 15 (5.5%) died during the study period. Th e number of PWE with seizure freedom increased from 66.2% in 2019 at enrolment to 82.6% in 2021. The majority of PWE (213, 89.9%) were on phenobarbital. PWE who were enrolled in the cohort for longer periods, who had good adherence to ASM, and who visited the clinic often had a lower risk of reporting weekly seizures (p<0.001). Moreover, patients on carbamazepine (IRR 0.75, 95% CI 0.60-0.94), phenytoin, or lamotrigine (IRR 0.44, 95%CI 0.23-0.84) were at lower risk of seizures than those PWE on phenobarbital.
Conclusion: well-established community-based epilepsy care using community health workers is crucial to scaling up epilepsy care in Mahenge, Tanzania.
