The Childhood Epilepsy Treatment Gap in Northern Nigeria
Abstract number :
2.395
Submission category :
17. Public Health
Year :
2022
Submission ID :
2205059
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Edwin Trevathan, MD, MPH – Vanderbilt University Medical Center; Aminu Abdullahi, MBBS, MSc – Consultant and Senior Lecturer, Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano; Hafsat Ahmad, MBBS – Professor, Paediatrics, Ahmadu Bello University; Folorunsho Nuhu, MBBS – Consultant and Senior Lecturer, Psychiatry, Federal Neuropsychiatric Hospital, Kaduna; Halima Adamu, MBBS – Consultant and Lecturer, Paediatrics, Aminu Kano Teaching Hospital & Bayero University Kano; Umar Sabo, MBBS, MSc, MPH – Consultant and Senior Lecturer, Paediatrics, Aminu Kano Teaching Hospital & Bayero University Kano; Liping Du, PhD – Assistant, Biostatistics, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Lawal Habiba, MBBS – Ahmadu Bello University; Gregory Ayers, M.S. – Senior Associate, Biostatistics, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Aliyu Ibrahim, MBBS – Senior Lecturer, Medicine (Neurology), Aminu Kano Teaching Hospital & Bayero University Kano; Jamila Ibrahim, MBBS – Aminu Kano Teaching Hospital & Bayero University Kano; Isa Abdulkadir, MBBS – Ahmadu Bello University; Sodangi Ibrahim, MPH – Aminu Kano Teaching Hospital; Angela Paolucci, M.S. – Program Manager, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Fajimolu Olugbenga, MBBS – Federal Neuropsychiatric Hospital, Kaduna; Auwal Salihu, MBBS, MSc – Consultant and Senior Lecturer, Psychiatry, Aminu Kano Teaching Hospital & Bayero University Kano; Bryan Shepherd, PhD – Professor, Biostatistics, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Abiola Tajudeen, MBBS – Federal Neuropsychiatric Hospital, Kaduna; Lizet Tirres, M.S., M.B.A. – Data Manager, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Zubairu Iliyasu, MBBS, PhD – Professor, Community Medicine, Aminu Kano Teaching Hospital & Bayero University Kano
Rationale: The childhood epilepsy treatment gap estimates in sub-Saharan Africa’s low- and middle-income countries (LMICs), estimated at 67% to 90%, are important for developing systems for enhancing epilepsy care access. Prior epilepsy treatment gap estimates often did not utilize a systematic search for non-motor seizures and/or focal onset seizures, and/or specifically included only convulsive epilepsy.
Methods: As part of the Bridging the Childhood Epilepsy Treatment Gap in Africa (BRIDGE) project, mothers in three northern Nigerian cities (Kano, Kaduna and Zaria) were administered a previously validated Hausa language epilepsy screening and seizure classification tool that screened for possible generalized and focal onset epilepsy, including types of non-convulsive epilepsy among their children. Children who screened positive underwent further diagnostic evaluation for epilepsy. Children with previously untreated epilepsy were identified and offered enrollment in the BRIDGE non-inferiority cluster randomized clinical trial (cRCT) comparing care provided by epilepsy-trained community health workers (CHWs) vs. physician epilepsy care. Screening was performed in pediatric clinics, schools, and in community door-to-door surveys. Prior to the epilepsy screening, an extensive community education and awareness campaign was executed that included weekly radio broadcasts in Hausa on epilepsy as an often undiagnosed and treatable medical disorder.
Results: From June 15, 2020, to September 3, 2021, 41,625 children were screened, of which 1854 screened positive for epilepsy and 1767 were diagnosed with active epilepsy. A total of 1706 of the 1767 children with active epilepsy were untreated (overall treatment gap = 96.5%). A total of 608 of the 623 children with active epilepsy who were screened in clinics were untreated (treatment gap from clinics = 97.8%). A total of 1098 of the 1144 children with active epilepsy who were screened in community door-to-door surveys were untreated (community treatment gap = 96%). None of the 43 children screened in schools screened positive. Some children who screened positive and were diagnosed with epilepsy were brought to screening sessions after their parents listened to the epilepsy education radio broadcasts.
Conclusions: The childhood epilepsy treatment gap in three large cities of northern Nigeria is higher (96.5%) than what has been previously reported in studies from other areas of Africa. The inclusion of non-convulsive epilepsy and focal onset epilepsy in the screening tool, screening by epilepsy trained CHWs from the local communities, and the utilization of a comprehensive community education and outreach program with radio broadcasts all likely played a role in the increased ascertainment of children with untreated epilepsy.
Funding: NINDS, FIC/NIH (R01 NS113171)
Public Health