Development of an interventional strategy for the management of epilepsy in South-East Asia.
Résumé
Background
The prevalence of epilepsy is 7.7‰ in Laos and 5.8‰ in Cambodia, and the treatment gap exceeds 90% in
both countries.
Objective
Our research program aims to measure the effectiveness of two community-based health care approaches using
two different types of Domestic Health Visitors (DHV) trained to screen and follow patients with epilepsy (PWE):
(1) in Laos, DHV were chosen from health center staff (2) in Cambodia, DHV were health volunteers residing in
the villages.
Patients and Methods / Material and Methods
Between 2015 and 2017, these two quasi-experimental studies were conducted in rural districts over a 12-
months period comparing an intervention area and a control area. Our intervention included an Information,
Education and Communication campaign, specific training of the DHV staff, and regular monitoring.
In Laos, the treatment gap was reduced by 5.5% (20 to 43 cases under treatment of the 418 expected) in the
intervention area versus 0.5% (21 to 25 cases under treatment of the 788 expected) in the control area
(p<0.0001). In Cambodia, after a 6-month period (ongoing study) in area, it was reduced by 31.1% (0 to 55
cases out of the 177 expected) in the intervention compared to a 7.0% decrease (0 to 23 cases out of the 327
expected) in the control area (p<0.0001).
Conclusion
The strategy is more successful when the DHV lives in the village where he/she is going to perform his/her duty.
The results of the intervention in Laos have resulted in an Advocacy Policy Plan which has been favorably
received by the Lao Ministry of Health.