Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

Joseph Nelson Siewe Fodjo; Marieke Dekker; Richard Idro; Michel Ndahura Mandro; Pierre-Marie Preux; Alfred Njamnshi; Robert Colebunders

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

Joseph Nelson Siewe Fodjo ^{1, *} Marieke Dekker Richard Idro ² Michel Ndahura Mandro ¹ Pierre-Marie Preux ^{3, 4, 5} Alfred Njamnshi Robert Colebunders ⁶

* Auteur correspondant

1 Université d'Anvers

2 Department of Paediatrics and Child Health [Kampala, Uganda]

3 NET - Neuroépidémiologie Tropicale

4 SIME - Service de l'Information Médicale et de l'Évaluation [CHU Limoges]

5 Laboratoire de Biostatistique et d'Informatique Médicale

6 UA - University of Antwerp

Abstract : BACKGROUND: Onchocerciasis-endemic regions are known to have a high epilepsy prevalence. Limited resources in these areas and poor access to healthcare by persons with epilepsy (PWE) result in a wide anti-epileptic treatment gap, poor seizure control and a high burden of seizure-related complications. Recent community-based surveys highlight the need for epilepsy management strategies suitable for remote onchocerciasis-endemic villages to ensure better health outcomes for PWE. In this paper, we propose a feasible approach to manage PWE in such settings. MAIN TEXT: Improved management of PWE in onchocerciasis-endemic areas may be achieved by decentralizing epilepsy care. Simplified approaches for the diagnosis and treatment of epilepsy may be used by non-physicians, under the supervision of physicians or specialists. To reduce the treatment gap, a regular supply of subsidized anti-epileptic drugs (AED) appropriate for different types of onchocerciasis-associated epilepsy should be instituted. Setting up a community-based epilepsy surveillance system will enable early diagnosis and treatment of PWE thereby preventing complications. Community awareness programs on epilepsy must be implemented to reduce stigma and facilitate the social rehabilitation of PWE. Finally, strengthening onchocerciasis elimination programs by optimizing community-directed treatment with ivermectin (CDTI) and considering alternative treatment strategies might reduce the incidence of epilepsy. CONCLUSIONS: A community-based approach with task-shifting of epilepsy care from specialists to non-physician health workers will reduce epilepsy-associated morbidity. Increased advocacy and collaboration with various stakeholders is needed to establish a sustainable, cost-effective chronic care model for epilepsy that will significantly improve the quality of life of PWE in onchocerciasis-endemic regions.

Keywords : Onchocerciasis Community-based approach Comprehensive management Epilepsy

Type de document :

Article dans une revue

Domaine :

Sciences du Vivant [q-bio] / Santé publique et épidémiologie

Liste complète des métadonnées

https://hal-unilim.archives-ouvertes.fr/hal-02015671
Contributeur : Elisabeth Grelier <>
Soumis le : mardi 12 février 2019 - 12:32:12
Dernière modification le : mercredi 13 mars 2019 - 16:38:16

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

Identifiants

Collections

Citation

Exporter

Métriques

41

Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

Identifiants

Collections

Citation

Exporter

Partager

Métriques

41