Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia

Farid Boumédiène (1, 2, 3, 4) , Channara Chhour , Phetvonsinh Chivorakoun , Vimalay Souvong , Peter Odermatt (5, 6) , Chamroeun Hun , Clémence Thebaut (1, 2, 3, 4) , Mayoura Bounlu , Navuth Chum , Somchit Vorachit , Sina Ros , Samleng Chan , Pierre-Marie Preux (1, 2, 3, 4)

1 NET - Neuroépidémiologie Tropicale
2 CHU Limoges
3 Institut d'Epidémiologie Neurologique et de Neurologie Tropicale
4 GEIST - Institut Génomique, Environnement, Immunité, Santé, Thérapeutique
5 Swiss Tropical and Public Health Institute [Basel]
6 Unibas - Université de Bâle = University of Basel = Basel Universität

BackgroundEpilepsy affects more than 50 million people worldwide, 80% of whom live in low- and middle-income countries (LMICs). In Southeast Asia, the prevalence is moderate (6‰), and the main public health challenge is reducing the treatment gap, which reaches more than 90% in rural areas.MethodsThis 12-month comparative study (intervention vs. control areas) assessed the community effectiveness of two different strategies for the identification and home follow-up of people with epilepsy by Domestic Health Visitors for epilepsy (DHVes). In Lao PDR, DHVes were health center staff covering several villages via monthly visits; in Cambodia, DHVes were health volunteers living in the villages.FindingsAt baseline, the treatment gap was >95% in Lao PDR and 100% in Cambodia. After 12 months, the treatment gap in Lao PDR decreased by 5·5% (range: 4·0–12·2) in the intervention area and 0·5% (range: 0·4–0·8) in the control area (p<0·0001). In Cambodia, the treatment gap decreased by 34·9% (range: 29·0–44·1) in the intervention area and 8·1% (range: 6·7–10·2) in the control area (p<0·0001). Among the PWEs followed at home by the DHVes, the proportion adhering to drug treatment was 85·2% in Lao PDR and 78·1% in Cambodia. The cost associated with strategy implemented in Cambodia, compared with the control area, was lower than the cost associated with strategy implemented in Lao PDR.”InterpretationThe treatment gap was significantly reduced with both intervention strategies, but the effect was larger in Cambodia. The results of this cost analysis pave the way for scaling-up in rural areas of Lao PDR and Cambodia, and experimental adaptation in other LMICs.

Domaines: Santé publique et épidémiologie

Farid Boumédiène, Channara Chhour, Phetvonsinh Chivorakoun, Vimalay Souvong, Peter Odermatt, et al.. Community-based management of epilepsy in Southeast Asia: Two intervention strategies in Lao PDR and Cambodia. The Lancet Regional Health - Western Pacific, 2020, 4, pp.100042. ⟨10.1016/j.lanwpc.2020.100042⟩. ⟨hal-02967514⟩