Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment

Nyirandagijimana, Beatha, Nshimyiryo, Alphonse, Mukasakindi, Hildegarde, Odhiambo, Jackline, Uwimana, Eugenie, Mukamurenzi, Valerie, Bienvenu, Robert, Ndikubwimana, Jean Sauveur, Uwamaliya, Clemence, Kundu, Priya, Park, Paul H., Mpunga, Tharcisse, Raviola, Giuseppe J., Kateera, Fredrick, Rusangwa, Christian and Smith, Stephanie L. (2021) 'Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment'. eNeurologicalSci, Vol 22, p. 100296.

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Abstract

Background
Integrating epilepsy care into primary care settings could reduce the global burden of illness attributable to epilepsy. Since 2012, the Rwandan Ministry of Health and the international nonprofit Partners In Health have collaboratively used a multi-faceted implementation program- MESH MH—to integrate and scale-up care for epilepsy and mental disorders within rural primary care settings in Burera district, Rwanda. We here describe demographics, service use and treatment patterns for patients with epilepsy seeking care at MESH-MH supported primary care health centers.

Methods and findings
This was a retrospective cohort study using routinely collected data from fifteen health centers in Burera district, from January 2015 to December 2016. 286 patients with epilepsy completed 3307 visits at MESH-MH participating health centers over a two year period (Jan 1st 2015 to Dec 31st 2016). Men were over twice as likely to be diagnosed with epilepsy than women (OR 2.38, CI [1.77–3.19]), and children under 10 were thirteen times as likely to be diagnosed with epilepsy as those 10 and older (OR 13.27, CI [7.18–24.51]). Carbamazepine monotherapy was prescribed most frequently (34% of patients).

Conclusion
Task-sharing of epilepsy care to primary care via implementation programs such as MESH-MH has the potential to reduce the global burden of illness attributable to epilepsy.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services WL Nervous System > WL 300 General works (Include works on brain alone)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1016/j.ensci.2020.100296
Depositing User:	Stacy Murtagh
Date Deposited:	17 Dec 2020 11:48
Last Modified:	17 Dec 2020 11:48
URI:	https://archive.lstmed.ac.uk/id/eprint/16446

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