Įxamination of potential causes of inadequate care provision requires consideration of both the characteristics of the healthcare system as well as those of the user. Having learning difficulties, focal seizures and epilepsy for > 10 years were also found to be associated with non-adherence in Kenya. Additionally, misconceptions about the causes of epilepsy and fears of stigmatization are individual factors that may be associated with inadequate care. These factors are likely to impact patients at different points along the care cascade. Proposed care cascade for people living with epilepsy.Ī number of potential structural factors have been suggested for the lack of provision of adequate care for epilepsy observed in LMICs, including lack of skilled healthcare providers, unavailability of ASMs at health facilities, inability to access health facilities and high cost of treatment.
As Begley and colleagues suggest, understanding these underlying factors is vital to developing targeted interventions aimed at contextually specific need. Furthermore, the cascade of care model takes a potentially broader approach in identifying possible factors responsible for the inadequate provision of epilepsy care. The value in adopting this approach is the ability to identify where along the cascade patients fall off, thereby allowing researchers and clinicians to direct interventions at that specific stage of the care continuum. The cascade of care model has been used in research on other chronic conditions, including depression, human immunodeficiency virus, and diabetes and has recently been proposed to be used in epilepsy research as well. This approach resonates with the recently proposed stepped model of care found in the World Health Organization report on epilepsy. The cascade of care model views care along a continuum: from the identification of possible cases, to diagnosis of a patient, accessing health care, initiating treatment, receiving appropriate treatment, through to disease resolution or acceptable management, including co-morbidities ( Fig. As such, using a more expanded model could allow researchers and clinicians to explore gaps in the care continuum. Furthermore, the ETG tends to aggregate a number of steps that are necessary for an individual to receive adequate care for epilepsy. Whilst a potentially useful metric to compare access to and quality of epilepsy care across different contexts, the ETG does not provide an indication of the underlying factors responsible for the gap. A study from rural Kenya found the ETG to be 62.4 % (95 %CI: 58.1–66.6), similar to findings from a small study from rural South Africa. Two systematic reviews found the ETG to be over 50 % in most LMICs. The epilepsy treatment gap (ETG), defined as the proportion of people with active epilepsy whose seizures are appropriately controlled over the total number of people with active epilepsy in a given population at a specific time, is found to be higher in both LMICs (compared to high-income countries) and particularly in rural areas (compared to urban areas), with significant intra-country heterogeneity.
A 2014 review found that 59 % of people with epilepsy in sub-Saharan Africa do not receive any treatment and only 33 % of patients who do receive treatment are managed appropriately. Whilst pharmacologic treatment results in seizure freedom in roughly 70 % of patients with epilepsy, the number of individuals diagnosed with epilepsy and receiving and correctly taking anti-seizure medication (ASM) in LMICs remains low. Epilepsy is a common neurologic disorder that currently affects more than 50 million people globally, with at least 80 % of cases found in low- and middle-income countries (LMICs).
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