Abstracts

A Childhood Epilepsy Screening, Diagnosis and Management Education Program for Community Health Extension Workers in Northern Nigeria

Abstract number : 3.418
Submission category : 13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year : 2018
Submission ID : 501767
Source : www.aesnet.org
Presentation date : 12/3/2018 1:55:12 PM
Published date : Nov 5, 2018, 18:00 PM

Authors :
Edwin Trevathan, Vanderbilt Institute for Global Health; Aminu T. Abdullahi, Aminu Kano Teaching Hospital; Muktar Aliyu, Associate Director for Research, Vanderbilt Institute for Global Health; Auwal Salihu, Aminu Kano Teaching Hospital; Umar Sabo, Aminu

Rationale: The childhood epilepsy treatment gap, or the percentage of children with epilepsy without epilepsy care, is up to 90% in sub-Saharan Africa.  Bridging the Childhood Epilepsy Treatment Gap in northern Nigeria (BRIDGE) seeks to close the childhood epilepsy treatment gap by task-shifting most epilepsy screening, diagnosis, and treatment to specially-trained community health extension workers (CHEWs). As a component of task-shifting epilepsy care to CHEWs, the BRIDGE project developed and implemented an epilepsy training program for CHEWs. Methods: A 4-month epilepsy training program was developed using a 'flipped classroom' pedagogy with 30 brief (10-15 minute) video lectures followed by 30-50 minute group activities that reinforced lecture topics. Topics included basic human cortical neuroanatomy, vascular neuroanatomy and stroke recognition, essentials of the neurological exam, seizure types, epilepsy syndromes, febrile seizures, causes of seizures and epilepsy, essential anti-epileptic drugs (AEDs), non-epileptic events, co-morbid conditions, status epilepticus, and seizure/epilepsy prognosis. The period of video lectures and group activities was followed by physician-supervised clinic experiences in Kano, Nigeria. All CHEWs enrolled in the course received tablet computers containing recorded lectures and other educational materials to facilitate study and review.  CHEWs were also trained in the administration of a childhood epilepsy screening questionnaire, and an epilepsy management protocol. Assessments included pre- and post-education focus groups of CHEWs, and post-course tests of essential epilepsy knowledge. Results: Twenty CHEWs started the epilepsy training program, 18 CHEWs completed the course, and then started an 18-month pilot program in task-shifted childhood epilepsy screening, diagnosis and, care.  The CHEWs demonstrated a good basic knowledge of basic cortical neuroanatomy, vascular neuroanatomy, seizure types, epilepsy syndromes, and essential AEDs on post-course examination.  The CHEWs were able to classify seizure types and epilepsy syndromes based upon historical data and clinical observation, with an emphasis on recognition of seizures versus non-epileptic events (e.g., breath holding spells), classifying focal onset seizures versus primarily generalized seizures, and identifying epilepsy syndromes that might be associated with seizure exacerbation with commonly used drugs (e.g., Juvenile Myoclonic Epilepsy).  Likewise, CHEWs demonstrated an ability to understand and follow basic epilepsy diagnosis and management protocols.  After training, CHEWs diagnosed epilepsy among some children whose epilepsy had been previously undiagnosed by primary care physicians. Post-course focus groups of CHEWs demonstrated an understanding of the burden of childhood epilepsy in the community, how to use educational interventions to combat epilepsy-associated stigma, and the importance of full inclusion of people with epilepsy in society.  CHEWs likewise demonstrated a desire to pursue task-shifted care strategies to improve access to epilepsy diagnostic and care services, and to improve epilepsy-associated outcomes. Conclusions: A childhood epilepsy course for CHEWs was administered effectively using video lectures, group exercises, and supervised clinics, using methods that can be taken to a larger scale.   Epilepsy training of CHEWs should be accompanied by epilepsy training of primary care physicians. Epilepsy-trained CHEWs may help reduce the childhood epilepsy treatment gap in sub-Saharan Africa. Funding: Funded by 1R21TW010899 from Fogarty International Center, NIH; and, by the Amos Christie Endowed Chair in Global Health (Trevathan).