Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session

Rationale: Epilepsy affects 1 to 2% of the world’s population with higher prevalence in low- and middle-income countries; reported prevalence as high as 4% in rural Kenya. The epilepsy treatment gap in Sub-Saharan Africa is 75 to 90%, compared to less than 10% in high-income countries. (Chin JH, Africa Health Science, 2012) The Addis Clinic, a nonprofit organization, uses telemedicine technology to connect frontline health workers (FHWs) in Kenya with specialist physicians located remotely. Epilepsy specialists hypothesized that The Addis Clinic’s platform and network of FHWs in Kenya could be utilized to identify factors contributing to epilepsy treatment gap and point to opportunities for intervention.    _x000D_
Methods: We surveyed FHWs of The Addis Clinic network, as well as health professionals associated with Moi Teaching and Referral Hospital. The survey examined six domains: demographics and practice type, current understanding of epilepsy, epilepsy training and level of confidence, utilization of Kenya National Guidelines for the Management of Epilepsy(Kenya Ministry of Health, 2016), resources and barriers for epilepsy care, and use of telemedicine. Survey responses were collected remotely using online survey. Descriptive statistics and generalized linear models were used for survey analysis._x000D_
Results: Among 210 health care workers, survey response rates of 67% were attained. Responses are summarized in Table 1 and Table 2. There were no statistically significant associations between healthcare workers’ characteristics, practice setup and region. Respondents were generally knowledgeable and confident about cause, diagnosis and treatment of epilepsy, with 67.9% defining epilepsy based on the longstanding definition, however only 22.9 % including the new definition. Nurses in Rift Valley province respondents had greater odds of incorrect responses to questions assessing knowledge. About 60% of respondents reported receiving formal epilepsy training; approximately 40% received post-graduation continued education. Over 95% expressed interest in undergoing further training. The great majority of respondents reported some or extreme barriers for epilepsy care provision, with multiple contributing factors, including community’s beliefs and stigma, and limited access and high costs of testing, medications and specialists consultations.

Conclusions: Health workers survey respondents commonly reported exposure and experience in epilepsy care, showed basic background knowledge of epilepsy and awareness of the Kenyan National Guidelines. However, the survey demonstrated significant gaps in knowledge of epilepsy management. The respondents reported that the greatest barriers to epilepsy care include community beliefs, stigma, and lack of resources, with regional variability. The study partnership of epilepsy specialists, The Addis Clinic, and regional local leaders will utilize these findings to develop focused interventions.  

References:_x000D_ Mbuba CK et al (2012) Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya. Lancet Neurology_x000D_ Chin, J. H. (2012) Epilepsy treatment in sub-Saharan Africa: closing the gap Africa Health Science_x000D_  _x000D_ Funding: Faculty Development Grant, University of North Carolina