Research Article: First choice of treatment place in the pathways to epileptic care at the outpatient department of University of Gondar Hospital, Northwest Ethiopia: Cross-sectional institutional based study

Date Published: August 15, 2017

Publisher: Public Library of Science

Author(s): Berhanu Boru Bifftu, Berihun Assefa Dachew, Bewket Tadesse Tiruneh, Wondale Getinet Alemu, Andrea Romigi.

http://doi.org/10.1371/journal.pone.0181310

Abstract

Epilepsy treatment gap range from 87% to 98%. In spite of this, there is a gross inadequacy of the availability, accessibility and affordability of Anti-Epileptic Drugs. In countries like Ethiopia, where most populations are less aware about mental health problems, most people seek help for their illness from traditional healers. Thus, the main purpose of this study was to assess the pathways to epilepsy care and associated factors.

Cross-sectional study design utilized among 409 participants selected by systematic random sampling technique. Pathways to epilepsy care were assessed by using the WHO Pathway Study tool. Multivariable logistic regression was done to identify factors associated with pathways to epileptic care.

Overall, 162 (39.6%) of participants first contacted with modern treatment. Two hundred and forty seven (60.4%) of participants counted traditional healers and religious healers were the most common (47.2%). Being men, attending higher education, urban residence, short duration of illness, social support and age at the onset of illness were factors associated with first contact with modern treatment.

Modern treatment was not the first place of choice for the majority of the respondents. Strengthening awareness creation program about epilepsy and its treatment is highly recommended with special emphases to urban dwellers and less educated people.

Partial Text

Epilepsy is one of the most common neurological disorders, affecting around 50 million people worldwide. Of these 50 million, majority them (80–85%) live in poor countries [1]. In low- and middle-income countries (LMICs), the median estimate for lifetime prevalence of epilepsy is 15.4 per 1000 people in rural areas and 10.3 per 1000 in urban settings and it is the second reason for consultation and hospitalization [2]. In Ethiopia, epilepsy is a huge problem, with an estimated prevalence of 520/100,000 people in a large-scale, rural, community-based survey [3, 4]. In spite of this, there is a gross inadequacy of the availability, accessibility and affordability of Anti-Epileptic Drugs [2–9]. In countries like Ethiopia, where most populations are less aware of health problems, most people seek help for their illness from traditional healers [3, 10, 11]. Use of traditional medicines (TMs) is widespread in developed and developing countries including Ethiopia. Up to 80% of the population in developing countries uses traditional medicine due to the cultural acceptability of healers, the relatively low cost, difficult access to modern health facilities and their perceived cause of the illness [12, 13]. Like other low and middle income countries, many people in Ethiopia also rely on spiritual remedies [13, 14]. Data on help-seeking confirm that decisions and choices about which practitioner to consult were associated with belief, choice or preference and the structural of health service which result in epilepsy treatment gap [10, 11].

A total of 409 participants participated in this study with a 96.9% response rate.

The main findings of our study revealed around 40% of the study participants’ contacted modern treatment, and associated with being men, attending higher education, urban residence, short duration of illness, social support and age at the onset of illness. Compared to other similar studies, the result of this finding was lower than the study carried out in India, 81.6% [15, 16], 62% [11], Kenya 74% [24] Nepal 51.1% [24]. This may be due the fact that those patients from India, Kenya and Nepal may have better access for different resource like: AED, educated man power and health facility. As evidence from Ethiopia revealed lack of epilepsy service include: inaccessibility of medical services, unavailability of anti-epileptic drugs and educated man power was barrier for the utilizations of modern epileptic treatments [10, 13, 25]. In addition to lack of resource, most of the Ethiopian societies consider epilepsy as psychiatric disorder. For example, the only mental hospital, Amanuel specialized hospital, approximately 25% of the customer were epileptic patients that is why individual with epilepsy shared the treatment gap, stigma and discrimination with individual suffering with mental illness [16, 25]. Even if there is scarce of similar study in Ethiopia among epileptic patients, the result of our finding is similar with studies carried out among psychiatric and epileptic patients [3, 10, 14]. From this it is observed the similarity of shared belief of Ethiopian society as evidenced by majority (58.7%) of our study participants’ explain the cause of the illness was spiritual possession [17].

Recall and response biases might have occurred since; we relied on respondents’ retrospective recall of information. The other possible limitation might occurred when some of the participants might not truly acknowledge and give true response to their previous source of first contact for care (i.e traditional healer) since some of this settings might not recommended in certain social and religious groups.

Modern treatment was not the first place of choice for the majority of the respondents. Education status, urban residence, social support, onset and duration of illness were factors statistically associated with first contact with modern treatment. Strengthening the educational status of epileptic patients was suggested especially for those patients reside in rural area and do not have social support.

 

Source:

http://doi.org/10.1371/journal.pone.0181310

 

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