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Oshi M, Chida K, Roy AM, Mann GK, An N, Yan L, Endo I, Takabe K. Higher inflammatory response in hepatocellular carcinoma is associated with immune cell infiltration and a better outcome. Hepatol Int 2024; 18:1299-1309. [PMID: 38898190 DOI: 10.1007/s12072-024-10678-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) often develops from chronic liver inflammation. Inflammation within a tumor can either promote cancer progression or activate an immune response against it. This study aims to determine the clinical significance of enhanced inflammation in HCC. METHODS Data from 655 HCC patients across four cohorts (TCGA, GSE6764, GSE76427, GSE89377) were examined. Inflammatory response was quantified using a scoring system derived from the gene set variation analysis of the "INFLAMMATORY_RESPONSE" gene set. RESULTS A stepwise increase in inflammatory response was noted from normal liver to cirrhosis, with consistently lower levels in HCC across both GSE6764 and GSE89377 cohorts (both p < 0.001). Similar trends were observed in interferon response, pathways such as IL6/JAK/STAT3 and complement signaling, coagulation cascade, and allograft rejection (all p < 0.02). HCCs with high inflammatory response were associated with increased immune cell infiltrations (p < 0.01) and cytolytic activity (p < 0.001). Interestingly, these HCCs had reduced mutation rates, no relationship with cell proliferation, and displayed both immune responses and pro-cancerous signals including epithelial-mesenchymal transition, KRAS, and hypoxia. Further, a high inflammatory score correlated with improved disease-free survival in TCGA (p = 0.034) and overall survival in GSE76427 (p = 0.008). CONCLUSION HCC with higher levels of inflammatory response demonstrated increased immune cell infiltration, enhanced immune-related and other pro-cancerous-related signaling, and showed a trend toward a better patient prognosis.
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Affiliation(s)
- Masanori Oshi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Kohei Chida
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Arya Mariam Roy
- Department of Hematology and Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Gabriella Kim Mann
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Nan An
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Li Yan
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA.
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan.
- Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, 160-8402, Japan.
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 951-8520, Japan.
- Department of Breast Surgery, Fukushima Medical University School of Medicine, Fukushima, 960-1295, Japan.
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, 14263, USA.
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Oshi M, Chida K, Roy AM, Mann GK, An N, Yan L, Endo I, Takabe K. Higher Inflammatory Response in Hepatocellular Carcinoma is Associated with Immune Cell Infiltration and a Better Outcome. RESEARCH SQUARE 2024:rs.3.rs-3768964. [PMID: 38260290 PMCID: PMC10802714 DOI: 10.21203/rs.3.rs-3768964/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background & Aims Hepatocellular carcinoma (HCC) often develops from chronic liver inflammation. Inflammation within a tumor can either promote cancer progression or activate an immune response against it. This study aims to determine the clinical significance of enhanced inflammation in HCC. Methods Data from 655 HCC patients across four cohorts (TCGA, GSE6764, GSE76427, GSE89377) were examined. Inflammatory response was quantified using a scoring system derived from the gene set variation analysis of the "INFLAMMATORY_RESPONSE" gene set. Results A stepwise increase in inflammatory response was noted from normal liver to cirrhosis, with consistently lower levels in HCC across both GSE6764 and GSE89377 cohorts (both p<0.001). Similar trends were observed in interferon response, pathways such as IL6/JAK/STAT3 and complement signaling, coagulation cascade, and allograft rejection (all p<0.02). HCCs with high inflammatory response were associated with increased immune cell infiltrations (p<0.01) and cytolytic activity (p<0.001). Interestingly, these HCCs had reduced mutation rates, no relationship with cell proliferation, and displayed both immune responses and pro-cancerous signals including epithelial-mesenchymal transition, KRAS, and hypoxia. Further, a high inflammatory score correlated with improved disease-free survival in TCGA (p=0.034) and overall survival in GSE76427 (p=0.008). Conclusion HCC with higher levels of inflammatory response demonstrated increased immune cell infiltration, enhanced immune-related and other pro-cancerous-related signaling, and better patient prognosis.
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Affiliation(s)
| | | | | | | | - Nan An
- Roswell Park Comprehensive Cancer Center
| | - Li Yan
- Roswell Park Comprehensive Cancer Center
| | - Itaru Endo
- Yokohama City University: Yokohama Shiritsu Daigaku
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Nakamura Y, Sakurai K, Ishikawa S, Horinouchi T, Hashimoto N, Kusumi I. Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy. Epilepsy Behav 2023; 145:109345. [PMID: 37441983 DOI: 10.1016/j.yebeh.2023.109345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients with epilepsy (PWE), especially those with Idiopathic Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. METHODS This was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as "not showing up for the day of an appointment without prior notice." Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. RESULTS Of the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17-3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22-3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43-0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13-0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04-0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14-0.72; p = 0.006). CONCLUSIONS GE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.
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Affiliation(s)
- Yuichi Nakamura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan.
| | - Kotaro Sakurai
- Department of Neuropsychiatry, Aichi Medical University, 1-1, Karimata, Yazako, Nagakute-shi, Aichi 480-1195, Japan
| | - Shuhei Ishikawa
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Toru Horinouchi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-Ku, Sapporo Hokkaido 060-8638, Japan
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Zena D, Tadesse A, Bekele N, Yaregal S, Sualih N, Worku E. Seizure control and its associated factors among epileptic patients at Neurology Clinic, University of Gondar hospital, Northwest Ethiopia. SAGE Open Med 2022; 10:20503121221100612. [PMID: 35646350 PMCID: PMC9134420 DOI: 10.1177/20503121221100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Epilepsy is characterized by two or more unprovoked recurrent seizures, which often respond to available antiseizure medications. However, seizure control among epileptic patients in the developing world is low. Factors determining seizure control among epileptic patients were not evidently explored in the study setting. Objectives This study aimed to determine the magnitude of uncontrolled seizures and associated factors among epileptic patients at the University of Gondar hospital. Methods This cross-sectional study was conducted at the University of Gondar hospital, Northwest Ethiopia. A convenience sampling method was used to recruit study subjects. Controlled seizure was defined as seizure freedom for the past 1 year. Logistic regression analysis was used to identify factors associated with seizure control. A p-value < 0.05 was used to declare a significant association. Results A total of 320 study subjects were included in the study. The mean (±SD) age of patients was 27.5 ± 7.6 years. More than half (182/320, 57%) of epileptic patients had uncontrolled seizures. Five or more pretreatment seizure episodes (adjusted odds ratio = 3.98, 95% confidence interval: 1.81-8.75, p = 0.001), less than 2 years on anti-seizure medications (adjusted odds ratio = 8.64, 95% confidence interval: 3.27-22.85, p < 0.001), taking 2 or more ASMs (adjusted odds ratio = 2.48, 95% confidence interval: 1.23-5.02, p = 0.011), poor adherence to ASMs (adjusted odds ratio = 9.37, 95% confidence interval: 4.04-21.75, p < 0.001), and living at a single trip distance from hospital equaled 1 h or more (adjusted odds ratio = 4.20, 95% confidence interval: 2.11-8.41, p < 0.001) were significantly associated with uncontrolled seizures. Conclusion The dose of a preferred anti-seizure medication should be optimized before combinations of anti-seizure medications are used. Adherence to anti-seizure medications should be reinforced for better seizure control. Epilepsy care should be integrated into primary health care services in the catchment region.
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Affiliation(s)
- Dawit Zena
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Bekele
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samson Yaregal
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuria Sualih
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Edilawit Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Zertuche-Ortuño L, Oropeza-Bustos N, Crail-Meléndez D, Bribiesca-Contreras E, Sebastián-Díaz MA, Martínez-Bustos V, Santos-Peyret A, Martínez-Medina S, Ochoa A, Jara-Prado A, Martínez-Juárez IE. Increased non-attendance at epilepsy clinic in patients with neuropsychiatric comorbidities: A prospective study. Epilepsy Behav 2021; 122:108202. [PMID: 34325158 DOI: 10.1016/j.yebeh.2021.108202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with epilepsy, regular follow-up is vital for adequate seizure control, antiseizure drugs' (ASDs) side effects, psychiatric comorbidities, and planning for epilepsy surgery. Non-attendance creates barriers to adequate patient care, inefficient allocation of resources, loss of income, and unnecessary emergency department visits due to lack of seizure control. This study aimed to determine the causes and sociodemographic characteristics of the non-attendant population at the Epilepsy Clinic. METHODS A prospective and observational study was carried out on patients treated at the Epilepsy Clinic of the National Institute of Neurology and Neurosurgery (NINN) in Mexico from August 2015 to June 2016. A phone interview was made with all those patients who did not attend the epilepsy consultation. This call incorporated ad hoc questions to meet the objectives of this study. RESULTS During the study period, 1299 patients had an appointment at the epilepsy clinic, where 233 (17.9%) patients missed their consultation, 123 (52.8%) were male, mean age was 35.9 ± 14.42 years. The most frequent cause of non-attendance was forgetfulness of the appointment in 62 patients (26.6%). Two patients died; no patient was reported to have experienced SUDEP. Non-attendant patients showed statistically significant overall prevalence of psychiatric comorbidities (41.6%), particularly depression, anxiety, and interictal psychosis. CONCLUSION Information on non-attendance at various specialist consultations is scarce, and to our knowledge, this is the first study to address non-attendance in patients with epilepsy in Latin America. Improving hospital protocols to reduce non-attendance can increase patient adherence to follow-up, ultimately improving the quality of care in the epilepsy clinic.
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Affiliation(s)
| | - Nayeli Oropeza-Bustos
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Daniel Crail-Meléndez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Mario A Sebastián-Díaz
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Andrea Santos-Peyret
- Neurology Residency Program, National Institute of Neurology and Neurosurgery, Mexico
| | - Salvador Martínez-Medina
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Posgraduate Program, Anáhuac Norte University, Estado de México, Mexico
| | - Adriana Ochoa
- Internal Medicine Residency Program, Medica Sur Hospital, Mexico City, Mexico
| | - Aurelio Jara-Prado
- Internal Medicine Residency Program, Medica Sur Hospital, Mexico City, Mexico
| | - Iris E Martínez-Juárez
- Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico; Neurogenetics Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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Koltai DC, Smith CE, Cai GY, Ratliff O, Kakooza-Mwesige A, Najjuma JN, Muhindo R, Rukundo GZ, Teuwen DE, Kayanja A, Kalubi P, Haglund MM, Fuller AT. Healthcare provider perspectives regarding epilepsy care in Uganda. Epilepsy Behav 2021; 114:107294. [PMID: 32763023 DOI: 10.1016/j.yebeh.2020.107294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Epilepsy is the most common chronic neurological disorder in the world and imposes a large economic burden on global healthcare systems, especially in low-income settings and rural areas as is found in sub-Saharan Africa (SSA). Despite the high epilepsy prevalence, there are no systematic descriptions of healthcare provider (HCP) perceptions and needs in managing people with epilepsy (PWE) in Uganda. Identifying these perceptions and needs is crucial for understanding community priorities, thereby enhancing the development of culturally sensitive communications, interventions, and research approaches. METHODS In this qualitative study, we used semistructured interview guides to conduct focus group discussions that explored the perspectives of 32 providers of epilepsy care from health facilities around Mbarara, Uganda. Our sample included nonspecialized general physicians (n = 3), medical residents (n = 8), medical clinical officers (n = 3), psychiatric clinical nurses (n = 6), medical nurses and nursing assistants (n = 9), and other providers (n = 3), who were loosely grouped into discussion groups based on level or type of training. Self-assessed proficiency ratings were also administered to gain a better understanding of participants' confidence in their training, preparedness, and capabilities regarding epilepsy care. Thematic analysis of the focus group transcripts was conducted to ascertain commonly occurring themes about perceptions and challenges in epilepsy care. RESULTS Our analyses identified nine major themes that dominated the perspectives of the study participants: care management, medications, diagnostics, HCP training, human resources, location, patient education, social support, and community knowledge and beliefs. Proficiency ratings prioritized areas of confidence as knowledge related to referrals, psychosocial impacts, and seizure neurophysiology. Areas of need were revealed as knowledge of diagnostic tools and antiepileptic drug (AED) regimens. CONCLUSIONS Our findings delineate the perspectives of providers caring for PWE, with consistent recognition of challenges centering around resource augmentation, infrastructure strengthening, and education. Participants emphasized the urgent need to augment these resources to address limitations in medication types and access, trained human resources, and diagnostic tools. They overwhelmingly recognized the need for infrastructure strengthening to address human, diagnostic, medicinal, and capital resource limitations that place undue burden on patients with epilepsy and physicians. Providers indicated a clear desire to learn more about different diagnostic tools and medical management practices, potentially through continuing education, specialized training, or more intentional in-school diagnostic preparation. They also advocated for the powerful influence of patient and family education and clearly articulated the need for community sensitization and support. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC, Box 3119, Trent Drive, Durham, NC, USA.
| | - Caleigh E Smith
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Grace Y Cai
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Olivia Ratliff
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Josephine N Najjuma
- Mbarara University of Science and Technology Department of Nursing, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda; Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rose Muhindo
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Godfrey Z Rukundo
- Mbarara University of Science and Technology, Department of Psychiatry, Faculty of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Dirk E Teuwen
- UCB, Allée de la recherche 60, 1070 Brussels, Belgium
| | - Adrian Kayanja
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Peter Kalubi
- Mbarara University of Science and Technology, Department of Paediatrics and Child Health, Plot 8 - 18 Kabale Road, P. O Box 1410, Mbarara, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
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Owolabi LF, Owolabi SD, Adamu B, Jibo A, Alhaji ID. Epilepsy treatment gap in Sub-Saharan Africa: Meta-analysis of community-based studies. Acta Neurol Scand 2020; 142:3-13. [PMID: 32219865 DOI: 10.1111/ane.13246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/16/2020] [Accepted: 03/20/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the prevalence, highlight the variation and determine the trend over time, of epilepsy treatment gap (ETG) in Sub-Saharan Africa (SSA). METHODS We systematically searched PubMed, MEDLINE, Embase, ISI databases, and African Journal Online (AJOL). We determined the pooled prevalence estimate of ETG and the degree of heterogeneity in the region. Further subgroup analysis by sub-region, settlement setting, and cutoff adopted for active epilepsy in the studies was carried out. Meta-regression technique was also used to determine the trend of the ETG magnitude over time. RESULTS Twenty-three studies from SSA met the inclusion criteria. We found a high level of discordance among the studies that were included. Collectively, the estimated ETG was 68.5% (95% CI: 59.5%-77.5%). On subgroup analysis, the prevalence of the ETG was 67% (95% CI: 52%, 83%) in the Western, 68% (95% CI: 56%, 80%) in the Eastern, and 63% (95% CI: 53%, 73%) in the Southern Africa sub-regions. On stratified analysis based on 1-year, 5-year, and 2-year cutoffs for definition of active epilepsy, the prevalence figures for the ETG were 71% (95% CI: 56%, 85%), 55% (95% CI: 33%, 77%), and 57% (95% CI: 43%, 71%), respectively. Meta-regression result suggested that the prevalence of the ETG decreases by approximately by 0.006 per year. CONCLUSION The study showed a high prevalence of ETG, higher than the average for resource poor countries, and twice in rural compared with urban settlements in SSA.
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Affiliation(s)
- L. F. Owolabi
- Departments of Medicine Bayero University Kano Nigeria
| | - S. D. Owolabi
- Department of Psychiatry, Bayero University Kano Nigeria
| | - B. Adamu
- Department of Medicine University of Bisha Bisha Saudi Arabia
| | - A.M. Jibo
- Department of Community Medicine Bayero University Kano Nigeria
| | - I. D. Alhaji
- Departments of Medicine Bayero University Kano Nigeria
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Knowledge, attitude, and practice towards epilepsy among religious cleric and traditional healers of Addis Ababa, Ethiopia. Seizure 2020; 78:57-62. [PMID: 32203881 DOI: 10.1016/j.seizure.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Understanding clerics and healers' knowledge, attitude, and practice towards epilepsy are crucial to identify the mechanisms of epilepsy stigma in Ethiopia. The objective of this study is to characterize the social and demographic determinants of knowledge, attitude, and practices of clerics and healers towards people with epilepsy in Addis Ababa, Ethiopia. METHODS A total of 440 clerics and healers were interviewed by trained data collectors using a pretested structured questionnaire. The count sum of outcome variables was grouped into "biological and cultural" knowledge attitude and practice scores. Ordinal regression analysis was performed for each outcome variable against socio-demographic variables of interest. RESULTS The percentage of responses matching cultural causes (58%) surpassed biological causes. The most frequently mentioned cultural cause was an evil spirit (22.5%). While the most frequently mentioned biological cause was a head injury (12%). Consistent with the above findings, cultural treatment responses (77%) exceeded biological treatment responses. The most commonly referred cultural treatment response was Church healing session (12%). The type of faith followed by the study participants positively correlated with higher cultural knowledge, attitude, and practice score. CONCLUSIONS Clerics and traditional healers in Ethiopia have a partiality to the cultural epilepsy explanation model. Cultural metaphors attached to an evil spirit, curse of God, and witchcraft have formed and fostered existing 'epilepsy societal norms' in Ethiopia. The findings of this study contribute to the understanding of epilepsy stigma and treatment gap. Besides, it provided direction to design and implement epilepsy stigma intervention programs in Ethiopia.
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Assessment of Quality of Life of Epileptic Patients in Ethiopia. Int J Chronic Dis 2020; 2020:8714768. [PMID: 31976314 PMCID: PMC6961609 DOI: 10.1155/2020/8714768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 01/26/2023] Open
Abstract
Background Patients with epilepsy are at an increased risk of poor quality of life. Purpose We aimed at assessing the quality of life and its determinants among epileptic patients at University of Gondar Referral Hospital (UoGRH), Ethiopia. Methods Institution based cross-sectional study was conducted on epileptic patients on follow up at UoGRH from January 15 to April 15, 2017. Information including socio-demographic profile and diagnosis was extracted from medical records and patients. Quality Of Life In Epilepsy-10 (QOLIE-10) tool was used to measure the quality of life. Independent t-test and one-way analysis of variance were used to look for factors associated with quality of life. The level of statistical significance was declared at P-value ≤ 0.05. Results A total of 354 patients were included in the study and mean age was 29.1 ± 11.7 years. The mean QOLIE-10 score was 19.85. One hundred ninety-four (54.8%) of participants had a good quality of life. Being illiterate, unemployment, and presence of co-morbid medical condition were associated with poorer quality of life. Conclusion Nearly half of the participants had a poor quality of life. Patients with co-morbidity, illiteracy, and unemployment should be given special emphasis in order to improve their quality of life.
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Mamo Y, Dukessa T, Mortimore A, Dee D, Luintel A, Fordham I, Phillips DIW, Parry EHO, Levene D. Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up. Public Health Action 2019; 9:102-106. [PMID: 31803581 DOI: 10.5588/pha.18.0095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood. Objective To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres. Method The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU. Results Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management. Conclusions The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.
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Affiliation(s)
- Y Mamo
- Jimma University Chronic Disease Project, Jimma, Ethiopia
| | - T Dukessa
- Jimma University Chronic Disease Project, Jimma, Ethiopia
| | - A Mortimore
- Academic Unit of Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - D Dee
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - A Luintel
- Hospital for Tropical Diseases, University College, London, UK
| | - I Fordham
- Queen Elizabeth Hospital, Woolwich, London, UK
| | - D I W Phillips
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E H O Parry
- London School of Hygiene & Tropical Medicine, London, UK
| | - D Levene
- School of Humanities, University of Southampton, Southampton, UK
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Harris C, George B, Harris U, Munyagwa M, Greenough A. Replacing hospital-based epilepsy clinics with rural epilepsy clinics and education in Uganda: impact on attendance. Paediatr Int Child Health 2019; 39:128-131. [PMID: 30477407 DOI: 10.1080/20469047.2018.1544803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: A high proportion of the Ugandan population with epilepsy receive no treatment. Aim: To determine whether introduction of an agreed multidisciplinary guideline and establishment of a local clinic outside the hospital and four rural satellite clinics improved attendance and follow-up by children with epilepsy in Western Uganda. Methods: A multidisciplinary team from Kagando Hospital, Kasese, south-west Uganda created a guideline for the management of epilepsy. A clinic local to the hospital and rural satellite clinics were established.Attendance and follow-up were audited for three months before the intervention. Attendance, follow-up and the cost of the hospital, local and rural clinics were audited 6 months and 5 years post intervention. Results: Pre-intervention, one patient a month attended the free Kagando Hospital epilepsy clinic. Post-intervention, a median of eight patients (range 2-12) attended the local clinic and 100% attended booked follow-up appointments; the cost per clinic was £15 (£1.88 per patient, range 1.25-7.50). A median of 42 (range 15-56) patients per clinic attended the rural clinics and 70% of patients attended follow-up appointments; the cost per clinic was £34 (£0.81 per patient, range 0.61-2.23). Rural clinic attendance was higher than in the hospital clinic (p = 0.007) and in the local clinic (p = 0.004). Five years post-intervention, the attendance was 44 patients (range 25-85) per rural clinic and the cost per clinic was £34. Conclusions: Rural epilepsy clinics were associated with higher attendance than the hospital or local clinic and the attendance rate remained higher 5 years post-intervention.
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Affiliation(s)
- Christopher Harris
- a MRC and Asthma UK Centre in Allergic Mechanisms of Asthma , King's College London , UK.,b Women and Children's Health, School of Life Course Sciences, Life Sciences and Medicine , King's College London , UK.,c Paediatrics , Kagando Hospital , Kagando , Uganda
| | | | - Unity Harris
- c Paediatrics , Kagando Hospital , Kagando , Uganda
| | | | - Anne Greenough
- a MRC and Asthma UK Centre in Allergic Mechanisms of Asthma , King's College London , UK.,b Women and Children's Health, School of Life Course Sciences, Life Sciences and Medicine , King's College London , UK.,d NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London , London , UK
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Sociodemographic, Clinical Variables, and Quality of Life in Patients with Epilepsy in Mekelle City, Northern Ethiopia. Behav Neurol 2018; 2018:7593573. [PMID: 30631380 PMCID: PMC6305035 DOI: 10.1155/2018/7593573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/24/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background Epilepsy is a chronic neurological disorder characterized by unprovoked recurrent seizure episodes. The disease has detrimental effects on social, cognitive, psychological, and physical components of life consequently quality of life of the patients. The level of the effect of the disease on quality life is influenced by different factors including the use of antiepileptic medications. Objectives The study was aimed at assessing quality of life in patients with epilepsy and the variables affecting it in Mekelle city, northern Ethiopia. Methods 175 patients with epilepsy aging 18 years old and above attending neurologic clinics of the two governmental hospitals available in Mekelle city were interviewed using standard and validated Tigrigna version of Quality of Life in Epilepsy Scale-31 (QOLIE-31). One-way ANOVA and independent t-test and analysis of covariance were used for data analysis. Result The mean age of the patients was 29.36 (standard deviation (SD) 12.77) years old, and 61% of them were males while 52% of the respondents were on phenobarbitone monotherapy. The mean total QOLIE-31 score was 77.97 (SD 20.78) with the highest subscale score for medication effects and the lowest for overall quality of life (QOL) functioning with a score of 86.2 (SD 22.12) and 70.97 (SD 26.43), respectively. The patients with high seizure frequency in the past month before the current visit had a significantly low quality of life 76.81 (SD 21.11). Conversely, patients with tertiary education and above had shown a significantly high quality of life 89.52 (SD 11.85). Conclusion The overall QOL of the patients was good. Seizure frequency and level of education were found significant predictors of QOL showing the necessity of seizure control and patient education for improving quality of life in patients with epilepsy.
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Tsigebrhan R, Hanlon C, Medhin G, Fekadu A. Help seeking and suicidality among people with epilepsy in a rural low income country setting: cross-sectional survey. Int J Ment Health Syst 2017; 11:44. [PMID: 28725260 PMCID: PMC5513075 DOI: 10.1186/s13033-017-0151-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/06/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUNDS Epilepsy is a serious neurological disorder associated with a high level of psychiatric comorbidity. Suicidality is a recognised complication of epilepsy. As part of developing an integrated service for people with epilepsy (PWE) and priority psychiatric disorders within primary care, a cross-sectional study was conducted in a rural district in Ethiopia to investigate patterns of help-seeking, suicidality and the association with duration of untreated epilepsy (DUE) among PWE. METHODS Cases were identified through community key informants and diagnosis was confirmed by trained primary care clinicians. Severity of epilepsy, depression and suicidality were assessed using standardised methods. Multivariable regression analysis was used to test the hypothesis that suicidality was associated with DUE. RESULTS The majority of PWE sought help from both religious and biomedical healing centres. The lifetime treatment gap for biomedical care was 26.9%, with a 12 month treatment gap of 56.7%. Close to one-third (29.9%) of participants reported using traditional and cultural healing practices. Nearly one-third (30.2%) of participants reported suicidality (suicidal ideation, plan or attempt) in the previous 1 year. The median (IQR) DUE was 24 months (4-72). There was no association between DUE and suicidality. In the multivariable model, being married [odds ratio (OR) 2.81, 95% CI 1.22, 6.46], increased depressive symptoms (OR 1.17, 95% CI 1.10, 1.26) and perceived poorer wealth relative to others (OR 2.67, 95% CI 1.07, 6.68) were associated independently with suicidality. CONCLUSION In this study, PWE sought help from both biomedical and religious healing centres. Suicidality and depression have a high prevalence in PWE in this setting. Integrated mental and neurological health care within primary care is needed for improved holistic management of epilepsy.
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Affiliation(s)
- Ruth Tsigebrhan
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Watila MM, Keezer MR, Angwafor SA, Winkler AS, Sander JW. Health service provision for people with epilepsy in sub-Saharan Africa: A situational review. Epilepsy Behav 2017; 70:24-32. [PMID: 28410462 DOI: 10.1016/j.yebeh.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA. METHODOLOGY This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported. RESULT The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies. CONCLUSION We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments.
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Affiliation(s)
- Musa M Watila
- Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Mark R Keezer
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Neurology, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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Marry Mhlari R, Sodi T. Understanding and management of epilepsy in a rural community in South Africa: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2016.1268296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Tholene Sodi
- Department of Psychology, University of Limpopo, South Africa
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Hunter E, Rogathi J, Chigudu S, Jusabani A, Jackson M, Whittaker RG, Gray W, McNally RJQ, Aris E, Mushi D, Walker R. The epilepsy treatment gap in rural Tanzania: A community-based study in adults. Seizure 2016; 36:49-56. [PMID: 26938970 DOI: 10.1016/j.seizure.2016.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Most people with epilepsy (PWE) in low-income countries are not treated. We identified risk factors for the epilepsy treatment gap in rural Tanzania. METHODS We identified adult PWE in a community-based prevalence study. Factors associated with failure to access or default from medical care were identified using logistic regression modelling. RESULTS A total of 291 PWE were included, of whom 253 (86.9%) had presented to medical services. Failure to present was positively associated with using alcohol (odds ratio (OR) 4.20; 95% confidence interval (CI) 1.63 to 10.82) or attending traditional healers (OR 2.62; CI 1.00 to 6.83) and inversely associated with having completed primary education (OR 0.33; CI 0.11 to 0.96). Default from treatment was associated with being male (OR 3.35; CI 1.39 to 8.09), having a seizure-related injury (OR 2.64; CI 1.12 to 6.19), believing in a supernatural cause for epilepsy (OR 5.44; CI 1.48 to 19.94) or having no expressed knowledge of cause (OR 5.29; CI 1.60 to 17.52). Cases less likely to default had a duration of epilepsy greater than 10 years (OR 0.28; CI 0.09 to 0.90) or had previously received a seizure-related diagnosis (OR 0.25; CI 0.09 to 0.65). Of all 291 PWE included, 118 denied taking AEDs; the epilepsy treatment gap in this population was therefore 40.5% (95% CI 34.9 to 46.2). CONCLUSION Interventions to improve access to education and to support formal diagnoses may promote access to, and retention under, medical care for PWE in rural Tanzania and in other low-income countries.
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Affiliation(s)
- Ewan Hunter
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - Simukai Chigudu
- Oxford University Department of International Development, Queen Elizabeth House, 3 Mansfield Road, Oxford OX1 3TB, UK
| | - Ahmed Jusabani
- Department of Radiology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Margaret Jackson
- Department of Neurology and Neurophysiology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK
| | - Roger G Whittaker
- Department of Neurology and Neurophysiology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK
| | - William Gray
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | | | - Eric Aris
- Muhimbili National Hospital, PO Box 65000, Dar es Salaam, Tanzania
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania
| | - Richard Walker
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK; Institute of Health & Society, Newcastle University, Newcastle NE2 4AX, UK
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Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, Patel AA. Task shifting for non-communicable disease management in low and middle income countries--a systematic review. PLoS One 2014; 9:e103754. [PMID: 25121789 PMCID: PMC4133198 DOI: 10.1371/journal.pone.0103754] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/02/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One potential solution to limited healthcare access in low and middle income countries (LMIC) is task-shifting- the training of non-physician healthcare workers (NPHWs) to perform tasks traditionally undertaken by physicians. The aim of this paper is to conduct a systematic review of studies involving task-shifting for the management of non-communicable disease (NCD) in LMIC. METHODS A search strategy with the following terms "task-shifting", "non-physician healthcare workers", "community healthcare worker", "hypertension", "diabetes", "cardiovascular disease", "mental health", "depression", "chronic obstructive pulmonary disease", "respiratory disease", "cancer" was conducted using Medline via Pubmed and the Cochrane library. Two reviewers independently reviewed the databases and extracted the data. FINDINGS Our search generated 7176 articles of which 22 were included in the review. Seven studies were randomised controlled trials and 15 were observational studies. Tasks performed by NPHWs included screening for NCDs and providing primary health care. The majority of studies showed improved health outcomes when compared with usual healthcare, including reductions in blood pressure, increased uptake of medications and lower depression scores. Factors such as training of NPHWs, provision of algorithms and protocols for screening, treatment and drug titration were the main enablers of the task-shifting intervention. The main barriers identified were restrictions on prescribing medications and availability of medicines. Only two studies described cost-effective analyses, both of which demonstrated that task-shifting was cost-effective. CONCLUSIONS Task-shifting from physicians to NPHWs, if accompanied by health system re-structuring is a potentially effective and affordable strategy for improving access to healthcare for NCDs. Since the majority of study designs reviewed were of inadequate quality, future research methods should include robust evaluations of such strategies.
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Affiliation(s)
- Rohina Joshi
- The George Institute for Global Health, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Mohammed Alim
- The George Institute for Global Health, Hyderabad, India
| | | | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Pallab K. Maulik
- The George Institute for Global Health, Hyderabad, India
- University of Oxford, Oxford, United Kingdom
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Anushka A. Patel
- The George Institute for Global Health, Sydney, Australia
- University of Sydney, Sydney, Australia
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Dewa E, January J, Nyati-Jokomo Z, Mafaune PT, Muteti S, Maradzika J. Non-Attendance of Treatment Review Visits among Epileptic Patients in a Rural District, Zimbabwe. J Public Health Afr 2014; 5:351. [PMID: 28299128 PMCID: PMC5345415 DOI: 10.4081/jphia.2014.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 12/16/2013] [Accepted: 04/02/2014] [Indexed: 11/23/2022] Open
Abstract
Epilepsy is the most common condition reported through the psychiatric returns surveillance system in Gokwe South District. Review visits attendance is crucial to the successful control of seizures among epilepsy patients. We sought out to establish the attendance pattern of epileptic patients, prevalence of non-attendance and the associated factors. An analytic cross-sectional study was conducted where consenting respondents (N=110) were selected randomly from the district epilepsy register. Interviewer-administered questionnaires were used to collect data. Odds ratios were calculated to determine associations. Logistic regression analysis was done to identify independent risk factors and to control for confounding variables. A total of 110 epileptic patients were included in the study. The patients missed treatment review visits ranging from 1 to 11 of the expected 12 visits between June 2011 and June 2012. Most (70.9%) missed at least 2 visits in a 12month period while 46.4% missed 2 or more consecutive visits. Knowledge of treatment duration [prevalence odds ratio (POR) 0.24 (95% confidence interval (CI) 0.08-0.74)] and high risk perception [POR 0.14 (95% CI: 0.06-0.33)] were associated with a lower likelihood of missing review visits. Barriers such as shortage of drugs [POR 7.09 (95% CI: 3.00-16.72)] and long distances to health facilities [POR 6.63 (95% CI: 2.63-16.76)] were associated with high likelihood of missing two or more review visits consecutively. Shortage of drugs [adjusted odds ratio (AOR) 6.7336 (95% CI: 1.8538-24.4581)] and higher risk perception [AOR 0.1948 (95% CI: 0.0625-0.6071)] remained significant on logistic regression analysis. A high number of epileptic patients miss their review visits mainly owing to shortage of drugs, and long distances from health facilities.
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Affiliation(s)
- Evans Dewa
- Department of Community Medicine, University of Zimbabwe, Midlands Province, Zimbabwe
- Ministry of Health & Child Welfare, Provincial Medical Directorate, Midlands Province, Zimbabwe
| | - James January
- Department of Community Medicine, University of Zimbabwe, Midlands Province, Zimbabwe
| | - Zibusiso Nyati-Jokomo
- Department of Community Medicine, University of Zimbabwe, Midlands Province, Zimbabwe
| | - Patron T. Mafaune
- Ministry of Health & Child Welfare, Provincial Medical Directorate, Midlands Province, Zimbabwe
| | - Shamiso Muteti
- Department of Community Medicine, University of Zimbabwe, Midlands Province, Zimbabwe
| | - Julita Maradzika
- Department of Community Medicine, University of Zimbabwe, Midlands Province, Zimbabwe
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Medication adherence in patients with epilepsy after a single neurologist visit in rural India. Epilepsy Behav 2013; 29:412-5. [PMID: 24090776 DOI: 10.1016/j.yebeh.2013.08.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/29/2013] [Indexed: 11/21/2022]
Abstract
In India, there are less than 2000 neurologists, and an estimated 5 million patients have epilepsy. With such limited neurological care available, novel treatment approaches for epilepsy are necessary. This study evaluates the effectiveness of a mobile clinic in treating epilepsy. Patients from two mobile clinic stop locations in northern India were contacted 7 and 9 months later for an in-person or over-the-phone survey. Of the 306 eligible patients who had been seen in the selected cities, 142 were interviewed, 72.5% of whom reported that they were still taking medications; among medication-naïve patients, 50.9% were still taking medications. The one-time clinic is effective and could be a model for working towards reducing the wide rural epilepsy treatment gap in India and other countries. Creative follow-up mechanisms need to be developed.
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Harimanana A, Clavel S, Chivorakul P, Perez F, Preux PM, Barennes H. Associated factors with adherence to antiepileptic drug in the capital city of Lao PDR. Epilepsy Res 2012. [PMID: 23182965 DOI: 10.1016/j.eplepsyres.2012.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Available medical care for epilepsy and antiepileptic drugs (AED) are provided in Vientiane Municipality by district hospitals supported by a non-governmental organization, which is referred to as a community-based intervention (CB), and reference hospital which is referred to as hospital-based interventions (HB). Identifying underlying factors of AED adherence is of public health interest. A community-based cross-sectional survey among randomly selected patients with epilepsy (PWE) who were being cared in Vientiane Municipality was undertaken in 2010. The Morisky scale was used to assess the level of adherence. Univariate and multivariate logistic regression analyses were performed to address predictive factors. Overall, 99 PWE were included in the study. Overall adherence was estimated at 57.6%, 57.1% and 58.0% for the HB and CB group, respectively. High level of adherence was related to illiteracy, being on monotherapy and experiencing fewer seizures. Implementing closer medical care at primary level to PWE improves the likelihood of reducing primary and secondary treatment gap which is related to PWEs' adherence. An active intervention through a downstream channel of training of medical health staff from reference level to community level enhances the prescription of adequate AED, the improvement of the quality of relation between PWE and medical staff.
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Affiliation(s)
- Aina Harimanana
- Institut de la Francophonie pour la Médecine Tropicale, BP 9519 Vientiane, Lao Democratic People's Republic
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Abstract
Epilepsy is a common disorder, particularly in poor areas of the world, and can have a devastating effect on people with the disorder and their families. The burden of epilepsy in low-income countries is more than twice that found in high-income countries, probably because the incidence of risk factors is higher. Many of these risk factors can be prevented with inexpensive interventions, but there are only a few studies that have assessed the effect of reducing risk factors on the burden of epilepsy. The mortality associated with epilepsy in low-income countries is substantially higher than in less impoverished countries and most deaths seem to be related to untreated epilepsy (eg, as a result of falls or status epilepticus), but the risk factors for death have not been adequately examined. Epilepsy is associated with substantial stigma in low-income countries, which acts as a barrier to patients accessing biomedical treatment and becoming integrated within society. Seizures can be controlled by inexpensive antiepileptic drugs, but the supply and quality of these drugs can be erratic in poor areas. The treatment gap for epilepsy is high (>60%) in deprived areas, but this could be reduced with low-cost interventions. The substantial burden of epilepsy in poor regions of the world can be reduced by preventing the risk factors, reducing stigma, improving access to biomedical diagnosis and treatment, and ensuring that there is a continuous supply of good quality antiepileptic drugs.
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Abstract
According to World Health Organization (WHO), the prevalence of epilepsy is highest in low- and lower middle-income countries, which include over eighty percent of the countries of sub-Saharan Africa, where the majority of people with epilepsy are not receiving appropriate care. In sub-Saharan Africa, shortages of trained health workers, limited diagnostic equipment, inadequate anti-epileptic drug supplies, cultural beliefs, and social stigma contribute to the large treatment gap for epilepsy. The number of people with epilepsy, particularly children, will continue to rise as a result of projected epidemiologic and demographic changes. This paper examines the state of epilepsy care and treatment in sub-Saharan Africa and discusses priorities and approaches to scale up access to medications and services for people with epilepsy.
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Chivorakoun P, Harimanana A, Clavel S, Jousseaume S, Barennes H. Épilepsie au Laos : le difficile parcours d’un antiépileptique de première ligne contribue à la forte carence de traitement. Rev Neurol (Paris) 2012; 168:221-9. [DOI: 10.1016/j.neurol.2012.01.584] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 12/25/2011] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
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Bradley E, Thompson JW, Byam P, Webster TR, Zerihun A, Alpern R, Herrin J, Abebe Y, Curry L. Access and quality of rural healthcare: Ethiopian Millennium Rural Initiative. Int J Qual Health Care 2011; 23:222-30. [PMID: 21467077 DOI: 10.1093/intqhc/mzr013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE More than half the world's population lives in rural areas; however, we have limited evidence about how to strengthen rural healthcare services. We sought to determine the impact of a systems-based approach to improving rural care, the Ethiopian Millennium Rural Initiative, on key healthcare services indicators. DESIGN We conducted an 18-month longitudinal mixed methods study of the 10 primary healthcare units (PHCUs) serving ~400,000 people, using monthly indicator tracking and focus groups. SETTING Rural Ethiopia. PARTICIPANTS Ten PHCUs and 140 focus group participants. INTERVENTION The Ethiopian Millennium Rural Initiative. MAIN OUTCOME MEASURES Antenatal care coverage, skilled birth attendant rates, HIV testing in antenatal care, HIV testing in the health center or at health posts overall, outpatient volume at the health center. Qualitative data assessed community members' perceptions of healthcare services. RESULTS We found significant increases (P-values of <0.05) in antenatal care coverage, skilled birth attendant rates, HIV testing in antenatal care and HIV testing at health center and health post levels. Outpatient visit rates also improved, but the change was not significant. Focus group data suggested that communities recognized substantial improvements but also voiced continued unmet needs. CONCLUSIONS A systems-based approach to strengthening rural healthcare units is feasible, although complex, particularly in rural settings. The combined use of quantitative and qualitative data is needed to provide a comprehensive view of impact. Future research is needed to understand the determinants of variation in improvement across health centers and regions.
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Affiliation(s)
- Elizabeth Bradley
- Yale School of Public Health, PO BOX 208034, New Haven, CT 06520-8034, USA.
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Multicultural challenges in epilepsy. Epilepsy Behav 2011; 20:428-34. [PMID: 21310665 DOI: 10.1016/j.yebeh.2010.12.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 12/24/2010] [Accepted: 12/27/2010] [Indexed: 11/22/2022]
Abstract
Epilepsy is a common neurological condition throughout the world. Its care involves medical expertise, but may also bring different cultural challenges. We discuss clinical, social and psychological outcomes in different cultural settings. We point out differences and similarities in epilepsy epidemiology (etiology and risk factors, prognosis, and natural history), disparities in care and health services, and cultural influences and traditional beliefs, with special respect to practical issues and possible transcultural misunderstandings. We also discuss the relevance of multicultural issues to clinicians working in developed countries.
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Abstract
In the second in a series of six articles on packages of care for mental health disorders in low- and middle-income countries, Caroline Mbuba and Charles Newton discuss treatment for epilepsy.
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Affiliation(s)
- Caroline K. Mbuba
- The Centre for Geographic Medicine Research (Coast), KEMRI, Kilifi, Kenya
| | - Charles R. Newton
- The Centre for Geographic Medicine Research (Coast), KEMRI, Kilifi, Kenya
- Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom
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