Barriers to biomedical care for people with epilepsy in Uganda: A cross-sectional study

Professional nurses' experiences of managing epilepsy at limited resource rural facilities in Limpopo and Mpumalanga Provinces, South Africa

BACKGROUND

Epilepsy is a neurological disorder affecting approximately 50 million individuals globally, contributing significantly to the global disease burden. Professional nurses play a crucial role in the care and treatment of people living with epilepsy, ensuring their safety and well-being. Professional nurses frequently encounter challenges, such as restricted access to drugs, specialised equipment, and epilepsy treatment training. Despite these obstacles, professional nurses are essential to providing high-quality care to patients with epilepsy in remote locations.

METHODS

A qualitative design using explorative, descriptive, and contextual design was employed to achieve the objectives of the study. The sample comprised 20 professional nurses working in selected rural communities in Limpopo and Mpumalanga. Data was collected through in-depth individual interviews and analysed using Tesch's eight steps of data analysis.

RESULTS

Four themes emerged from the data: experiences of professional nurses during management of epilepsy; inadequate training in management of epilepsy; insufficient supply of antiepileptic drugs and late presentation to local clinics.

CONCLUSION

The study found that professional nurses experienced several challenges hindering the effective management of epilepsy. Cultural beliefs in supernatural causes of epilepsy significantly influence treatment preferences, consequently delaying diagnosis and treatment. Despite limited resources and cultural barriers experienced by professional nurses, they strive to provide appropriate care to minimise seizures. Ongoing education and training on epilepsy management is vital to enable professional nurses to keep up-to-date with current methods and new developments.

Prevalence and factors associated with psychosis among adults with epilepsy at a tertiary hospital in Uganda, cross-sectional study

BACKGROUND

Psychotic disorders are prevalent among people with epilepsy compared to the general population. However, there is limited information regarding psychosis among people with epilepsy in Uganda. This study therefore determined the prevalence and associated factors of psychosis among adults with epilepsy attending Butabika National Referral Mental Hospital in Uganda.

METHODS

This was a cross-sectional study involving adults with epilepsy. The diagnosis of psychosis was assessed using the Mini-International Neuropsychiatric Interview, module for Psychotic disorders. Logistic regression analysis identified factors associated with psychosis.

RESULTS

Out of 250 participants, 6.8% had psychosis and 13.6% had depression. Psychosis was significantly associated with older age, greater perceived stigma and substance use.

CONCLUSION

Psychosis affects nearly 7% of adults with epilepsy in Uganda especially among those who are older, with perceived stigma and substance use. Routine screening and early intervention to management of psychosis in PWE is highly recommended.

Impact of COVID-19 on the well-being of children with epilepsy including nodding syndrome in Uganda: A qualitative study

OBJECTIVE

To investigate the impact of the COVID-19 pandemic and related restrictions on the access and use of health services by children with epilepsy including nodding syndrome in Uganda.

METHODS

Four focus group discussions (FGD) with parents/caregivers of children with epilepsy and five in-depth interviews with key informants were conducted between April and May 2021 at Butabika National Mental Referral Hospital and Kitgum General Hospital.

RESULTS

COVID-19-related restrictions, including the halting of non-essential services and activities, and suspension of public transport, created several challenges not only for children with epilepsy and their parents/caregivers but also for their healthcare providers. Study participants described extreme transport restrictions that reduced their access to healthcare care services, increased food insecurity and shortage or inability to afford essential medicines as consequences of COVID-19-related restrictions. However, parents/caregivers and healthcare workers adopted several coping strategies for these challenges. Parents/caregivers mentioned taking on casual work to earn an income to buy food, medicines, and other necessities. Healthcare workers intensified outreach services to affected communities. A positive impact of lockdown measures described by some FGD participants was that most family members stayed at home and were able to care for children with epilepsy in turn.

CONCLUSIONS

Our study highlights the significant negative impact of the COVID-19 pandemic and related restrictions on access to health services and the general well-being of children with epilepsy. Decentralized epilepsy treatment services and nutritional support could reduce the suffering of children with epilepsy and their families during the ongoing COVID-19 pandemic and similar future emergencies.

Anti-seizure effects of medicinal plants in Malawi on pentylenetetrazole-induced seizures in zebrafish larvae

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plants are used to manage and treat epilepsy in Malawi because of traditional beliefs and barriers to conventional anti-seizure drugs. Among the plants prescribed by traditional medical practitioners are Margaritaria discoidea, Dalbergia boehmii, Dalbergia nitidula, Catunaregam spinosa, and Lannea discolor. Despite the wide use of these plants, there is a lack of scientific evidence to support their anti-seizure efficacy.

AIM OF THE STUDY

This study used the pentylenetetrazole (PTZ)-induced larval zebrafish seizure model to screen for anti-seizure effects of a collection of medicinal plants traditionally used in Malawi.

MATERIALS AND METHODS

Zebrafish larvae were incubated in decoctions at maximum tolerated concentrations for 18 h and exposed to PTZ. As a primary screen, the effects of the decoctions on seizure-induced locomotor activity were determined. Decoctions that significantly reduced total distance traveled were further checked for effects on seizure latency and frequency, brain activity, immediate early gene expression, and c-fos protein expression.

RESULTS

M. discoidea male leaves, D. boehmii roots, and D. nitidula leaves showed significant anti-seizure effects in the primary screen and were selected for further study. Electrophysiological and immediate early gene analyses corroborated anti-seizure effect of D. boehmii and D. nitidula. The results of c-fos protein expression further suggested that the anti-seizure effects in the larval brain may be mediated by the suppression of neurons localized in midbrain regions.

CONCLUSIONS

These findings provide pioneering scientific evidence of the presence of anti-seizure activity in M. discoidea, D. boehmii, and D. nitidula, prescribed by traditional Malawian medical practitioners. Further studies are needed to identify and isolate compounds responsible for such biological activities and elucidate the possible mechanisms of action.

Concepts, Beliefs, and Traditional Treatment for Childhood Seizures in a Quilombola Community in Northeastern Brazil: Analysis by the Discourse of the Collective Speech

Background: Non-pharmacological therapy related to traditional, magical, and/or religious treatments for managing recurrent and non-recurrent seizures in children persists in several traditional communities. The research aims to investigate the concepts, beliefs, and types of traditional treatments used for cases of seizures in children reported by residents of a quilombola community. Methods: The research took place in the quilombo community Sítio Arruda, Ceará, northeastern Brazil. The study population consisted of 19 participants, including healers, prayers, and midwives. Applied a socioeconomic form and a semi-structured interview script. For data analysis, the Discourse of the Collective Speech (DCS) technique was used. Results: For the questions asked, a total of 14 central ideas were found. The most prevalent was seizure is the most common type of disease in children (50.0%); The seizure occurs because of the fever (42.0%); In the community, we treat and prevent seizures with the use of plants (63.2%). Conclusions: The present study’s results addressed relevant issues that include valuing and understanding the traditional knowledge of the community, access to health services, and the need for clarification actions about seizures.

Leveraging the lessons learned from studies on the cultural context of epilepsy care in Uganda: Opportunities and future directions

In this summary paper, we review the body of research contained in this special issue, The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda, and corollary recommendations for a way forward. We review key findings and conclusions for the studies, which tell a story of culture and care-seeking through discussions and data gleaned from a rich research landscape traversing community village dwellings, shared communal areas, churches, and urban hospitals. The voices and perspectives of over 16,000 study participants inclusive of people living with epilepsy, their neighbors and healthcare workers, traditional healers, and faith leaders are reported. From this, we synthesize findings and prioritize a set of recommendations to advance epilepsy care in Uganda. Progress will require infrastructure strengthening, multilevel educational investments, and an ambitious, extensive program of community sensitization. These proposed priorities and actions outline a way forward through formidable but surmountable challenges but require harmonized efforts by government and other relevant stakeholders, scholars, clinicians, and community leaders. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".