Fewer women receive tertiary care for epilepsy in Kerala State, India.

PURPOSE: The stigma attached to epilepsy often restricts early diagnosis and optimal care, particularly among the underprivileged. We aimed to ascertain any gender bias in the utilization of services for epilepsy in a tertiary and community care facility in Kerala State, India. METHODS: The R. Madhavan Nayar Center for Comprehensive Epilepsy Care (RMNC) is a leading tertiary care facility in South India. The District Mental Health Program (DMHP) is a community-based care facility that provides medical consultation and anti-epileptic drugs (AED) free of charge. We analyzed the sex ratio (SR) - number of women per one thousand men - of all registrations in these centers according to year of registration, age, religion, income, distance from domicile to the center, and religion. RESULTS: The SR in the RMNC (1976-2004, n = 12354) was 729. At RMNC, age-specific SR increased up to the 3rd decade (864), and progressively declined beyond 50 years. The SR was lower for those domiciliated at more than 200 km from the center when compared to others. The SR at the DMHP (1999-2004, n = 221) was high (1125). The age-specific SR at DMHP showed two peaks at 21-30 years (1368) and 51-60 years (2333). CONCLUSION: Fewer women with epilepsy (particularly in lower socioeconomic groups) receive tertiary care in this state, in spite of a higher SR in the community (907 for epilepsy and 1058 for all population). The tertiary treatment gap is wider for women over 30 years (particularly over 50 years), when their longer life expectancy is also taken into consideration.

Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India.

PURPOSE: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population. METHODS: We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area. RESULTS: Through a three-phased survey, we ascertained 1,175 cases (616 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children. CONCLUSIONS: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized.