The problem of epilepsy and its care in rural Ethiopia.

BACKGROUND: Jimma University Hospital (JUH) in south west Ethiopia has been running an integrated rural chronic disease programme since 1999, focusing on treatment of epilepsy, diabetes and heart disease. OBJECTIVE: The purpose of this review is to compare clinical data of the epilepsy patients with those previously published from a similar programme in Gondar university, in the north west of the country. METHOD: In November 2005, we identified a total of 1,250 patients with epilepsy from the JUH study with case records for analysis. Clinical data are documented in the case records using a structured questionnaire and follow-up chart. We entered the data into SPSS software and performed descriptive analyses. RESULTS: The age of the patients was weighted towards teenage years and young adult life, very similar to that seen in Gondar. The majority of those presenting to the clinic were male (M:F = 1.6:1) and educational level in rural communities was poor. The seizure history was very similar to that observed in Gondar. The average age at onset of unprovoked seizures was 13 years, and only 35% of patients presented within six months of their first seizure. A family history was found in 8% compared with 24% in Gondar. Other risk factors for epilepsy such as previous intracranial infection, head injury and perinatal factors were reported more frequently by patients from Jimma. Status epilepticus was reported by 2.7% in Jimma and 2.0% in Gondar. 10% in both Jimma and Gondar had received burns as a result of seizures. The psychosocial impact of epilepsy was substantial; 24-47% of patients were affected in some way. Default from follow-up was high in both Jimma (40%) and Gondar (62%). CONCLUSION: The JUH data show good general agreement with Gondar university, suggesting that the areas have comparable populations of people with epilepsy. Despite the large number of patients registered at the health centres, there is still a considerable gap between those who suffer from the condition and those who actually get treatment with phenobarbitone. Future work will need to address this shortfall and increase the availability of this inexpensive and effective treatment.

A primary healthcare approach to the management of chronic disease in Ethiopia: an example for other countries.

Chronic non-communicable diseases such as epilepsy, diabetes, cardiac disease and hypertension represent a growing but neglected burden in developing countries. Rural sufferers, distant from health facilities, bear this most acutely. In response, a community care programme has been developed at Jimma University Hospital and its allied health centres in rural southwest Ethiopia. This involves general duty nurses at rural health centres being trained to provide care for chronic disease patients, with regular supervision from the hospital physicians. The programme allows treatment to be provided away from the main hospital so that those who cannot afford to travel can access care near their homes. Improved access increases the request for care, and helps to address the large unmet need for chronic disease treatment. This is a good model in which rural healthcare delivery through a team can bring widespread benefit. In this article chronic disease care is discussed with a particular focus on diabetes and epilepsy. The model can be replicated in more or less developed countries and may also be relevant for HIV care.