Prevalence and treatment gap of active convulsive epilepsy: a large community-based survey in rural West China.

PURPOSE: Active convulsive epilepsy (ACE) impacts patients greatly, especially in low-income countries where patients do not receive appropriate treatment. In the present study, we measured the prevalence and treatment gap (TG) of ACE in rural West China. METHODS: Six rural areas in West China that have a total population of 3,541,319 were selected to conduct prevalence and TG estimates of ACE via a clue survey from 2007 to 2009. Clue survey here is a community-based screening strategy among defined population which requires employed well-trained local physicians//health workers to collect all clues available to discover/identify/recruit patients within a study period. Questionnaire-based interviews were used for the identification of ACE patients, and information was obtained during the survey. Prevalence and TG of ACE were calculated. RESULTS: A total of 6547 patients with ACE were identified. The estimated prevalence of ACE was 1.8 per 1000 in the general population, with the prevalences in males and females determined to be 2.0 and 1.7, respectively (p<0.001). The TG in the general population was 66.3%, and it was 66.6% and 66.0% in males and females, respectively (p>0.05). The TG figures dropped with advancing age and increased above 30 years of age. Patients aged 60 years or older had the largest TG (77.8%); those with disease course less than 10 years showed a larger TG and those who experienced two to five seizures annually had a significantly larger TG (70.6%). Additionally, only 63.9% of the ACE patients included in the study were aware of the disease and had consulted a doctor. CONCLUSIONS: There exists a large TG of ACE in West China rural areas. Majority of those ever consulted a doctor but failed to receive or adhere to an appropriate treatment program. Management including public education as well as training of local physicians were necessary to fill that gap.

Enhancing medical compliance of patients with convulsive epilepsy in rural community: a randomized intervention trial.

PURPOSE: This randomized intervention trial was to determine whether the implementation of a practical intervention was effective in enhancing medical compliance and improving seizure control among patients with convulsive epilepsy in rural communities in western China. METHODS: Two of four areas were randomly selected for this study and assigned to be the intervention group (IG) and the control group (CG), respectively. An intervention package with four components (intensive education, consultation services, maintenance of an epilepsy tracking card, and repeated reminders) was formulated. Medical compliance included antiepileptic drug (AED) adherence and lifestyle; each was graded on a 6-point scale with possible scores. Medical compliance and seizure control were measured and compared between the groups before and after the intervention. In addition, correlation of both changes in medical compliance and seizure frequency were investigated. KEY FINDINGS: After 1-year follow-up, 183 patients in the IG (105 male) and 177 in the CG (99 male) remained for the analysis. At the end of the study, the average number of seizures in the IG declined 18.3% compared to that prior to the intervention (after 6-month phenobarbital monotherapy), nearly twice as much as in CG (9.1%) with statistical difference (p = 0.023). The proportion of patients with a reduction in seizures >50% (including those who were seizure-free) rose to 79.8% in the IG compared to 61.0% in the CG (p < 0.05). With regard to medical compliance, the majority of the IG members were rated as excellent or very good, but medical compliance remained nearly unchanged for the CG. A moderate correlation was found between the changes in AED adherence and seizure control (r = 0.4, p < 0.05), and a weaker correlation was found between lifestyle and seizure control (r = 0.328, p < 0.05). SIGNIFICANCE: This intervention package proved to be efficient in enhancing medical compliance and improving seizure control in rural communities of resource-poor areas.

Epidemiological analysis of pulmonary tuberculosis in Sichuan Province, China, 2000-2006.

OBJECTIVES: To investigate the epidemiological features of pulmonary tuberculosis in Sichuan Province, China, for the period 2000-2006. MATERIALS AND METHODS: Data from the China Information System for Disease Control and Prevention, the World Health Organization, and the high caseload provinces in China were collected. This was a descriptive study, and the Besag and Newell method was applied. RESULTS: From 2000 to 2006, the incidence rate of pulmonary tuberculosis increased from 54 to 103/100,000, the mortality rate increased from 0.02 to 0.30/100,000, and the case-fatality rate increased from 0.04% to 0.29%. The age groups 20-24, 65-69, and 70-74 years had higher incidences. There were more cases and deaths in males compared to females. Peasants contributed the most to caseloads (64%) and deaths (69%) in the total population. The north and west regions of Sichuan Province had higher incidences. Sichuan had a higher incidence, mortality rate, and case-fatality rate than both the national level and Henan Province between 2001 and 2003. It also had a higher prevalence of active tuberculosis and smear-positive pulmonary tuberculosis than the national level and Guangdong Province after 1990. Multidrug-resistant tuberculosis is a major problem in China compared to India and Indonesia. CONCLUSIONS: Sichuan should be the most important province in China with regard to tuberculosis prevention and control, especially for male peasants from the north and west regions and the active pulmonary tuberculosis and sputum smear-positive cases. The major challenge is multidrug-resistant tuberculosis.