Epilepsy Treatment Gap in Nigeria: A Prospective Cross-sectional Study of Socio-demographic and Cultural Determinants
Ezunu Okechukwu Emmanuel *
Neurology Unit, Internal Medicine Department, Federal Medical Centre, Asaba, Nigeria.
Adesola Ogunniyi
Neurology Unit, University College Hospital, Ibadan, Nigeria.
Mayowa Owolabi
Neurology Unit, University College Hospital, Ibadan, Nigeria.
Akpekpe Ebiwhiehi John
Neurology Unit, Internal Medicine Department, Federal Medical Centre, Asaba, Nigeria.
Ezunu Ngozi Esther
College of Nursing, Federal Medical Centre Asaba (Onitcha-Uku), Delta-State, Nigeria.
Onwueme Ngozi Pauline
Internal Medicine, Asaba Specialist Hospital, Asaba, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Epilepsy is a chronic neurological condition described by unprovoked repeated seizure episodes. In the developing countries of Africa, people with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and many do not receive treatment due to socioeconomic and cultural barriers. The treatment gap of epilepsy in Nigeria is high, and there is a paucity of data on the magnitude and causes of the epilepsy treatment gap in our environment. We aimed to study the Socio-Demographic and Cultural Determinants of the Epilepsy treatment gap in our region.
Methods: We conducted a prospective cross-sectional study with 147 participants aged ≥16 years. The subjects were enrolled consecutively from the Neurology Clinic of University College Hospital, Ibadan, for a 6-month period, and met the inclusion criteria. They had clinically confirmed diagnoses of epilepsy based on the International League against Epilepsy (ILAE) criteria. Participants were scheduled and interviewed with a structured questionnaire.
Results: A total of 147 subjects were studied, comprising 79 males (53.7%) and 68 females (46.3%), with a male-to-female ratio of 1.2:1. Treatment adherence was poor, as 88.4% missed their medication at least once within the 6 months, and only 25.9% restricted themselves to only Orthodox treatment. We found a significant association between newly recruited patients (p value =0.0001), age (p value 0.034), gender (p value 0.027), educational status (p value 0.0001), monthly income (p value 0.01), clinic attendance (p value 0.0001), and the pattern of treatment of epilepsy in our environment. However, freshly recruited male patients who were non-defaulters and attended tertiary education were found to be likely predictors of adherence to orthodox treatment.
Conclusion: We found the Treatment Gap as high as 88.4%, as the majority of our patients missed their medication, and only very few restricted themselves to Orthodox treatment. There is a positive correlation between the Socio-demographic characteristics of epilepsy patients with their pattern of treatment. Socio-economic, cultural, and religious factors can be improved through patient and community education, increasing access to quality and affordable drugs, and improving adherence to Epilepsy treatment.
Keywords: Epilepsy treatment, gap, socio-demographic, cultural, determinant