[Treatment of epilepsy in rural areas in Mali]

Epilepsy is a public health problem in Africa due to prevalence and social exclusion. We report a follow-up protocol for epileptic patients treated at home in rural areas of Mali. The objectives were: education for the patient, family, and village leaders in orders to achieve good compliance, uninterrupted supply of generic phenobarbitol, follow-up visits once a month for one year then every two months if good compliance with a country physician with delivery of phenobarbitol in sufficient quantity to reach the next visit, verification of correct drug dosage and use, supervision of treatment effect. After two years, the follow-up visits showed that 57.4% of the patients had been seizure free for at least 24 months (more than 4 monthly seizures before treatment). Rate of seizures decreased in 15.7% of the patients. Results were excellent with no seizures, clear physical, psychic and social improvement (work, married life, school attendance). Very few side effects were observed. There were no cases of poisoning. The management scheme is very cost effective: 1.5 USD per month per patient, including phenobarbitol and implementation. There is a need for anti-epilepsy programs in Africa which should be implemented on the local (rural medicalisation), national and international level ("Epilepsy out of the shadows" campaign).